Estimates of the size of key populations at risk for HIV infection: men who have sex with men, female sex workers and injecting drug users in Nairobi, Kenya

Okal, Jerry; Geibel, Scott; Muraguri, Nicholas; Musyoki, Helgar; Tun, Waimar; Broz, Dita; Kuria, David Ndegwa; Kim, Andrea; Oluoch, Tom; Raymond, H. Fisher

doi:10.1136/sextrans-2013-051071

Cited by 74 publications

(75 citation statements)

References 14 publications

(12 reference statements)

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“…82, 83 Accurate estimation of the population size of such high-risk groups should be undertaken to ensure that sufficient resources are allocated to meet the HIV intervention needs in this region. 82, 84 Another important knowledge gap is the cost-effectiveness of targeted intervention strategies to these ‘hidden populations’. On the one hand, targeting can focus on people who can benefit most from an intervention, potentially increasing the effectiveness per intervention dollar.…”

Section: Discussionmentioning

confidence: 99%

Concentrated HIV subepidemics in generalized epidemic settings

Tanser

Oliveira

Maheu‐Giroux

et al. 2014

Current Opinion in HIV and AIDS

117

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Purpose of review A relatively neglected topic to date has been the occurrence of concentrated epidemics within generalized epidemic settings and the potential role of targeted interventions in such settings. We review recent studies in high-risk groups as well as findings relating to geographical heterogeneity and the potential for targeting ‘high-transmission zones’ in the ten highest HIV prevalence countries in sub-Saharan Africa and the world. Recent findings Recent studies have confirmed earlier findings that, even in the context of generalized epidemics, men who have sex with men (MSM) have a substantially higher prevalence than the general population. Estimates of prevalence of HIV among people who inject drugs (PWID) in sub-Saharan countries are rarely available and, when they are, often outdated. We identified recent studies of sex workers (SW) in Kenya and Uganda. In all three cases – MSM, PWID and SW – HIV prevalence estimates are mostly based on convenience. Moreover, good estimates of the total size of these populations are not available. Our review of recent studies of high-risk populations defined on the basis of geography showed very high levels of both new and existing infections in Kenya (slums), South Africa (peri-urban communities) and Uganda (fishing villages). Summary Recent empirical findings combined with evidence from phylogenetic studies and supported by mathematical models provide a clear rationale for testing the feasibility, acceptability, and effectiveness of targeted HIV prevention approaches in hyper-endemic populations to supplement measures aimed at the general population.

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Section: Discussionmentioning

confidence: 99%

Concentrated HIV subepidemics in generalized epidemic settings

Tanser

Oliveira

Maheu‐Giroux

et al. 2014

Current Opinion in HIV and AIDS

117

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“…6 Recent size estimation in Kenya revealed a growing PWID population, high background HIV prevalence, 7 and high risk behaviors. 8,9 …”

Section: Introductionmentioning

confidence: 99%

HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who Inject Drugs in Kenya

Kurth

Cleland

Jarlais

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective HIV infection in sub-Saharan Africa increasingly occurs among people who inject drugs (PWID). Kenya is one of the first to implement a national needle and syringe program (NSP). Our study undertook a baseline assessment as part of evaluating NSP in a seek, test, treat, and retain approach. Methods Participants enrolled May–December 2012 from 10 sites. Respondent-driven sampling was used to reach n=1,785 PWID for HIV-1 prevalence and viral load determination and survey data. Results Estimated HIV prevalence, adjusted for differential network size and recruitment relationships, was 14.5% in Nairobi (95% CI 10.8–18.2) and 20.5% in the Coast region (95% CI 17.3–23.6). Viral load (log10 transformed) in Nairobi ranged from 1.71 to 6.12 (median 4.41; IQR 3.51–4.94) and in the Coast from 1.71 to 5.88 (median 4.01; IQR 3.44–4.72). Using log10 viral load 2.6 as a threshold for HIV viral suppression, the percentage of HIV-infected participants with viral suppression was 4.2% in Nairobi and 4.6% in the Coast. Heroin was the most commonly injected drug in both regions, used by 93% of participantsin the past month typically injecting 2–3 times/day. Receptive needle/syringe sharing at last injection was more common in Nairobi (23%) than the Coast (4%). Estimated incidence among new injectors was 2.5/100 person-years in Nairobi and 1.6/100 person-years in the Coast. Conclusion The HIV epidemic is well-established among PWID in both Nairobi and Coast regions. Public health scale implementation of combination HIV prevention has the potential to greatly limit the epidemic in this vulnerable and bridging population.

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“…HIV prevalence rates in recent studies with MSM in East and Southern Africa range from low estimates of 1.2 % in Nairobi, Kenya [15], and 3.8 % in Luanda Province, Angola [16], to 11.1 % [17] in two cities in Tanzania, 12.5 % in Malawi [14], 17.6 % in Swaziland [18] [21].…”

Section: The Epidemiology Of Hiv In Msm In Ssamentioning

confidence: 99%

“…Two recent studies conducted in East and Southern Africa aimed to estimate MSM population sizes. In Nairobi, Kenya, Okal et al [15] estimate the MSM population at 11,042, with a plausible range of between 10,000 and 22,222 of a total of 1,600,000 men [26], while in Luanda Province, Angola, Kendall et al [16] estimate a population size of 6236 MSM of a total population of approximately 3,200,000 [27].…”

Section: The Epidemiology Of Hiv In Msm In Ssamentioning

confidence: 99%

“In the Fell Clutch of Circumstance”: HIV and Men Who Have Sex With Men in Sub-Saharan Africa

2015

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Men who have sex with men (MSM) in sub-Saharan Africa (SSA) have been repeatedly found to have high risk of HIV infection, and in spite of the differing nature of the HIV epidemic in the general population between East and Southern Africa, and West and Central Africa, MSM are disproportionately affected by HIV across the entire region. Recent research has examined the drivers of HIV risk, and the dynamics of the MSM HIV epidemic in greater detail. However, this growing knowledge has generally not been translated into effective HIV prevention interventions. In part, this is due to the highly stigmatised and frequently criminalised nature of same-sex sexualities in much of the region. Without human-rights-based advocacy targeting governments and interventions aiming to decrease stigma and homophobia, translating research into effective HIV interventions for MSM in SSA at the scale needed to reduce HIV transmission in this population remains highly unlikely.

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Estimates of the size of key populations at risk for HIV infection: men who have sex with men, female sex workers and injecting drug users in Nairobi, Kenya

Cited by 74 publications

References 14 publications

Concentrated HIV subepidemics in generalized epidemic settings

Concentrated HIV subepidemics in generalized epidemic settings

HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who Inject Drugs in Kenya

“In the Fell Clutch of Circumstance”: HIV and Men Who Have Sex With Men in Sub-Saharan Africa

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