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HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution.

Lesotho has a broadly generalized HIV epidemic with nearly one in three reproductive-aged women living with HIV. Given this context, there has been limited research on specific HIV risks. In response, this study aimed to characterize the burden of HIV and multi-level correlates of HIV infection amongst female sex workers (FSW) in Lesotho. Respondent driven sampling was used to recruit 744 FSW from February to September 2014 in Maseru and Maputsoe, Lesotho. Robust Poisson regression was used to model weighted prevalence ratios (PR) for HIV, leveraging a modified social ecological model. The HIV prevalence among participants was 71.9% (534/743), with a mean age of 26.8 (SD 7.2). Both individual and structural determinants involving stigma were significantly associated with HIV. Women with the highest enacted stigma score (≥ 5) had a 26% higher prevalence of HIV than individuals that did not experience any stigma (PR 1.26, 95% CI 1.01, 1.57). These data reinforce the extraordinarily high burden of HIV borne by FSW even in the context of the generalized HIV epidemic observed in Lesotho and across southern Africa. Moreover, stigma represents a structural determinant that is fundamental to an effective HIV response for FSW in Lesotho.

Female sex workers (FSW) in South Africa are disproportionately affected by HIV, yet little is known about their HIV-status disclosure with clients. Among 410 FSW participating in a cross-sectional study, 213 were HIV positive and aware of their status prior to enrollment. Among FSW aware of their HIV-status, 35% (74/213) reported disclosing their HIV-status to paying clients, whereas 75% (118/158) of those with regular, non-paying partners disclosed to them. In a multivariable analysis, disclosure to clients was associated with more years of education, disclosure to non-paying partners, and meeting clients at established sex work venues, whereas a history of sexual violence was associated with less disclosure. There was also evidence of mutual disclosure with clients, however disclosure was not associated with condom use with clients or being on antiretrovirals. Safer working environments may improve FSW HIV disclosure practices, however disclosure must also be linked with protective behaviors in this population.

The TRUST/RV368 project was undertaken to apply innovative strategies to engage Nigerian MSM into HIV care. In this analysis we evaluate characteristics of online sex-seekers from the TRUST/RV368 cohort of 1370 MSM in Abuja and Lagos. Logistic regression and generalized estimating equation models were used to assess associations with online sex-seeking. Online sex-seeking (n = 843, 61.5 %) was associated with participation in MSM community activities, larger social and sexual networks, and higher levels of sexual behavior stigma. In addition, online sex-seeking was associated with testing positive for HIV at a follow-up visit [adjusted odds ratio (aOR) = 2.02, 95 % confidence interval (CI) = 1.37, 2.98)] among those who were unaware of or not living with HIV at baseline. Across visits, online sex-seekers were marginally more likely to test positive for chlamydia/gonorrhea (aOR 1.28, 95 % CI 0.99, 1.64). Online sex-seekers in Nigeria are at increased risk for HIV/STIs but may not be benefiting from Internet-based risk reduction opportunities.

This study describes HIV and syphilis bio-behavioral survey conducted among 200 men who have sex with men (MSM) recruited via respondent-driven sampling (RDS) between January 4 and February 1, 2012 in Ulaanbaatar, Mongolia. Participants were administered a structured questionnaire and data were analyzed with RDS-network program in STATA. Of 196 participants who agreed to be tested for HIV and syphilis, 21 (10.7 %; weighted 7.5; 95 % CI: 4.9, 11.4) and 8 (4.1 %; weighted 3.4; 95 % CI: 1.7, 6.7) were positive for HIV and syphilis, respectively. Exposure to HIV prevention programs in the last 12 months was reported by 51.8 % (weighted 33.6; 95 % CI: 27.6, 40.1) of participants. This study found high HIV prevalence and limited uptake of HIV prevention services among MSM in Mongolia. Given the concentrated HIV epidemic among MSM in Mongolia, HIV prevention, treatment and care services should focus on MSM as the population group most affected by HIV.

Social stigma is common among men who have sex with men (MSM) across Sub-Saharan Africa, and may influence risks for HIV and sexually transmitted infections (STIs) via its association with depression. We conducted a cross-sectional study of 530 MSM in Lesotho accrued via respondent-driven sampling. Using generalized structural equation models we examined associations between stigma, social capital, and depression with condom use and testing positive for HIV/STIs. Depression was positively associated with social stigma experienced or perceived as a result of being MSM. In contrast, increasing levels of social cohesion were negatively associated with depression. Social stigma was associated with testing positive for HIV; however, this association did not appear to be mediated by depression or condom use. These data suggest a need for integrated HIV and mental health care that addresses stigma and discrimination and facilitates positive social support for MSM.