Intimate Relationships and HIV Infection Risks Among Shan Female Sex Workers From Myanmar in Chiang Mai, Thailand: A Qualitative Study

This study aimed to investigate HIV risks among female sex workers (FSWs) who were from the Shan ethnic group, and how they relate to complex relationships with inconsistent condom use. The study was conducted using in-depth interviews with 17 Shan FSWs (aged 18–45 years old) in Chiang Mai. Intimate relationships between participants and regular clients/steady partners were found to facilitate inconsistent condom use. Participating Shan FSWs sustained intimacy with regular clients not only for economic ends but also for emotional support. Gender norms and male power dominated condom use decision making. Some participants lacked proper HIV preventive knowledge regarding condom breakage and HIV risks. Effective intervention and proper HIV preventive practices should address these intimate contexts. Capacity building among women would assist FSWs to make choices that protect them from HIV/STDs infections. Couples-based HIV interventions addressing emotional intimacy is an urgent need for HIV communication and service delivery in Thailand.

The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis

Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

Condom use and risk of HIV infection among fishers in Elmina fishing community in Ghana

This paper is a follow-up to a cross-sectional study which employed a mix-method design for data collection and analysis to investigate the relationship between mobility and human immunodeficiency virus (HIV) risks amongst 385 fishers in Elminafishing community in Ghana. It discusses condom use among fishers andthe perceived barriers in using it and concludes with a discussion on the implications for risks of HIV infection as a result of the reported low condom use among them. The reported low usage suggests the engagement in unprotected sex of the fishers and the likelyhoodtheir exposure to sexually transmitted infections such as HIV in the study area. The paper thus recommends on-going and future HIV education programs by the Komenda-Edina-Eguafo-Abirem (KEEA) Municipality Assembly and civil society organisations in Elmina to explore ways of including the supply of free condoms to fishers and at the various fishing destination points along the coast of Elmina. Equally, this outreach or mobile HIV service outlets should emphasize the consistent use of condom within Elmina and the surrounding fishing communities.

Community Legal Systems: Targeting PrEP and HIV Education to Decrease Risk of HIV Transmission

The southern U.S. has both high HIV and incarceration rates in comparison to its population. As in the rest of the country, HIV prevention is based on education, behavior change, and biomedical efforts, such as pre-exposure prophylaxis (PrEP). This study examined the implementation of an educational intervention and supportive services to obtain PrEP in a population of individuals (N = 218) involved in an Adult Drug Court (ADC) or on probation or parole (P-P). Nearly all ADC and P-P participants self-reported risk behaviors linked to HIV acquisition. Results supported the acceptance and usefulness of the intervention as rated by participants. Participants showed increased knowledge of HIV risks and testing post-education. In multivariate analysis, predictors of interest in using PrEP included low stigma beliefs, specifically their level of prejudice views, high depressive symptoms, and white race. The intervention shows promise. Given the high risk documented for ADC and P-P individuals, HIV prevention is a critical component for increased protective behaviors.

14.H. Workshop: Ecosystems of HIV risk among key populations in Europe: empirical findings and solutions

Key populations, such as men who have sex with men and persons who inject drugs (PWID) have an increased risk of HIV. These same key populations experience extensive barriers in accessing HIV/AIDS services that are acceptable, accessible, and of high quality. These issues are particularly acute in Eastern Europe where stigma and structural barriers to HIV services are large. This workshop is important because of the rising incidence of HIV in Europe. This is particularly a challenge in Eastern Europe, the only geographical region in the world experiencing rising rates of HIV. Thus, understanding key population's specific HIV risk factors are crucial to address their needs and prevent new infections. This workshop will give examples of studies on the health and HIV situation of key populations in Europe. The workshop will identify the social and structural contexts that create the specific determinants of HIV risks among the population in the region. The workshop will also discuss avenues and interventions to address their HIV risks. Kristefer Stojanovski (USA) will present results on a European analysis regarding the role of policy and laws in shaping HIV risk among MSM. Sladjana Baros (Serbia) will present findings on the barriers that persons living with HIV (PLHIV) in Serbia face, particularly stigma, that limits their access treatment and access to services. Elizabeth King (USA) will present on stigma's role in perpetuating HIV risk among women who inject drugs in Russia, including ways to address the issues. Lastly, Francisco Fernandes (Portugal) will present results from their work over the last 10 years providing community-based HIV and STI testing and counseling in Portugal. After the individual presentations, the audience will be invited to a monitored open discussion on the papers, and how the findings can help inform public health and policy to address HIV in Europe. The situation for HIV and key populations in Europe is worrisome from a public health standpoint, especially as research shows how structural factors can drive HIV risk and infection. Our workshop aims to facilitate a conversation on understanding the structural situation and exploring ways to reduce the disproportionate health burden and risk factors. Given this year's theme of public health for the future of humanity, we believe our workshop asks salient questions to address HIV risk, globally. Key messages Key populations in Europe have an elevated risk of structurally induced stigma, which influences HIV risk. Disproportionate HIV burdens among key populations require urgent attention from public health professionals given the rising rates of HIV in Europe.