The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

Background Transgender women (TGW) and men who have sex with men (MSM) in sub-Saharan Africa have high HIV acquisition risks and can benefit from daily pre-exposure prophylaxis (PrEP). We assessed PrEP adherence by measuring tenofovir-diphosphate (TFV-DP) levels and explore motives for PrEP persistence in TGW and MSM. Methods Participants were enrolled in a one-year PrEP programme and made quarterly visits irrespective of whether they were still using PrEP. At their month 6 visit, participants provided a dried blood spot to test for TFV-DP levels; protective levels were defined as those compatible with ≥4 pills per week (700–1249 fmol/punch). Before TFV-DP levels were available, a sub-set of these participants were invited for an in-depth interview (IDI). Semi-structured IDI topic guides were used to explore motives to uptake, adhere to, and discontinue PrEP. IDI data were analyzed thematically. Results Fifty-three participants (42 MSM and 11 TGW) were enrolled. At month 6, 11 (20.7%) participants (8 MSM and 3 TGW) were lost to follow up or stopped taking PrEP. Any TFV-DP was detected in 62.5% (5/8) of TGW vs. 14.7% of MSM (5/34, p = 0.01). Protective levels were detected in 37.5% of TGW (3/8), but not in any MSM. Nineteen IDI were conducted with 7 TGW and 9 MSM on PrEP, and 1 TGW and 2 MSM off PrEP. Unplanned or frequent risky sexual risk behaviour were the main motives for PrEP uptake. Among participants on PrEP, TGW had a more complete understanding of the benefits of PrEP. Inconsistent PrEP use was attributed to situational factors. Motives to discontinue PrEP included negative reactions from partners and stigmatizing healthcare services. Conclusion While MSM evinced greater adherence challenges in this PrEP programme, almost 40% of TGW were protected by PrEP. Given high HIV incidences in TGW these findings hold promise for TGW PrEP programming in the region.

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Concurrency and the limited effectiveness of behavioural interventions on sexual risk behaviour of youth in sub-Saharan Africa

AIDS ◽

10.1097/qad.0b013e32833c8745 ◽

2010 ◽

Vol 24 (13) ◽

pp. 2140-2142 ◽

Cited By ~ 3

Author(s):

Michielsen Kristien ◽

Chersich Matthew ◽

Luchters Stanley ◽

Van Rossem Ronan ◽

Temmerman Marleen

Keyword(s):

Sexual Risk ◽

Risk Behaviour ◽

Sub Saharan Africa ◽

Sexual Risk Behaviour ◽

Behavioural Interventions ◽

Limited Effectiveness ◽

Sub Saharan

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Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort

BMJ Open ◽

10.1136/bmjopen-2017-015898 ◽

2017 ◽

Vol 7 (10) ◽

pp. e015898 ◽

Cited By ~ 12

Author(s):

Simon Gregson ◽

Owen Mugurungi ◽

Jeffrey Eaton ◽

Albert Takaruza ◽

Rebecca Rhead ◽

...

Keyword(s):

General Population ◽

Sexual Risk ◽

Risk Behaviour ◽

Small Towns ◽

Scientific Data ◽

Hiv Prevalence ◽

Sexual Risk Behaviour ◽

Sub Saharan ◽

Demographic Impact

PurposeThe Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART).ParticipantsGeneral population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15–44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years).Findings to dateHIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART.Future plansWe plan to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome.

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