Advancing the strategic use of HIV operations research to strengthen local policies and programmes: the Research to Prevention Project

Kerrigan, Deanna; Kennedy, Caitlin E.; Cheng, Alison; Sandison, Sarah; Fonner, Virginia A.; Holtgrave, David R.; Brahmbhatt, Heena

doi:10.7448/ias.18.1.20029

Cited by 7 publications

(4 citation statements)

References 43 publications

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“…Several South-to-South initiatives are also ongoing to document and share community-led, programmatic lessons learned between lower- or middle-income countries. 70…”

Section: Research Gaps and Agendamentioning

confidence: 99%

The global response and unmet actions for HIV and sex workers

et al. 2018

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Female, male, and transgender sex workers continue to have disproportionately high burdens of HIV infection in low-income, middle-income, and high-income countries in 2018. 4 years since our Lancet Series on HIV and sex work, our updated analysis of the global HIV burden among female sex workers shows that HIV prevalence is unacceptably high at 10·4% (95% CI 9·5-11·5) and is largely unchanged. Comprehensive epidemiological data on HIV and antiretroviral therapy (ART) coverage are scarce, particularly among transgender women. Sustained coverage of treatment is markedly uneven and challenged by lack of progress on stigma and criminalisation, and sustained human rights violations. Although important progress has been made in biomedical interventions with pre-exposure prophylaxis and early ART feasibility and demonstration projects, limited coverage and retention suggest that sustained investment in community and structural interventions is required for sex workers to benefit from the preventive interventions and treatments that other key populations have. Evidence-based progress on full decriminalisation grounded in health and human rights-a key recommendation in our Lancet Series-has stalled, with South Africa a notable exception. Additionally, several countries have rolled back rights to sex workers further. Removal of legal barriers through the decriminalisation of sex work, alongside political and funding investments to support community and structural interventions, is urgently needed to reverse the HIV trajectory and ensure health and human rights for all sex workers.

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“…Several South-to-South initiatives are also ongoing to document and share community-led, programmatic lessons learned between lower- or middle-income countries. 70…”

Section: Research Gaps and Agendamentioning

confidence: 99%

The global response and unmet actions for HIV and sex workers

et al. 2018

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“…Interventions targeting male partners of sex workers offer an opportunity to address the risk associated with this sub-population. However, male clients are rarely reached (Fleming et al, 2015;Jackson et al, 2009;Kerrigan et al, 2015;Syvertsen, Robertson, Rolón, et al, 2013) and the stigma associated with sex work and masculinity drives such men underground, with negative consequences for both themselves, their partners and efforts to fast track HIV prevention.…”

Section: Introductionmentioning

confidence: 99%

Relationship dynamics and sexual risk behaviour of male partners of female sex workers in Kampala, Uganda

Mbonye

Siu

Kiwanuka

et al. 2016

African Journal of AIDS Research

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Male regular partners of female sex workers represent an important population to reach with HIV-prevention interventions. In this paper we discuss the relationship dynamics and HIV/STI risk behaviour of men involved with self-identified female sex workers (FSW) in Kampala. Between 2011 and 2014 we conducted repeat in-depth interviews with 42 male partners of FSWs attending a clinic for women at high risk of HIV-infection in Kampala. Men publicly struggled with the stigma of dating women who are considered to be engaged in a shamed profession, but privately saw meaning in these relationships. In coping with the stigma, some described the work of their partners in terms that distanced them from sex work, while others struggled to have the control that `being a man' demanded since they could not monitor all movements of their partners. Dealing with HIV disclosure was hard, and seeking support difficult for some of the men leading to missed opportunities and guilt. Despite challenges, relationships with sex workers offered men some benefits such as access to much needed care and treatment. A few men also admitted to being motivated by material and financial benefits from sex workers who they perceived as being rich and this was one factor that helped them sustain the relationships. These findings offer insights into the complex relationship dynamics within high risk sexual partnerships but the findings suggest that effective interventions that are couple centred can be established to promote better health.

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“…There have been substantial investments into the evaluation of large-scale combination prevention programmes in some low-income countries with generalized epidemics [ 48 – 50 ] as well as developments in the use of implementation and operations research [ 51 ]. However, most investments have not focused on the relationships between the components of a combination prevention system or the ongoing adaptations required because of unpredictable interactions and dynamics.…”

Section: Discussionmentioning

confidence: 99%

Investigating combination HIV prevention: isolated interventions or complex system

Brown

Reeders

Dowsett

et al. 2015

Journal of the International AIDS Society

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IntroductionTreatment as prevention has mobilized new opportunities in preventing HIV transmission and has led to bold new UNAIDS targets in testing, treatment coverage and transmission reduction. These will require not only an increase in investment but also a deeper understanding of the dynamics of combining behavioural, biomedical and structural HIV prevention interventions. High-income countries are making substantial investments in combination HIV prevention, but is this investment leading to a deeper understanding of how to combine interventions? The combining of interventions involves complexity, with many strategies interacting with non-linear and multiplying rather than additive effects.DiscussionDrawing on a recent scoping study of the published research evidence in HIV prevention in high-income countries, this paper argues that there is a gap between the evidence currently available and the evidence needed to guide the achieving of these bold targets. The emphasis of HIV prevention intervention research continues to look at one intervention at a time in isolation from its interactions with other interventions, the community and the socio-political context of their implementation. To understand and evaluate the role of a combination of interventions, we need to understand not only what works, but in what circumstances, what role the parts need to play in their relationship with each other, when the combination needs to adapt and identify emergent effects of any resulting synergies. There is little development of evidence-based indicators on how interventions in combination should achieve that strategic advantage and synergy. This commentary discusses the implications of this ongoing situation for future research and the required investment in partnership. We suggest that systems science approaches, which are being increasingly applied in other areas of public health, could provide an expanded vocabulary and analytic tools for understanding these complex interactions, relationships and emergent effects.ConclusionsRelying on the current linear but disconnected approaches to intervention research and evidence we will miss the potential to achieve and understand system-level synergies. Given the challenges in sustaining public health and HIV prevention investment, meeting the bold UNAIDS targets that have been set is likely to be dependent on achieving systems level synergies.

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Advancing the strategic use of HIV operations research to strengthen local policies and programmes: the Research to Prevention Project

Cited by 7 publications

References 43 publications

The global response and unmet actions for HIV and sex workers

The global response and unmet actions for HIV and sex workers

Relationship dynamics and sexual risk behaviour of male partners of female sex workers in Kampala, Uganda

Investigating combination HIV prevention: isolated interventions or complex system

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