18 results on '"MEN who have sex with men"'
Search Results
2. Advancing the use of Long-Acting Extended Delivery formulations for HIV prevention in sub-Saharan Africa: challenges, opportunities, and recommendations.
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Mgodi, Nyaradzo M., Murewanhema, Grant, Moyo, Enos, Samba, Chesterfield, Musuka, Godfrey, Dzinamarira, Tafadzwa, and Brown, Joelle M.
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HIV prevention , *TEENAGE girls , *MEDICAL personnel , *YOUNG women , *PARENTERAL therapy - Abstract
Introduction: The burden of HIV in sub-Saharan Africa (SSA) remains unacceptably high, and disproportionately affects girls and women. While the introduction of oral HIV pre-exposure prophylaxis (PrEP) in 2012 revolutionized HIV prevention, its effectiveness is dependent on user adherence and its implementation in SSA has faced numerous challenges. Patient-level, interpersonal and structural barriers, including, for example, daily pill burden, side effects, lack of partner support, testing and disclosure, and costs have been found to reduce adherence to oral PrEP. Discussion: Long-acting extended delivery (LAED) formulations for PrEP, such as injectable long-acting cabotegravir (CAB-LA) and dapivirine vaginal ring (DPV-VR) are critical additions to the HIV prevention toolkit and are especially important for populations such as adolescent girls and young women (AGYW) and other key populations who remain at significant risk of HIV acquisition while facing substantial barriers to preventive services. These LAED formulations have been shown to result in better adherence and fewer side effects, with CAB-LA being superior to oral PrEP in reducing the risk of HIV acquisition. They can be used to overcome user burden and adherence challenges. However, the successful rollout of the DPV-VR and CAB-LA may be hampered by issues such as a shortage of healthcare providers (HCPs), inadequate parenteral medication infrastructure, increased workload for HCPs, patient concerns, the price of the medications and the possibility of drug resistance. Conclusions: SSA must develop laboratory capabilities for monitoring patients on LAED formulations and enhance research on developing more non-injectable LAED formulations. There is a need to train and retain more HCPs, implement task shifting, invest in healthcare infrastructure and integrate healthcare services. To reduce costs and improve availability, the region must advocate for patent license waivers for LAED formulations and procure drugs collectively as a region. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Pre‐exposure prophylaxis in real life: experience from a prospective, observational and demonstration project among men who have sex with men in Benin, West Africa.
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Diabaté, Souleymane, Béhanzin, Luc, Guédou, Fernand A., Goma‐Matsétsé, Ella, Olodo, Marius, Aza‐Gnandji, Marlène, Dossouvo, Alban, Akpaka, Axel, Chagas, Elyote, Gangbo, Flore, Zannou, Djimon Marcel, and Alary, Michel
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PRE-exposure prophylaxis , *UNSAFE sex , *PILOT projects , *CHLAMYDIA trachomatis , *HIV prevention - Abstract
Introduction: Since many countries in sub‐Saharan Africa are willing to implement HIV oral pre‐exposure prophylaxis (PrEP) for men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life. The study objectives were to assess drug uptake, adherence, condom use and number of sexual partners, HIV incidence and trends in the prevalence of gonorrhoea and chlamydia. Methods: In this oral PrEP demonstration study conducted prospectively in Benin, a combination of tenofovir disoproxil fumarate‐TDF 300 mg and emtricitabine‐FTC 200 mg (TDF‐FTC) was offered daily or on‐demand to MSM. Participants were recruited from 24 August to 24 November 2020 and followed over 12 months. At enrolment, month‐6 and month‐12, participants answered to a face‐to‐face questionnaire, underwent a physical examination and provided blood samples for HIV, gonorrhoea and chlamydia. Results: Overall, 204 HIV‐negative men initiated PrEP. The majority of them (80%) started with daily PrEP. Retention rates at month‐3, 6, 9 and 12 were 96%, 88%, 86% and 85%, respectively. At month‐6 and month‐12, respectively, 49% and 51% of the men on daily PrEP achieved perfect adherence (self‐reported), that is seven pills taken during the last week. For event‐driven PrEP, the corresponding proportions for perfect adherence (last seven at‐risk sexual episodes covered) were 81% and 80%, respectively. The mean number (standard deviation) of male sexual partners over the last 6 months was 2.1 (1.70) at baseline and 1.5 (1.27) at month‐12 (p‐value for trend <0.001). Consistent condom use during the last 6 months was 34% (enrolment), 37% (month‐6) and 36% (month‐12). Three HIV seroconversions (2‐daily and 1‐event‐driven) were recorded. Crude HIV incidence (95% confidence interval) was 1.53 (0.31−4.50)/100 person‐years. Neisseria gonorrhoeae and/or Chlamydia trachomatis prevalence at the anal and/or pharyngeal and/or urethral sites was 28% at baseline and 18% at month‐12 (p‐value = 0.017). Conclusions: In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM. Since HIV incidence was still higher, additional interventions, such as culturally tailored adherence counselling, may be needed to optimize the benefits of PrEP. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa.
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Embleton, Lonnie, Logie, Carmen H., Ngure, Kenneth, Nelson, LaRon, Kimbo, Liza, Ayuku, David, Turan, Janet M., and Braitstein, Paula
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HIV prevention ,SOCIAL stigma ,DISEASE incidence ,HUMAN services programs ,INTERSECTIONALITY ,MEN who have sex with men ,THEMATIC analysis ,PSYCHOLOGY of HIV-positive persons ,DRUG abusers ,ADOLESCENCE - Abstract
Adolescents in sub-Saharan Africa, specifically adolescent girls and young women, young men who have sex with men, transgender persons, persons who use substances, and adolescents experiencing homelessness experience intersectional stigma, have a high incidence of HIV and are less likely to be engaged in HIV prevention and care. We conducted a thematic analysis informed by the Health and Discrimination Framework using a multiple case study design with five case studies in 3 sub-Saharan African countries. Our analysis found commonalities in adolescents' intersectional stigma experiences across cases, despite different contexts. We characterize how intersectional stigma impacts the uptake and implementation of HIV prevention and treatment services along the continuum for adolescents. Findings reveal how intersectional stigma operates across social-ecological levels and worsens HIV-related outcomes for adolescents. We identify opportunities for implementation science research to address stigma-related barriers to the uptake and delivery of HIV services for adolescents in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Stopping and restarting PrEP and loss to follow‐up among PrEP‐taking men who have sex with men and transgender women at risk of HIV‐1 participating in a prospective cohort study in Kenya.
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Wahome, Elizabeth, Boyd, Anders, Thiong'o, Alexander N., Mohamed, Khamisi, Oduor, Tony, Gichuru, Evans, Mwambi, John, van der Elst, Elise, Graham, Susan M., Prins, Maria, and Sanders, Eduard J.
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DIAGNOSIS of HIV infections , *HIV prevention , *HIV infection risk factors , *PATIENT aftercare , *HEALTH services accessibility , *CONFIDENCE intervals , *SEROCONVERSION , *RISK assessment , *DESCRIPTIVE statistics , *MEN who have sex with men , *RISK management in business , *ANAL sex , *LONGITUDINAL method , *RELIGION - Abstract
Objective: To assess frequency and predictors of switching between being on and off PrEP and being lost to follow‐up (LTFU) among men who have sex with men (MSM) and transgender women (TGW) with access to PrEP services in Sub‐Saharan Africa. Methods: This was a prospective cohort study of MSM and TGW from coastal Kenya who initiated daily oral PrEP from June 2017 to June 2019. Participants were followed monthly for HIV‐1 testing, PrEP refill, risk assessment and risk reduction counselling. Follow‐up was censored at the last visit before 30 June 2019, or the last HIV‐1‐negative visit (for those with HIV‐1 seroconversion), whichever occurred first. We estimated transition intensities (TI) and predictors of switching: (i) between being off and on PrEP; and (ii) from either PrEP state and being LTFU (i.e. not returning to the clinic for > 90 days) using a multi‐state Markov model. Results: In all, 134 participants starting PrEP were followed for a median of 20.3 months [interquartile range (IQR): 7.7–22.1]. A total of 49 (36.6%) people stopped PrEP 73 times [TI = 0.6/person‐year (PY), 95% confidence interval (CI): 0.5–0.7] and, of these, 25 (51.0%) restarted PrEP 38 times (TI = 1.2/PY, 95% CI: 0.9–1.7). In multivariable analysis, stopping PrEP was related to anal sex ≤ 3 months, substance‐use disorder and travelling. Restarting PrEP was related to non‐Christian or non‐Muslim religion and travelling. A total of 54 participants were LTFU: on PrEP (n = 47, TI = 0.3/PY, 95% CI: 0.3–0.5) and off PrEP (n = 7, TI = 0.2/PY, 95% CI: 0.1–0.4). In multivariable analysis, becoming LTFU while on PrEP was associated with secondary education or higher, living in the area for ≤ 1 year, residence outside the immediate clinic area and alcohol‐use disorder. Conclusions: Switching between being on and off PrEP or becoming LTFU while on PrEP was frequent among individuals at risk of HIV‐1 acquisition. Alternative PrEP options (e.g. event‐driven PrEP) may need to be considered for MSM and TGW with PrEP‐taking challenges, while improved engagement with care is needed for all MSM and TGW regardless of PrEP regimen. [ABSTRACT FROM AUTHOR]
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- 2022
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6. Declining HIV incidence in sub‐Saharan Africa: a systematic review and meta‐analysis of empiric data.
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Joshi, Keya, Lessler, Justin, Olawore, Oluwasolape, Loevinsohn, Gideon, Bushey, Sophrena, Tobian, Aaron A R, and Grabowski, M Kate
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HIV infections , *HIV , *MEN who have sex with men - Abstract
Introduction: UNAIDS models suggest HIV incidence is declining in sub‐Saharan Africa. The objective of this study was to assess whether modelled trends are supported by empirical evidence. Methods: We conducted a systematic review and meta‐analysis of adult HIV incidence data from sub‐Saharan Africa by searching Embase, Scopus, PubMed and OVID databases and technical reports published between 1 January 2010 and 23 July 2019. We included prospective and cross‐sectional studies that directly measured incidence from blood samples. Incidence data were abstracted according to population risk group, geographic location, sex, intervention arm and calendar period. Weighted regression models were used to assess incidence trends across general population studies by sex. We also identified studies reporting greater than or equal to three incidence measurements since 2010 and assessed trends within them. Results: Total 291 studies, including 22 sub‐Saharan African countries, met inclusion criteria. Most studies were conducted in South Africa (n = 102), Uganda (n = 46) and Kenya (n = 41); there were 26 countries with no published incidence data, most in western and central Africa. Data were most commonly derived from prospective observational studies (n = 163; 56%) and from geographically defined populations with limited demographic or risk‐based enrolment criteria other than age (i.e., general population studies; n = 151; 52%). Across general population studies, average annual incidence declines since 2010 were 0.12/100 person‐years (95% CI: 0.06–0.18; p = 0.001) among men and 0.10/100 person‐years (95% CI: −0.02–0.22; p = 0.093) among women in eastern Africa, and 0.25/100 person‐years (95% CI: 0.17–034; p < 0.0001) among men and 0.42/100 person‐years (95% CI: 0.23–0.62; p = 0.0002) among women in southern Africa. In nine of 10 studies with multiple measurements, incidence declined over time, including in two studies of key populations. Across all population risk groups, the highest HIV incidence estimates were observed among men who have sex with men, with rates ranging from 1.0 to 15.4/100 person‐years. Within general population studies, incidence was typically higher in women than men with a median female‐to‐male incidence rate ratio of 1.47 (IQR: 1.11 to 1.83) with evidence of a growing sex disparity over time. Conclusions: Empirical incidence data show the rate of new HIV infections is declining in eastern and southern Africa. However, recent incidence data are non‐existent or very limited for many countries and key populations. [ABSTRACT FROM AUTHOR]
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- 2021
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7. Management practices in community-based HIV prevention organizations in Nigeria.
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Akeju, David, Nance, Nerissa, Salas-Ortiz, Andrea, Fakunmoju, Ayoola, Ezirim, Idoteyin, Oluwayinka, Adejumoke G., Godpower, Omoregie, and Bautista-Arredondo, Sergio
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HIV prevention , *MEN who have sex with men , *HIV , *COMMUNITY organization , *HEALTH facility management , *COMMUNITY health services , *HIV infection epidemiology , *MULTIDIMENSIONAL Health Locus of Control scales , *HOMOSEXUALITY - Abstract
Background: Nigeria has one of the largest Human Immunodeficiency Virus (HIV) epidemics in the world. Addressing the epidemic of HIV in such a high-burden country has necessitated responses of a multidimensional nature. Historically, community-based organizations (CBOs) have played an essential role in targeting key populations (eg. men who have sex with men, sex workers) that are particularly burdened by HIV. CBOs are an essential part of the provision of health services in sub-Saharan Africa, but very little is known about the management practices of CBOs that provide HIV prevention interventions.Methods: We interviewed 31 CBO staff members and other key stakeholders in January 2017 about management practices in CBOs. Management was conceptualized under the classical management process perspective; these four management phases-planning, organizing, leading, and evaluating-guided the interview process and code development. Data analysis was conducted thematically using Atlas.ti software. The protocol was approved by the ethics committees of the National Institute of Public Health of Mexico (INSP), the National Agency for the Control of AIDS in Nigeria (NACA), and the Nigerian Institute for Medical Research (NIMR).Results: We found that CBOs implement variable management practices that can either hinder or facilitate the efficient provision of HIV prevention services. Long-standing CBOs had relatively strong organizational infrastructure and capacity that positively influenced service planning. In contrast, fledgling CBOs were deficient of organizational infrastructure and lacked program planning capacity. The delivery of HIV services can become more efficient if management practices are taken into account.Conclusions: The delivery of HIV services by CBOs in Nigeria was largely influenced by inherent issues related to skills, organizational structure, talent retention, and sanction application. These, in turn, affected management practices such as planning, organizing, leading, and evaluating. This study shows that KP-led CBOs are evolving and have strong potentials and capacity for growth, and can become more efficient and effective if attention is paid to issues such as hierarchy, staff recruitment, and talent retention. [ABSTRACT FROM AUTHOR]- Published
- 2021
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8. From general to specific: moving past the general population in the HIV response across sub‐Saharan Africa.
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Makofane, Keletso, Elst, Elise M, Walimbwa, Jeffrey, Nemande, Steave, and Baral, Stefan D
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HIV prevention , *IMPACT response , *CIRCUMCISION , *HIV , *PANDEMICS - Abstract
Introduction: As the HIV field evolves to better serve populations which are diverse in risk and access to services, it is crucial to understand and adapt the conceptual tools used to make sense of the HIV pandemic. In this commentary, we discuss the concept of general population. Using a synthetic and historical review, we reflect on the genesis and usage of the general population in HIV research and programme literature, pointing to its moral connotations and its impact on epidemiologic reasoning. Discussion: From the early days of the HIV pandemic, the category of general population has carried implicit normative meanings. General population represented those people considered to be undeserving of HIV acquisition, and therefore deserving of a response. Framing the HIV epidemic in sub‐Saharan Africa as a generalized epidemic primarily affecting the general population has contributed to the exclusion of men who have sex with men from epidemic responses. The usage of this category has also masked heterogeneity among those it includes; the increasing focus on the use of interventions such as circumcision and HIV treatment as general population HIV prevention approaches has been marked by a lack of attention to heterogeneity among beneficiaries. Conclusions: We recommend that the term general population be retired from the field's lexicon. HIV programmes should strengthen their capacity to describe the heterogeneity of those they serve and plan their interventions accordingly. To increase the efficiency and impact of the HIV response, it is urgent to stratify the category of general population by risk. Sexual networks are a promising basis for this stratification. [ABSTRACT FROM AUTHOR]
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- 2020
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9. The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub‐Saharan Africa (HPTN 075).
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Sandfort, Theodorus GM, Hamilton, Erica, Marais, Anita, Guo, Xu, Sugarman, Jeremy, Chen, Ying Q, Cummings, Vanessa, Dadabhai, Sufia, Dominguez, Karen, Panchia, Ravindre, Schnabel, David, Zulu, Fatima, Reynolds, Doerieyah, Radebe, Oscar, Mbeda, Calvin, Kamba, Dunker, Kanyemba, Brian, Ogendo, Arthur, Stirratt, Michael, and Chege, Wairimu
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HIV prevention , *ANAL sex , *COHORT analysis , *HIV-positive persons , *LONGITUDINAL method , *PRE-exposure prophylaxis - Abstract
Introduction: Men who have sex with men (MSM) and transgender women (TGW) in sub‐Saharan Africa (SSA) are profoundly affected by HIV with high HIV prevalence and incidence. This population also faces strong social stigma and legal barriers, potentially impeding participation in research. To date, few multi‐country longitudinal HIV research studies with MSM/TGW have been conducted in SSA. Primary objective of the HIV Prevention Trials Network (HPTN) 075 study was to assess feasibility of recruiting and retaining a multinational prospective cohort of MSM/TGW in SSA for HIV prevention research. Methods: HPTN 075, conducted from 2015 to 2017, was designed to enroll 400 MSM/TGW at four sites in SSA (100 per site: Kisumu, Kenya; Blantyre, Malawi; Cape Town, South Africa; and Soweto, South Africa). The number of HIV‐positive persons was capped at 20 per site; HIV‐positive persons already in care were excluded from participation. The one‐year study included five biobehavioural assessments. Community‐based input and risk mitigation protocols were included in study design and conduct. Results: Of 624 persons screened, 401 were enrolled. One in five participants was classified as transgender. Main reasons for ineligibility included: (a) being HIV positive after the cap was reached (29.6%); (b) not reporting anal intercourse with a man in the preceding three months (20.6%); and (c) being HIV positive and already in care (17.5%). Five (1.2%) participants died during the study (unrelated to study participation). 92.9% of the eligible participants (368/396) completed the final study visit and 86.1% participated in all visits. The main, overlapping reasons for early termination included being (a) unable to adhere to the visit schedule, predominantly because of relocation (46.4%), and (b) unable to contact the participant (32.1%). Participants reported strong motivation to participate and few participation barriers. Four participants reported social harms (loss of confidentiality and sexual harassment by study staff) that were successfully addressed. Conclusions: HPTN 075 successfully enrolled a multinational sample of MSM/TGW in SSA in a prospective HIV prevention research study with a high retention rate and few documented social harms. This supports the feasibility of conducting large‐scale research trials in this population to address its urgent, unmet HIV prevention needs. [ABSTRACT FROM AUTHOR]
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- 2020
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10. Healthcare-related stigma among men who have sex with men and transgender women in sub-Saharan Africa participating in HIV Prevention Trials Network (HPTN) 075 study.
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Mbeda, Calvin, Ogendo, Arthur, Lando, Richard, Schnabel, David, Gust, Deborah A., Guo, Xu, Akelo, Victor, Dominguez, Karen, Panchia, Ravindre, Mbilizi, Yamikani, Chen, Ying, and Chege, Wairimu
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HIV prevention , *ATTITUDE (Psychology) , *CLINICAL trials , *HEALTH services accessibility , *LONGITUDINAL method , *MULTIVARIATE analysis , *SOCIAL stigma , *THERAPEUTICS , *PATIENT participation , *SOCIAL support , *HUMAN research subjects , *PATIENT selection , *PSYCHOLOGY of human research subjects , *MEN who have sex with men , *DESCRIPTIVE statistics , *ODDS ratio - Abstract
The inability to access health services when needed is a critical barrier to HIV prevention, treatment and care among men who have sex with men (MSM) and transgender women (TGW). Using data collected in HPTN 075, we explored factors associated with any experienced healthcare-related stigma. HPTN 075 was a cohort study to assess the feasibility of recruiting and retaining MSM and TGW in clinical trials in sub-Saharan Africa. Of 401 MSM and TGW enrolled at four sites (Kisumu, Kenya; Blantyre, Malawi; Cape Town, Soweto, South Africa) 397 contributed to the analysis (79.9% cis-gender and 20.1% TGW). Of these, (45.3%; 180/397) reported one or more of healthcare-related stigma experiences. Most frequently reported experiences included fear to seek healthcare services (36.3%) and avoiding seeking such services because of the discovery of MSM status (29.2%). Few men and TGW (2.5%) reported having been denied health services because of having sex with men. In multivariable analysis, more participants in Soweto [adjusted odds ratio (AOR) = 2.60] and fewer participants in Blantyre (AOR = 0.27) reported any healthcare-related stigma experiences, in comparison to participants in Kisumu. MSM and TGW that did not have a supportive gay community to rely on were more likely to report any healthcare-related stigma experiences (AOR = 1.46), whereas MSM and TGW who reported high social support and who never had engaged in transactional sex were less likely to report such experiences (AOR = 0.76 and AOR = 0.43, respectively). Our results suggest that encouraging support groups for MSM and TGW as well as training and sensitizing healthcare staff, and the general community, on MSM and TGW health issues and cultural competence may reduce stigma, improve access to healthcare, which could ultimately reduce HIV transmission. [ABSTRACT FROM AUTHOR]
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- 2020
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11. HIV testing and the HIV care continuum among sub-Saharan African men who have sex with men and transgender women screened for participation in HPTN 075.
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Sandfort, Theo G. M., Dominguez, Karen, Kayange, Noel, Ogendo, Arthur, Panchia, Ravindre, Chen, Ying Q., Chege, Wairimu, Cummings, Vanessa, Guo, Xu, Hamilton, Erica L., Stirratt, Michael, and Eshleman, Susan H.
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CONTINUUM of care , *HIV infections , *HIV infection transmission , *VIRAL load , *MEN who have sex with men , *TRANSGENDER people , *ANTIRETROVIRAL agents , *SUB-Saharan Africans - Abstract
Throughout the world, men who have sex with men (MSM) are at increased risk for HIV infection compared to heterosexual men. Little is known about awareness of HIV infection and other gaps in the HIV care continuum for MSM, especially in sub-Saharan Africa (SSA). This information is urgently needed to address the HIV epidemic in this population. This study assessed gaps in the HIV care continuum among persons screened for participation in a multi-country prospective study that evaluated the feasibility of recruiting and retaining MSM for HIV prevention studies in SSA (HIV Prevention Trials Network (HPTN) 075, conducted in four cities in Kenya, Malawi, and South Africa). Participants were recruited using site-specific strategies, that included outreach and informal networks. Transgender women (TW) were eligible to participate. During screening, 601 MSM and TW were tested for HIV infection and asked about prior HIV testing, HIV status, engagement in care, and HIV treatment. Viral load testing and retrospective antiretroviral (ARV) drug testing were performed for HIV-infected participants. Most participants (92.2%) had a prior HIV test; 42.1% were last tested >6 months earlier. HIV prevalence was 30.4%. HIV infection was associated with older age and identifying as female or transgender; 43.7% of the HIV-infected participants were newly diagnosed, especially younger persons and persons with a less recent HIV test. Almost a third of previously-diagnosed participants were not linked to care. Most participants (88.7%) in care were on ARV treatment (ART). Only about one-quarter of all HIV-infected participants were virally suppressed. These findings demonstrate substantial prevalence of undiagnosed HIV infection and sub-optimal HIV care engagement among MSM and TW in SSA. Increased HIV testing frequency and better linkage to care represent critical steps in preventing further HIV transmission in this population. Once in care, gaps in the HIV care continuum appear less critical. [ABSTRACT FROM AUTHOR]
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- 2019
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12. HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.
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Poteat, Tonia, Ackerman, Benjamin, Diouf, Daouda, Ceesay, Nuha, Mothopeng, Tampose, Odette, Ky-Zerbo, Kouanda, Seni, Ouedraogo, Henri Gautier, Simplice, Anato, Kouame, Abo, Mnisi, Zandile, Trapence, Gift, van der Merwe, L. Leigh Ann, Jumbe, Vicente, and Baral, Stefan
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HIV infections , *TRANSGENDER people , *MEN who have sex with men , *CISGENDER people , *UNSAFE sex , *ANAL sex , *SOCIAL stigma , *PSYCHOSOCIAL factors , *HIV infection transmission , *HIV infection epidemiology , *RESEARCH funding , *HUMAN sexuality , *SURVEYS , *DISEASE prevalence , *CROSS-sectional method ,HIV infections & psychology - Abstract
Introduction: Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.Methods and Findings: Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January-August 2013), Côte d'Ivoire (March 2015-February 2016), The Gambia (July-December 2011), Lesotho (February-September 2014), Malawi (July 2011-March 2012), Senegal (February-November 2015), Swaziland (August-December 2011), and Togo (January-June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42-2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63-2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12-1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05-2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49-2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65-2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments.Conclusions: In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs. [ABSTRACT FROM AUTHOR]- Published
- 2017
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13. Community-based strategies to strengthen men's engagement in the HIV care cascade in sub-Saharan Africa.
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Sharma, Monisha, Barnabas, Ruanne V., and Celum, Connie
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EVIDENCE-based medicine , *MEN'S health services , *HIV , *MEDICAL care of HIV-positive persons , *DISEASES in men , *MEDICAL care - Abstract
Monica Sharma and colleagues discuss evidence-based approaches to improving HIV services for men in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]
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- 2017
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14. HIV epidemic and human rights among men who have sex with men in sub-Saharan Africa: Implications for HIV prevention, care, and surveillance.
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Abara, Winston E. and Garba, Ibrahim
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HIV prevention , *HIV infection risk factors , *THERAPEUTICS , *HIV infections , *HIV infection epidemiology , *DISCRIMINATION (Sociology) , *GAY men , *HEALTH , *HUMAN rights , *EVALUATION of medical care , *PUBLIC health surveillance , *SOCIAL justice , *SOCIAL stigma , *LEGAL status of gay men , *HEALTH & social status - Abstract
Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a ‘health in all policies’ approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness. [ABSTRACT FROM AUTHOR]
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- 2017
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15. Respondent-driven sampling as a recruitment method for men who have sex with men in southern sub-Saharan Africa: a cross-sectional analysis by wave.
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Stahlman, Shauna, Johnston, Lisa G., Yah, Clarence, Ketende, Sosthenes, Maziya, Sibusiso, Trapence, Gift, Jumbe, Vincent, Sithole, Bhekie, Mothopeng, Tampose, Mnisi, Zandile, and Baral, Stefan
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MEN who have sex with men ,HIV infection epidemiology ,HIV prevention ,COMMUNITY organization ,BLACK people ,HEALTH attitudes ,HOMOSEXUALITY ,RESEARCH funding ,STATISTICAL sampling ,DISEASE prevalence ,CROSS-sectional method ,PATIENT selection - Abstract
Objectives: Respondent-driven sampling (RDS) is a popular method for recruiting men who have sex with men (MSM). Our objective is to describe the ability of RDS to reach MSM for HIV testing in three southern African nations.Methods: Data collected via RDS among MSM in Lesotho (N=318), Swaziland (N=310) and Malawi (N=334) were analysed by wave in order to characterise differences in sample characteristics. Seeds were recruited from MSM-affiliated community-based organisations. Men were interviewed during a single study visit and tested for HIV. χ(2) tests for trend were used to examine differences in the proportions across wave category.Results: A maximum of 13-19 recruitment waves were achieved in each study site. The percentage of those who identified as gay/homosexual decreased as waves increased in Lesotho (49% to 27%, p<0.01). In Swaziland and Lesotho, knowledge that anal sex was the riskiest type of sex for HIV transmission decreased across waves (39% to 23%, p<0.05, and 37% to 19%, p<0.05). The percentage of participants who had ever received more than one HIV test decreased across waves in Malawi (31% to 12%, p<0.01). In Lesotho and Malawi, the prevalence of testing positive for HIV decreased across waves (48% to 15%, p<0.01 and 23% to 11%, p<0.05). Among those living with HIV, the proportion of those unaware of their status increased across waves in all study sites although this finding was not statistically significant.Conclusions: RDS that extends deeper into recruitment waves may be a promising method of reaching MSM with varying levels of HIV prevention needs. [ABSTRACT FROM AUTHOR]- Published
- 2016
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16. Time to change the paradigm: limited condom and lubricant use among Nigerian men who have sex with men and transgender women despite availability and counseling.
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Crowell, Trevor A., Baral, Stefan D., Schwartz, Sheree, Nowak, Rebecca G., Kokogho, Afoke, Adebajo, Sylvia, Keshinro, Babajide, Makanjuola, Olumide, Michael, Nelson L., Robb, Merlin L., Charurat, Manhattan E., Ake, Julie A., and TRUST/RV368 Study Group
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HIV-positive women , *HUMAN sexuality , *CONDOM use , *HUMAN beings , *HIV infection epidemiology , *HIV prevention , *RESEARCH , *LUBRICATION & lubricants , *RESEARCH methodology , *DISEASE incidence , *EVALUATION research , *MEDICAL cooperation , *HOMOSEXUALITY , *COMPARATIVE studies , *DISEASE prevalence , *RESEARCH funding , *CONDOMS , *SEXUAL partners , *LONGITUDINAL method - Abstract
Purpose: This study characterized availability and uptake of condoms and condom-compatible lubricants (CCLs) at community-engaged condom education and distribution programs serving cisgender men who have sex with men and transgender women in Abuja and Lagos, Nigeria.Methods: Condoms and water-based CCLs were freely available to participants in the TRUST/RV368 cohort. Factors associated with their consistent use were assessed using Poisson regression with robust error variance to estimate relative risks (RRs) and 95% confidence intervals (CIs).Results: From March 2013-November 2017, 2090 cisgender men who have sex with men and transgender women enrolled with HIV prevalence 40.4% and incidence 12.8 cases per 100 person-years. Fifteen months after enrollment, the proportion who reported consistent condom and CCL use increased during receptive anal sex (21.7%-67.1%, P < .001) and insertive anal sex (25.4%-67.8%, P < .001). Multivariable analyses demonstrated independent impact of 15 months in care on uptake during both receptive (RR 2.62 [95% CI 2.29-3.00]) and insertive (RR 2.27 [95% CI 2.01-2.57]) sex.Conclusions: Engagement in care improved condom and CCL uptake over time but inconsistent use remained common. Novel approaches to further increase uptake must be pursued alongside complementary strategies, such as sustained access to antiretroviral therapy for those living with HIV and provision of pre and postexposure prophylaxis for those at risk. [ABSTRACT FROM AUTHOR]- Published
- 2019
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17. HIV treatment as prevention: applicable in sub-Saharan Africa?
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Newell, Marie-Louise and Iwuji, Collins
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THERAPEUTICS , *HIV infections , *HIV prevention , *PUBLIC health research , *MEN who have sex with men , *CD4 antigen - Published
- 2016
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18. Participants' accrual and delivery of HIV prevention interventions among men who have sex with men in sub-Saharan Africa: a systematic review.
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Nyato, Daniel, Kuringe, Evodius, Drake, Mary, Casalini, Caterina, Nnko, Soori, Shao, Amani, Komba, Albert, Baral, Stefan D., Wambura, Mwita, and Changalucha, John
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HIV prevention , *MEN who have sex with men , *PUBLIC health , *HEALTH facilities , *HEALTH services accessibility , *HEALTH - Abstract
Background: Across sub-Saharan Africa (SSA), HIV disproportionately affects men-who-have-sex-with-men (MSM) compared with other men of the same age group in the general population. Access to HIV services remains low among this group although several effective interventions have been documented. It is therefore important to identify what has worked well to increase the reach of HIV services among MSM.Methods: We searched MEDLINE, POPLINE and the Web of Science databases to collect published articles reporting HIV interventions among MSM across sub-Saharan Africa. Covidence was used to review the articles. The review protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO) - CRD42017060808.Results: The search identified 2627 citations, and following removal of duplicates and inclusion and exclusion criteria, only 15 papers were eligible for inclusion in the review. The articles reported various accrual strategies, namely: respondent driven sampling, known peers identified through hotspot or baseline surveys, engagement with existing community-based organizations, and through peer educators contacting MSM in virtual sites. Some programs, however, combined some of these accrual strategies. Peer-led outreach services were indicated to reach and deliver services to more MSM. A combination of peer outreach and mobile clinics increased uptake of health information and services. Health facilities, especially MSM-friendly facilities attract access and use of services by MSM and retention into care.Conclusions: There are various strategies for accrual and delivering services to MSM across SSA. However, each of these strategies have specific strengths and weaknesses necessitating combinations of interventions and integration of the specific context to inform implementation. If the best of intervention content and implementation are used to inform these services, sufficient coverage and impact of HIV prevention and treatment programs for MSM across SSA can be optimized. [ABSTRACT FROM AUTHOR]- Published
- 2018
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