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1 | INTRODUCTION Despite high HIV prevalence's among key populations (KPs) such as female sex workers (FSW, 39.5% to 71.8% [1-11]) and men who have sex with men (MSM, 13.2% [...], Introduction: In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). Methods: We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiologica data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. Results: Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-leve impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. Conclusions: Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response. Keywords: mathematical modelling; population attributable fraction; key populations; female sex workers; clients; men who have sex with men

Author(s): Garazi Zulaika 1,*, Elizabeth Nyothach 2, Anna Maria van Eijk 1, David Obor 2, Linda Mason 1, Duolao Wang 1, Tao Chen 1, Emily Kerubo 2, Valarie Opollo 2, [...], Background Adolescence is a sensitive time for girls&apos; sexual and reproductive health (SRH), as biological changes occur concurrently with heightening pressures for sexual activity. In western Kenya, adolescent girls are vulnerable to acquiring sexually transmitted infections (STIs), such as HIV and herpes simplex virus type 2 (HSV-2), and to becoming pregnant prior to reaching adulthood. This study examines associations between individual, household, and partner-related risk factors and the prevalence of sex, adolescent pregnancy, HIV, and HSV-2. Methods and findings We report baseline findings among 4,138 girls attending secondary school who were enrolled between 2017 and 2018 in the Cups or Cash for Girls (CCG) cluster randomized controlled trial in Siaya County, rural western Kenya. Laboratory confirmed biomarkers and survey data were utilized to assess the effects of girls&apos; individual, household, and partner characteristics on the main outcome measures (adolescent reported sex, prior pregnancy, HIV, and HSV-2) through generalized linear model (GLM) analysis. Complete data were available for 3,998 girls (97%) with median age 17.1 years (interquartile range [IQR] 16.3 to 18.0 years); 17.2% were HSV-2 seropositive (n = 686) and 1.7% tested positive for HIV (n = 66). Sexual activity was reported by 27.3% girls (n = 1,090), of whom 12.2% had been pregnant (n = 133). After adjustment, orphanhood (adjusted risk ratio [aRR] 2.81, 95% confidence interval [CI] 1.18 to 6.71, p-value [p] = 0.020), low body mass index (BMI) (aRR 2.07; CI: 1.00 to 4.30, p = 0.051), and age (aRR 1.34, 1.18 to 1.53, p < 0.001) were all associated with HIV infection. Girls reporting light menstrual bleeding (aRR 2.42, 1.22 to 4.79, p = 0.012) for fewer than 3 days (aRR 2.81, 1.16 to 6.82, p = 0.023) were over twice as likely to have HIV. Early menarche (aRR 2.05, 1.33 to 3.17, p = 0.001) was associated with adolescent pregnancy and HSV-2-seropositive girls reported higher rates of pregnancy (aRR 1.62, CI: 1.16 to 2.27, p = 0.005). High BMI was associated with HSV-2 (aRR 1.24, 1.05 to 1.46, p = 0.010) and sexual activity (aRR 1.14, 1.02 to 1.28, p = 0.016). High levels of harassment were detected in the cohort (41.2%); being touched indecently conveyed the strongest association related to reported sexual activity (aRR 2.52, 2.26 to 2.81, p < 0.001). Study limitations include the cross-sectional design of the study, which informs on the SRH burdens found in this population but limits causal interpretation of associations, and the self-reported exposure ascertainment, which may have led to possible underreporting of risk factors, most notably prior sexual activity. Conclusions Our findings indicate that adolescent girls attending school in Kenya face frequent harassment for sex and are at high risk of pregnancy and HSV-2, with girls experiencing early menarche particularly vulnerable. Targeted interventions, such as earlier sexual education programs, are warranted to address their vulnerability to SRH harms. Trial registration ClinicalTrials.gov NCT03051789.

Introduction Globally, the prevalence and incidence of hepatitis C virus (HCV) infection among people who inject drugs (PWID) is high, with approximately 42.4% to 62.1% of PWID estimated to be [...], : Introduction: Over the last two decades, the incidence of hepatitis C virus (HCV) co?infection among men who have sex with men (MSM) living with HIV began increasing in post?industrialized countries. Little is known about transmission of acute or recent HCV, in particular among MSM living with HIV co?infection, which creates uncertainty about potential for reinfection after HCV treatment. Using phylogenetic methods, clinical, epidemiological and molecular data can be combined to better understand transmission patterns. These insights may help identify strategies to reduce reinfection risk, enhancing effectiveness of HCV treatment as prevention strategies. The aim of this study was to identify multi?risk profiles and factors associated with phylogenetic pairs and clusters among people with recent HCV infection. Methods: Data and specimens from five studies of recent HCV in Australia and New Zealand (2004 to 2015) were used. HCV Core?E2 sequences were used to infer maximum likelihood trees. Clusters were identified using 90% bootstrap and 5% genetic distance threshold. Multivariate logistic regression and latent class analyses were performed. Results: Among 237 participants with Core?E2 sequences, 47% were in a pair/cluster. Among HIV/HCV co?infected participants, 60% (74/123) were in a pair/cluster, compared to 30% (34/114) with HCV mono?infection (p < 0.001). HIV/HCV co?infection (vs. HCV mono?infection; adjusted odds ratio (AOR), 2.37, 95% confidence interval (CI), 1.45, 5.15) was independently associated with phylogenetic clustering. Latent class analysis identified three distinct risk profiles: (1) people who inject drugs, (2) HIV?positive gay and bisexual men (GBM) with low probability of injecting drug use (IDU) and (3) GBM with IDU & sexual risk behaviour. Class 2 (vs. Class 1, AOR 3.40; 95% CI, 1.52, 7.60), was independently associated with phylogenetic clustering. Many clusters displayed homogeneous characteristics, such as containing individuals exclusively from one city, individuals all with HIV/HCV co?infection or individuals sharing the same route of acquisition of HCV. Conclusions: Clusters containing individuals with specific characteristics suggest that HCV transmission occurs through discrete networks, particularly among HIV/HCV co?infected individuals. The greater proportion of clustering found among HIV/HCV co?infected participants highlights the need to provide broad direct?acting antiviral access encouraging rapid uptake in this population and ongoing monitoring of the phylogeny.

Introduction Much of the research on the sexual exploitation of children has been conducted in Asia and the Americas, but studies have increasingly explored this topic in sub?Saharan Africa. For [...], : Introduction: Sustainable Development Goals (SDGs) about gender equality; decent work; and peace, justice, and strong institutions include a focus on eradicating trafficking and sexual exploitation of and violence against women and children. In Lesotho, 86% of women have experienced gender?based violence. In addition, overall HIV prevalence is among the highest globally, and higher among adolescent girls than boys. Moreover, nearly three quarters of female sex workers (FSW) are estimated to be living with HIV in Lesotho. In this context, sexually exploited children may be particularly vulnerable to violence and HIV acquisition risks. This study&apos;s objective is to examine the prevalence and correlates of experiencing sexual exploitation as a child among FSW in Lesotho. Methods: FSW (?18 years) recruited through respondent?driven sampling in Maseru and Maputsoe from February to September 2014 completed HIV and syphilis testing and an interviewer?administered survey, including a question about the age at which they started providing sex for money. This study examined correlates of experiencing sexual exploitation as a child ( Results: Across both cities, 20.0% (142/710) of participants were sexually exploited as children. Among them, 65.5% (93/142) tested positive for HIV and 31.0% (44/142) for syphilis, which was similar to those who started selling sex as adults, after adjusting for current age. Participants who experienced child sexual exploitation were more likely to have been forced to have sex before age 18 than those who started selling sex as adults (Maseru?adjusted odds ratio (aOR): 3.52, 95% Confidence Interval (CI): 1.61 to 7.66, p = 0.002; Maputsoe?aOR: 4.39, 95% CI: 1.22 to 15.75, p = 0.023). In Maseru, participants who were sexually exploited as children were more likely to avoid carrying condoms to prevent trouble with police (aOR: 3.18, 95% CI: 1.50 to 6.75, p = 0.003). Conclusions: Risk determinants for HIV and violence among sexually exploited children can be studied retrospectively through research with adult FSW. Further research working directly with sexually exploited children will improve understanding of their needs. Preventing commercial sexual exploitation of children and addressing the social and healthcare needs of those who are exploited are necessary to fully achieve SDGs 5, 8 and 16 and an AIDS?Free Generation.

OA02.05LB M. Malahleha (1); H. Janes (2); F. Laher (3); L.-G. Bekker (4); B. S. Prigmore (5); D. Grove (5); J.J. Kee (5); M. Allen (6); M. Andrasik (2); M. [...], Background: South Africa has the highest HIV incidence globally. HIV risk has been extensively studied in South African cisgender women; however, less is known about risk drivers in cisgender men and transgender women (TGW). We characterised HIV incidence, and sexual behaviours and clinical characteristics associated with HIV acquisition, amongst cisgender men and TGW in two South African HIV vaccine efficacy trials. Methods: We included data from heterosexual cisgender men (HCM), men who have sex with men (MSM) and TGW who participated in Uhambo (N = 1611 randomised to vaccine/placebo, 2016 to 2020) and Phambili (N = 219 randomised to placebo, 2007 to 2011; vaccinees excluded due to potential vaccine-increased risk). Cox proportional hazards models were used to associate baseline variables--self-reported last thirty-days (Uhambo) or six-months (Phambili) sexual behaviours and laboratory-confirmed STIs--with HIV acquisition. Results: Median age was 25 (IQR: 22 to 30). Most identified as heterosexual or reported no male partner (1636/1830 [89.40%]). More MSM and TGW versus HCM reported anal sex (90.21% vs. 5.01%), transactional sex (41.75% vs. 11.37%), [greater than or equal to]2 partners (82.99% vs. 65.28%), sex with alcohol/drugs (67.53% vs. 55.50%) or sex with an HIV-positive partner (71.65% vs. 44.74%). Overall HIV incidence was 1.32% annually (95% CI: 0.99 to 1.74) and higher in MSM and TGW (8.84%, 95% CI: 5.40 to 13.65) or those with an STI (2.99%, 95% CI: 1.63 to 5.01). Based on multiplicity-adjusted univariate analyses, anal sex (HR 6.34, 95% CI: 3.45 to 11.66), transactional sex (HR 3.42, 95% CI: 1.80 to 6.51), and MSM or homosexual identity (HR 15.62, 95% CI: 7.82 to 31.81) were significantly associated with HIV acquisition. In a multivariate model of published HIV risk factors, only MSM and homosexual identity (HR 12.90, 95% CI: 4.03 to 41.29; p < 0.001) was significantly associated with HIV acquisition. Conclusions: Identifying as MSM or homosexual is a strong predictor of HIV acquisition in South African men and TGW. While overall incidence in cisgender men and TGW is low relative to women, subpopulations of cis-gender men and TGW experience exceptionally high incidence.

The prevalence of HIV infection in the Caribbean is estimated at 2.4%, second only to sub-Saharan Africa (UNAIDS/WHO, 2002). While incidence rates in North America and Latin America have either [...], In the Caribbean AIDS has become the leading cause of death among those aged 15-45. The homeless are at high risk due to the nexus of mobility, psychiatric disorders and substance use, particularly crack. Seventy-four homeless, out-of-treatment drug users were recruited in Saint Lucia and Trinidad to assess risk behaviour and healthcare needs. Information was collected in several domains: medical, mental health, substance use, sexual risk, and barriers to care. Ninety-five percent of the sample reported crack cocaine use within the previous 30 days. Approximately 35% of the sample had ever been diagnosed with a sexually transmitted disease and 25% of the sample reported being HIV+. Approximately 40% had a history of trading sex for crack or money. Due to the range of needs in this population, interventions should be multimodal. A focus on the individual, community, and structural levels' is warranted to improve chances of program effectiveness. Key Words: Caribbean, Homeless, Substance Abuse, Crack Cocaine, HIV.

Unlike North and Latin America, where the rates of HIV/AIDS have either been reduced or have leveled off, the Caribbean remains the only region in the Western Hemisphere with steadily [...], There is a critical need to deliver empirically validated interventions to underserved populations. Haiti, the country most heavily affected by the AIDS epidemic in the Caribbean, accounts for approximately 50% of all cases in the region. Poverty, disparities in access to healthcare, and socio-political instability are among the reasons why the country has been ravaged by the disease. Ongoing projects in Haiti have shown that integrated prevention and care in resource poor settings are feasible and can be successful, as evidenced by a 50% drop in incidence among pregnant women since 1993. The AIDS prevention program has embarked on a comprehensive effort to culturally adapt a cognitive-behavioral stress management program for Haitian HIV+ individuals. The purpose of the program is to improve adherence to antiretroviral medication, reduce transmission to uninfected partners, and improve coping. This comprehensive approach is necessary to ensure the validity of the cross-cultural adaptation of this intervention. Key Words: Haiti, HIV, Cultural adaptation, CBSM, Adherence.

Introduction Although the HIV epidemic is generalized in sub?Saharan Africa, there is heterogeneity in where and among whom HIV infections occur, with certain localities and populations being consistently more vulnerable [...], Introduction: Young women aged 15 to 24 years in sub?Saharan Africa continue to be disproportionately affected by HIV. A growing number of studies have suggested that the practice of transactional sex may in part explain women&apos;s heightened risk, but evidence on the association between transactional sex and HIV has not yet been synthesized. We set out to systematically review studies that assess the relationship between transactional sex and HIV among men and women in sub?Saharan Africa and to summarize the findings through a meta?analysis. Methods: The search strategy included 8 databases, hand searches in 10 journals, and searches across 17 websites and portals for organizations as informed by expert colleagues. A systematic review of cross?sectional and longitudinal studies was carried out for studies on women and men who engage in transactional sex published up through 2014. Random effects meta?analysis was used to further examine the relationship between transactional sex and prevalent HIV infection across a subset of studies with the same exposure period. Analyses were conducted separately for men and women. Results: Nineteen papers from 16 studies met our inclusion criteria. Of these 16 studies, 14 provided data on women and 10 on men. We find a significant, positive, unadjusted or adjusted association between transactional sex and HIV in 10 of 14 studies for women, one of which used a longitudinal design (relative risk (RR)=2.06, 95% confidence interval (CI): 1.22 ?3.48). Out of 10 studies involving men, only 2 indicate a positive association between HIV and transactional sex in unadjusted or adjusted models. The meta?analysis confirmed general findings from the systematic review (unadjusted meta?analysis findings are significant for women (n=4; pooled odds ratio (OR)=1.54, 95% CI: 1.04?2.28; I[sup.2] =42.5%, p=0.156), but not for men (n=4; pooled OR=1.47, 95% CI: 0.85?2.56; I[sup.2] =50.8%, p=0.107). Conclusions: Transactional sex is associated with HIV among women, whereas findings for men were inconclusive. Given that only two studies used a longitudinal approach, there remains a need for better measurement of the practice of transactional sex and additional longitudinal studies to establish the causal pathways between transactional sex and HIV.

In a South African study conducted primarily at clinics providing HIV services, roughly two in five HIV-positive men and women said they had recently had sex without disclosing their HIV [...]

Among young rural South African women, having experienced intimate partner violence is strongly associated with certain risk factors for HIV infection, according to an observational analysis. (1) Women who had [...]