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BACKGROUND: For workers engaged in animal care, workplace hazards are common and may outnumber those experienced by human healthcare workers. METHODS: We used accepted Washington State workers' compensation claims for the period from January 1, 2007 and December 31, 2011 to compare injury rates and types of injuries across animal care occupations. RESULTS: Work-related injuries frequently affect veterinary support staff and those working in pet stores, shelters, grooming facilities and kennels. Animal-related injuries were the most commonly reported injury type experienced by all groups, though the animal source of injury appears to differ by work setting. CONCLUSIONS: Workplace related injuries among animal care workers are common and most often caused by physical insults resulting from worker-animal interaction. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc. Language: en

Introduction The Global Fund and the US President's Emergency Plan for AIDS Relief (PEPFAR) are major donors to HIV services with key populations (KPs) to achieve the UNAIDS 95‐95‐95 epidemic control goals. The programmes they fund are not always well aligned or coordinated, decreasing their effectiveness. Joint assessments are designed and led by LINKAGES, a project funded by PEPFAR and the US Agency for International Development, to improve coordination among donors and on‐the‐ground implementation of KP HIV programmes. Joint assessments help identify barriers that prevent KPs from accessing interventions along the cascade of prevention, diagnosis and treatment services, and provide recommendations to improve and align programmes. Detailed reports from eight assessments in Malawi, Cameroon, Swaziland, Haiti, Angola, Nepal, Côte d'Ivoire and Botswana were analysed for thematic challenges, and recommendations are presented. The purpose of the paper is to identify commonalities across KP HIV programmes that were found through the assessments so others can learn and then strengthen their programmes to become more effective. Discussion The joint cascade assessments offered countries feedback on HIV programme challenges and recommendations for strengthening them at national, subnational and local levels. Shared intervention areas included: (1) robust population size estimates to inform service delivery targets and to budget resources for KP outreach; (2) accessible and KP‐friendly services most relevant to individuals to increase retention in the HIV cascade; (3) decentralized, community‐based services for HIV testing and antiretroviral therapy, and new approaches including self‐testing and PrEP; (4) addressing structural issues of stigma, discrimination and violence against KPs to create a more enabling environment; and (5) more effective and continual tracking of KPs across the cascade, and coordinated, harmonized monitoring tools and reporting systems between donor‐funded and national programmes. Conclusions The assessment teams and country stakeholders viewed the assessments as a best practice for coordinating donor‐funded programmes that may overlap or inefficiently serve KPs. Global and national HIV programmes need investments of time, resources, and commitment from stakeholders to continually course‐correct to align and improve programmes for sustained impact. The type of continued partnership demonstrated by the joint assessments is key to address HIV among KPs globally.

Introduction: Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. Methods: We collected information on construction firms with 10–50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n = 1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011–2013 to predict time-loss claim rates in the following year, 2014. Results: Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011–2013 were predicted to have higher WC claim rates in 2014. Conclusions: We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk.

Background Recent research suggests that heat exposure may increase the risk of traumatic injuries. Published heat-related epidemiological studies have relied upon exposure data from individual weather stations. Objective To evaluate the association between heat exposure and traumatic injuries in outdoor agricultural workers exposed to ambient heat and internal heat generated by physical activity using modeled ambient exposure data. Methods A case-crossover study using time-stratified referent selection among 12,213 outdoor agricultural workers with new Washington State Fund workers’ compensation traumatic injury claims between 2000 and 2012 was conducted. Maximum daily Humidex exposures, derived from modeled meteorological data, were assigned to latitudes and longitudes of injury locations on injury and referent dates. Conditional logistic regression was used to estimate odds ratios of injury for a priori daily maximum Humidex categories. Results The mean of within-stratum (injury day and corresponding referent days) standard deviations of daily maximum Humidex was 4.8. The traumatic injury odds ratio was 1.14 (95% confidence interval 1.06, 1.22), 1.15 (95% confidence interval 1.06, 1.25), and 1.10 (95% confidence interval 1.01, 1.20) for daily maximum Humidex of 25–29, 30–33, and ≥34, respectively, compared to < 25, adjusted for self-reported duration of employment. Stronger associations were observed during cherry harvest duties in the June and July time period, compared to all duties over the entire study period. Conclusions Agricultural workers laboring in warm conditions are at risk for heat-related traumatic injuries. Combined heat-related illness and injury prevention efforts should be considered in high-risk populations exposed to warm ambient conditions in the setting of physical exertion.

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools – supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups – provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.

Background Studies suggest employers underreport injuries to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII); less is known about reporting differences by establishment characteristics. Methods We linked SOII data to Washington State workers’ compensation claims data, using unemployment insurance data to improve linking accuracy. We used multivariable regression models to estimate incidence ratios (IR) of unreported workers’ compensation claims for establishment characteristics. Results An estimated 70% of workers’ compensation claims were reported in SOII. Claims among state and local government establishments were most likely to be reported. Compared to large manufacturing establishments, unreported claims were most common among small educational services establishments (IR = 2.47, 95%CI: 1.52–4.01) and large construction establishments (IR = 2.05, 95%CI: 1.77–2.37). Conclusions Underreporting of workers’ compensation claims to SOII varies by establishment characteristics, obscuring true differences in work injury incidence. Findings may differ from previous research due to differences in study methods. Am. J. Ind. Med. 59:274–289, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

For workers engaged in animal care, workplace hazards are common and may outnumber those experienced by human healthcare workers.We used accepted Washington State workers' compensation claims for the period from January 1, 2007 and December 31, 2011 to compare injury rates and types of injuries across animal care occupations.Work-related injuries frequently affect veterinary support staff and those working in pet stores, shelters, grooming facilities and kennels. Animal-related injuries were the most commonly reported injury type experienced by all groups, though the animal source of injury appears to differ by work setting.Workplace related injuries among animal care workers are common and most often caused by physical insults resulting from worker-animal interaction.

To describe the burden of knee work-related musculoskeletal disorders (WMSDs).Knee WMSDs were identified using Washington State Fund workers' compensation data from 1999 to 2007 and analyzed by cost, industry, occupation, and claims incidence rates.Knee WMSDs accounted for 7% of WMSD claims and 10% of WMSD costs. The rate of decline in claims incidence rates for knee WMSDs was similar to the rate of decline for all other WMSDs. Industries at highest risk for knee WMSDs included construction and building contractors. Occupations of concern included carpenters and truck drivers in men and nursing aides and housekeepers in women.Between 1999 and 2007, Washington State Fund knee WMSDs were widespread and associated with a large cost. Identification of specific occupational knee WMSD risk factors in high-risk industries is needed to guide prevention efforts.

Objective This study compares construction industry groups in Washington State by injury severity and cost, and ranks industry groups according to potential for prevention. Methods All Washington State workers' compensation compensable claims with date of injury between 2003 and 2007 were classified into North American Industrial Classification System (NAICS) industry groups. Claims were then aggregated by injury type and industry groups were ranked according to a prevention index (PI). The PI is the average of the rank orders of the claim count and the claim incidence rate. A lower PI indicates a higher need for prevention activities. The severity rate was calculated as the number of days of time loss per 10,000 full-time equivalents (FTEs). Results For all injury types, construction industry groups occupy 7 of the top 15 PI ranks in Washington State. The severity rate among construction industry groups was twice that for non-construction groups for all injury types. Foundation, structure, and building exterior contractors (NAICS 2381) ranked highest in prevention potential and severity among construction industry groups for most common injury types including falls from elevation, fall on same level, struck by/against, and musculo-skeletal disorders of the neck, back, and upper extremity (WMSDs). Median claim costs by injury type were generally higher among construction industry groups. Conclusions The construction industry in Washington State has a high severity rate and potential for prevention. The methods used for characterizing these industry groups can be adapted for comparison within and between other industries and states. Impact on Industry These data can be used by industry groups and employers to identify higher cost and higher severity injury types. Knowledge about the relative frequencies and costs associated with different injury types will help employers and construction industry associations make better informed decisions about where prevention efforts are most needed and may have the greatest impact. The results of this study can also be used by industry stakeholders to cooperatively focus on high cost and high severity injuries and explore best practices, interventions, and solutions as demonstrated by efforts to prevent musculoskeletal disorders in masonry ( Entzel, Albers, & Welch, 2007 ). Initiating construction industry groups to focus on high cost and high severity injuries may also help prevent other types of injuries.

Chemical substance exposure data from the Washington State Occupational Safety and Health Administration (OSHA) program were reviewed to determine if inspections conducted as a result of a report of a hazard from a complainant or referent may alert the agency to uncharacterized or emerging health hazards. Exposure and other electronically stored data from 6890 health inspection reports conducted between April 2003 and August 2008 were extracted from agency records. A total of 515 (7%) inspections with one or more personal airborne chemical substance samples were identified for further study. Inspections by report of a hazard and by targeting were compared for the following: number of inspections, number and percentage of inspections with workers exposed to substances above an agency's permissible exposure limit, types of industries inspected, and number and type of chemical substances assessed. Report of a hazard inspections documented work sites with worker overexposure at the same rate as agency targeted inspections (approximately 35% of the time), suggesting that complainants and referents are a credible pool of observers capable of directing the agency to airborne chemical substance hazards. Report of a hazard inspections were associated with significantly broader distribution of industries as well as a greater variety of chemical substance exposures than were targeted inspections. Narrative text that described business type and processes inspected was more useful than NAICS codes alone and critical in identifying processes and industries that may be associated with new hazards. Finally, previously identified emerging hazards were found among the report of a hazard data. These findings indicate that surveillance of OSHA inspection data can be a valid tool to identify uncharacterized and emerging health hazards. Additional research is needed to develop criteria for objective review and prioritization of the data for intervention. Federal OSHA and other state OSHA agencies will need to add electronic data entry fields more descriptive of industry, process, and substance to fully use agency exposure data for hazard surveillance.

In recent years, gender and sexual minorities have become increasingly visible across sub-Saharan Africa, marking both the progression and violation of their human rights. Using data from a study with sexual minorities in Lesotho, this analysis leveraged the social ecological model to examine relationships between stigma, human rights, and sexual health among women who have sex with women in Lesotho. A community-based participatory approach was used for the mixed-method, cross-sectional study. A total of 250 women who have sex with women completed a structured questionnaire, of which 21 participated in a total of three focus group discussions. Stigma was common within and outside the health sector. Stigma and human rights abuses were associated with increased risk for HIV and STIs. Interventions to address stigma at the structural, community, and interpersonal levels are essential to ensuring sexual health and rights for women who have sex with women in Lesotho.

Background The Services Sector, as defined by the National Occupational Research Agenda (NORA), is comprised of a diverse industry mix and its workers face a variety of occupational exposures and hazards. The objective of this study was to identify high-risk industry groups within the Services Sector for prevention targeting. Methods Compensable Washington State workers’ compensation claims from the Services Sector from 2002 through 2010 were analyzed. A “prevention index” (PI), the average of the rank orders of claim count and claim incidence rate, was used to rank 87 Services Sector industry groups by seven injury types: Work- Related Musculoskeletal Disorders (WMSDs), Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle, and Overexertion. In the PI rankings, industry groups with high injury burdens appear higher ranked than industry groups with low counts or low rates of injury, indicating a need for prioritizing injury prevention efforts in these groups. Results In the Services Sector, these 7 injury types account for 84% of compensable claims in WA. The industry groups highest ranked by PI across the injury types included: Services to Buildings and Dwellings; Executive, Legislative, and Other General Government Support; and Waste Collection. WMSDs had the highest compensable claims rates. Conclusions Services is a large sector of the economy, and the substantial number, rate, and cost of occupational injuries within this sector should be addressed. Several Services Sector industry groups are at high risk for a variety of occupational injuries. Using a PI to rank industry groups based on their injury risk provides information with which to guide prevention efforts.

Washington State passed Safe Patient Handling legislation (ESHB 1672) for hospitals in 2006 with full implementation by 2010. We assessed the impact of the legislation by comparing workers compensation claims rates for Washington State hospitals (with) nursing homes (without) over this period, focusing on work- related musculoskeletal disorders (WMSDs). We also compared implementation of SPH in Washington State hos- pitals (with legislation) to comparable hospitals in Idaho (no legislation) via focus groups and surveys. Over the study period, hospital WC rates for WMSDs declined more rapidly than nursing home WC rates. Washington hospital nursing staff reported significantly greater SPH implementation than Idaho nursing staff.

Drywall installers are at high risk for work-related falls from height (FFH).We defined a 20-year (1989-2008) cohort of 5,073 union drywall carpenters in Washington State, their worker-hours, and FFH. FFH rate patterns were examined using Poisson regression.Drywall installers' FFH rates declined over time and varied little by worker age and time in the union. However, among FFH involving drywall sheets, workers with10 union years were at high risk. Narratives consistently described the surface from which workers fell, commonly scaffolds (33%), ladders (21%), and stilts (13%). Work task, height fallen, protective equipment use, work speed, weather, influence of other workers/workgroups, and tool/equipment specifics were not often reported.In addition to continued efforts to prevent falls from scaffolds and ladders, efforts should address stilt use and less experienced workers who may have greater exposure. Consistency in reported narrative elements may improve FFH risk factor identification and prevention effort evaluation.

Background HIV is hyperendemic in Swaziland with a prevalence of over 25% among those between the ages of 15 and 49 years old. The HIV response in Swaziland has traditionally focused on decreasing HIV acquisition and transmission risks in the general population through interventions such as male circumcision, increasing treatment uptake and adherence, and risk-reduction counseling. There is emerging data from Southern Africa that key populations such as female sex workers (FSW) carry a disproportionate burden of HIV even in generalized epidemics such as Swaziland. The burden of HIV and prevention needs among FSW remains unstudied in Swaziland. Methods A respondent-driven-sampling survey was completed between August-October, 2011 of 328 FSW in Swaziland. Each participant completed a structured survey instrument and biological HIV and syphilis testing according to Swazi Guidelines. Results Unadjusted HIV prevalence was 70.3% (n = 223/317) among a sample of women predominantly from Swaziland (95.2%, n = 300/316) with a mean age of 21(median 25) which was significantly higher than the general population of women. Approximately one-half of the FSW(53.4%, n = 167/313) had received HIV prevention information related to sex work in the previous year, and about one-in-ten had been part of a previous research project(n = 38/313). Rape was common with nearly 40% (n = 123/314) reporting at least one rape; 17.4% (n = 23/314)reported being raped 6 or more times. Reporting blackmail (34.8%, n = 113/314) and torture(53.2%, n = 173/314) was prevalent. Conclusions While Swaziland has a highly generalized HIV epidemic, reconceptualizing the needs of key populations such as FSW suggests that these women represent a distinct population with specific vulnerabilities and a high burden of HIV compared to other women. These women are understudied and underserved resulting in a limited characterization of their HIV prevention, treatment, and care needs and only sparse specific and competent programming. FSW are an important population for further investigation and rapid scale-up of combination HIV prevention including biomedical, behavioral, and structural interventions.

Introduction: Despite the knowledge that men who have sex with men (MSM) are more likely to be infected with HIV across settings, there has been little investigation of the experiences of MSM who are living with HIV in sub-Saharan Africa. Using the framework of positive health, dignity and prevention, we explored the experiences and HIV prevention, care and treatment needs of MSM who are living with HIV in Swaziland. Methods: We conducted 40 in-depth interviews with 20 HIV-positive MSM, 16 interviews with key informants and three focus groups with MSM community members. Qualitative analysis was iterative and included debriefing sessions with a study staff, a stakeholders’ workshop and coding for key themes using Atlas.ti. Results: The predominant theme was the significant and multiple forms of stigma and discrimination faced by MSM living with HIV in this setting due to both their sexual identity and HIV status. Dual stigma led to selective disclosure or lack of disclosure of both identities, and consequently a lack of social support for care-seeking and medication adherence. Perceived and experienced stigma from healthcare settings, particularly around sexual identity, also led to delayed care-seeking, travel to more distant clinics and missed opportunities for appropriate services. Participants described experiences of violence and lack of police protection as well as mental health challenges. Key informants, however, reflected on their duty to provide non-discriminatory services to all Swazis regardless of personal beliefs. Conclusions: Intersectionality provides a framework for understanding the experiences of dual stigma and discrimination faced by MSM living with HIV in Swaziland and highlights how programmes and policies should consider the specific needs of this population when designing HIV prevention, care and treatment services. In Swaziland, the health sector should consider providing specialized training for healthcare providers, distributing condoms and lubricants and engaging MSM as peer outreach workers or expert clients. Interventions to reduce stigma, discrimination and violence against MSM and people living with HIV are also needed for both healthcare workers and the general population. Finally, research on experiences and needs of MSM living with HIV globally can help inform comprehensive HIV services for this population. Keywords: men who have sex with men; positive health dignity and prevention; people living with HIV; qualitative research; Swaziland. (Published: 2 December 2013) Citation: Kennedy CE et al. Journal of the International AIDS Society 2013, 16 (Suppl 3):18749 http://www.jiasociety.org/index.php/jias/article/view/18749 | http://dx.doi.org/10.7448/IAS.16.4.18749

Introduction : Same-sex practices and orientation are both stigmatized and criminalized in many countries across sub-Saharan Africa. This study aimed to assess the relationship of fear of seeking healthcare and disclosure of same-sex practices among a sample of men who have sex with men (MSM) in Swaziland with demographic, socio-economic and behavioural determinants. Methods : Three hundred and twenty-three men who reported having had anal sex with a man in the past year were recruited using respondent-driven sampling and administered a structured survey instrument. Asymptotically unbiased estimates of prevalence of stigma and human rights abuses generated using the RDSII estimator are reported with bootstrapped confidence intervals (CIs). Weighted simple and multiple logistic regressions of fear of seeking healthcare and disclosure of same-sex practices to a healthcare provider with demographic, social and behavioural variables are reported. Results : Stigma was common, including 61.7% (95% CI=54.0-69.0%) reporting fear of seeking healthcare, 44.1% (95% CI=36.2-51.3%) any enacted stigma and 73.9% (95% CI=67.7-80.1%) any perceived social stigma (family, friends). Ever disclosing sexual practices with other men to healthcare providers was low (25.6%, 95% CI=19.2-32.1%). In multiple logistic regression, fear of seeking healthcare was significantly associated with: having experienced legal discrimination as a result of sexual orientation or practice (aOR=1.9, 95% CI=1.1-3.4), having felt like you wanted to end your life (aOR=2.0, 95% CI=1.2-3.4), having been raped (aOR=11.0, 95% CI=1.4-84.4), finding it very difficult to insist on condom use when a male partner does not want to use a condom (aOR=2.1, 95% CI=1.0-4.1) and having a non-Swazi nationality at birth (aOR=0.18, 95% CI=0.05-0.68). In multiple logistic regression, disclosure of same-sex practices to a healthcare provider was significantly associated with: having completed secondary education or more (aOR=5.1, 95% CI=2.5-10.3), having used a condom with last casual male sexual partner (aOR=2.4, 95% CI=1.0-5.7) and having felt like you wanted to end your life (aOR=2.1, 95% CI=1.2-3.8). Conclusions : MSM in Swaziland report high levels of stigma and discrimination. The observed associations can inform structural interventions to increase healthcare seeking and disclosure of sexual practices to healthcare workers, facilitating enhanced behavioural and biomedical HIV-prevention approaches among MSM in Swaziland. Keywords : sexual stigma; MSM; disclosure; structural HIV prevention; combination HIV prevention. (Published: 13 November 2013) Citation : Risher K et al. Journal of the International AIDS Society 2013, 16 (Suppl 2):18715 http://www.jiasociety.org/index.php/jias/article/view/18715 | http://dx.doi.org/10.7448/IAS.16.3.18715

Objectives To examine trends in workers’ compensation payments for falls from height (FFH) among a large cohort of carpenters over a 20-year period (1989–2008). Cost data provide an important metric reflecting frequency of falls and severity of associated injuries. Method Using combined administrative data we evaluated workers’ compensation (WC) payments associated with FFH among a large (n = 24 830) 20-year cohort (1989–2008) of union carpenters in Washington State. Mean payments, costs rates and adjusted rate ratios based on hours worked were calculated using negative binomial regression to evaluate cost patterns based on age, union tenure, type of carpentry work and calendar time after adjusting and discounting to 2011 dollar values. Results FFH accounted for $66.6 million in WC payments (a burden of $0.35 per hour worked) over the 20-year period. FFH were responsible for 5.5% of injuries but 15.1% of costs. Marked cost declines were observed over time, but not in a monotonic fashion. Reductions were more pronounced for indemnity than for medical care. Mean costs per fall were unchanged in the latter years of observation from those observed 1995–1996. Individuals performing millwrighting or drywall installation had cost rates over twice as high as commercial construction. Mean costs were 2.3 times greater among carpenters over 50 than those under 30, but their cost rates were only modestly higher. Conclusions Progress has been made in reducing direct costs associated with FFH in this cohort particularly though 1996, but primary gains reflect the reduction in frequency while FFH that occur remain serious.

Background Swaziland has the highest HIV prevalence in the world – 32% of adults are currently living with HIV — and many Swazis are chronically food insecure — in 2011 one in four Swazis required food aid from the World Food Programme. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy (ART) adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. Methods In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers. Results Hunger was a major and consistent theme in our informants’ lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access “healthy” foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession. Conclusions Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for ‘healthy foods’ and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider poverty alleviation, and address social and policy level changes are necessary and likely to have the greatest success.

Globally, overall rates of HIV are on the decline; however, rates among gay men and other men who have sex with men (MSM) and transgender persons are increasing. Meanwhile, there has been exponential growth in access to communication technology over the last decade. More innovative prevention and care technology-based programmes are needed to help address the growing numbers of MSM and transgender persons living with HIV and those at risk for infection. To address this need, a meeting was hosted by the U.S. Agency for International Development (USAID) through the President's Emergency Plan for AIDS Relief (PEPFAR) and co-sponsored by amfAR, The Foundation for AIDS Research and the National Institute of Mental Health (NIMH). The meeting brought together researchers, community implementers, advocates and federal partners to discuss the current landscape of technology-based interventions for MSM and transgender persons and to discuss key considerations. Presentations and discussions focused on the research gaps, facilitators and barriers to programme implementation and public-private partnerships. This article summarizes the meeting proceedings and outlines key considerations for future work in this area.

Introduction: Similar to other Southern African countries, Swaziland has been severely affected by HIV, with over a quarter of its reproductive-age adults estimated to be living with the virus, equating to an estimate of 170,000 people living with HIV. The last several years have witnessed an increase in the understanding of the potential vulnerabilities among men who have sex with men (MSM) in neighbouring countries with similarly widespread HIV epidemics. To date, there are no data characterizing the burden of HIV and the HIV prevention, treatment and care needs of MSM in Swaziland. Methods: In 2011, 324 men who reported sex with another man in the last 12 months were accrued using respondent-driven sampling (RDS). Participants completed HIV testing using Swazi national guidelines as well as structured survey instruments administered by trained staff, including modules on demographics, individual-level behavioural and biological risk factors, social and structural characteristics and uptake of HIV services. Population and individual weights were computed separately for each variable with a data-smoothing algorithm. The weights were used to estimate RDS-adjusted univariate estimates with 95% bootstrapped confidence intervals (BCIs). Crude and RDS-adjusted bivariate and multivariate analyses were completed with HIV as the dependent variable. Results: Overall, HIV prevalence was 17.6% (n=50/284), although it was strongly correlated with age in bivariate- [odds ratio (OR) 1.2, 95% BCI 1.15-1.21] and multivariate-adjusted analyses (adjusted OR 1.24, 95% BCI 1.14-1.35) for each additional year of age. Nearly, 70.8% (n=34/48) were unaware of their status of living with HIV. Condom use with all sexual partners and condom-compatible-lubricant use with men were reported by 1.3% (95% CI 0.0-9.7). Conclusions: Although the epidemic in Swaziland is driven by high-risk heterosexual transmission, the burden of HIV and the HIV prevention, treatment and care needs of MSM have been understudied. The data presented here suggest that these men have specific HIV acquisition and transmission risks that differ from those of other reproductive-age adults. The scale-up in HIV services over the past decade has likely had limited benefit for MSM, potentially resulting in a scenario where epidemics of HIV among MSM expand in the context of slowing epidemics in the general population, a reality observed in most of the world. Keywords: public health; men who have sex with men (MSM); Africa; HIV; Swaziland; epidemiology (Published: 2 December 2013) Citation: Baral SD et al. Journal of the International AIDS Society 2013, 16(Suppl 3 ):18768 http://www.jiasociety.org/index.php/jias/article/view/18768 | http://dx.doi.org/10.7448/IAS.16.4.18768

Background Evidence is increasing of high HIV risks among southern African men who have sex with men (MSM). This represents the first study of HIV risks and human rights contexts among MSM in Lesotho. Methods Two hundred and fifty-two men who reported ever having anal sex with another man were accrued with snowball sampling and were administered a structured quantitative instrument in October and November 2009. Results Of the participants, 96.4% (240/249) were ethnic Basotho with a mean age of 26.3 years (range 18-56), 49.6% (124/250) were currently employed, and 95.2% (238/250) had at least a secondary-level education. Self-reported HIV prevalence was 11.6% (22/190); 54.5% (128/235) reported being tested for HIV in the last year. HIV knowledge was low; only 3.7% (8/212) of MSM knew that receptive anal intercourse was the highest risk for HIV and that a water-based lubricant was most appropriate to use with condoms. Bivariate associations of wearing condoms during last intercourse with men include: having easy access to condoms (OR 3.1, 95% CI 1.2-8.5, p < 0.05); being older than 26 years (OR 2.3, 95% CI 1.3-4.2, p < 0.01); knowing that receptive anal intercourse is higher risk than insertive anal intercourse (OR 2.6, 95% CI 1.2-5.9, p < 0.05); wearing condoms with female sexual partners (OR 3.5, 95% 1.4-8.3, p < 0.01); using water-based lubricants (OR 2.8, 95% CI 1.4-5.5, p < 0.01); being less likely to report having been diagnosed with a sexually transmitted infecton (OR 0.21, 95% CI 0.06-0.76, p < 0.05); and being more likely to have been tested for HIV in the last year (OR 2.0, 95% CI 1.2-3.6, p > 0.05). Human rights abuses were common: 76.2% (170/223) reported at least one abuse, including rape (9.8%, 22/225), blackmail (21.3%, 47/221), fear of seeking healthcare (22.2%, 49/221), police discrimination (16.4%, 36/219), verbal or physical harassment (59.8%, 140/234), or having been beaten (18.9%, 43/228). Conclusions MSM in Lesotho are at high risk for HIV infection and human rights abuses. Evidence-based and rights-affirming HIV prevention programmes supporting the needs of MSM should be developed and implemented.