Focusing the HIV response through estimating the major modes of HIV transmission: a multi-country analysis

Gouws, Eleanor; Cuchí, Paloma

doi:10.1136/sextrans-2012-050719

Cited by 100 publications

(82 citation statements)

References 19 publications

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“…It has also been argued that vaccine protection might be easier to achieve in high-risk populations with predominantly heterosexual transmission such as those found in Africa, 108,174 in contrast to MSM populations with rectal transmission, with the highest risk mode of sexual HIV transmission at 1:20-1:300 infections per exposure. 189 This adds to the complexity of the decision as to which HIV vaccine strategy makes best scientific sense for efficacy testing among MSM populations.…”

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

“…127,174 Despite undeniable gaps in HIV prevention and in access to care and treatment of key populations, 14 an overall decrease of HIV prevalence is observed in the region due to effective prevention programs. Furthermore, with treatment programs starting at higher CD4 thresholds, HIV incidence may significantly decrease in all populations.…”

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

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HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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“…HIV transmission amongst MSM contributes between 1 and 8 % of all new HIV infections amongst adults in Eastern and Southern Africa [7]. Data on MSM are limited in some countries due to social marginalisation, stigma and punitive laws.…”

Section: Drivers Of the Epidemic In Ssamentioning

confidence: 99%

“…There are persistent high HIV prevalence rates amongst women aged [15][16][17][18][19][20][21][22][23][24] Modelling studies from Eastern and Southern Africa estimate that between 60 and 95 % of new HIV infections are due to unprotected sex and occur in the heterosexual population [7], with the impact of high prevalence amongst sex workers is increased by inadequate allocation of healthcare resources [8].…”

Section: Drivers Of the Epidemic In Ssamentioning

confidence: 99%

Innovative Strategies for Scale up of Effective Combination HIV Prevention Interventions in Sub-Saharan Africa

Shanaube

Böck

2015

Curr HIV/AIDS Rep

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For the last three decades, sub-Saharan Africa has been the epicentre of the HIV epidemic. Some key drivers of the epidemic are specific to this region and there is an urgent need to develop context-specific strategies to reduce HIV-related burden. Implementation frameworks should endeavour to combine structural, behavioural and biomedical interventions and the future of the HIV response involves embracing different approaches for different populations; it is not 'one-size fits all approach'. Expanded use of community-based interventions will be key in expanding the role of antiretroviral treatment as prevention (TasP) in the region. For TasP to be effective, high antiretroviral therapy (ART) coverage rates need to be attained. Data from programmatic trials currently underway will provide crucial data to guide the future implementation of TasP.

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“…While people fitting these categories have been targeted by public health programs and policies in order to decrease HIV incidence, in Kenya most new HIV infections occur among heterosexual couples in a stable partnership 8 . Committed sero-discordant partnerships either begin as discordant, or become so after the initiation of the relationship -most often through unfaithfulness by one of the partners who returns to the relationship with the virus contracted from a different partner (concurrency) 9 .…”

Section: Introductionmentioning

confidence: 99%

Self-Efficacy Mediates the Association between Partner Trust and Condom Usage among Females but not Males in a Kenyan Cohort of Orphan and Vulnerable Youth

Goodman¹,

Harrell²,

Gitari³

et al. 2016

Afr J Reprod Health

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Continuing gains against incidence of HIV and other unwanted consequences of unprotected sex requires deeper understanding of characteristics of condom usage among sexually active youth. The present study assesses whether partner trust predicts condom usage, and whether potential associations were mediated by general self-efficacy, among a cohort of sexually active adolescents in Meru County, Kenya. We also sought to discover associations between socio-economic status, psychological resilience and partner trust to increase understanding of trust towards one's intercourse partner. Mediation analyses, stratified by gender, reveal that condom usage is predicted by self-efficacy and partner trust among females but not males. Higher psychological resilience predicts lower partner trust among both genders. Partner trust was lower among female respondents who were not literate, but did not significantly vary by literacy among males. Reported previous monthly earnings were not significantly associated with partner trust among males or females. The present findings support further study on partner trust, and its association with protective sex behaviors. Further, interventions targeting condom usage among females may benefit from actions to increase awareness of partner sexual behavior and increasing self-efficacy. RésuméLa poursuite des gains contre l'incidence du VIH et d'autres conséquences non désirés des rapports sexuels non protégés nécessite une meilleure compréhension des caractéristiques de l'utilisation du préservatif chez les jeunes qui sont sexuellement actifs. La présente étude évalue si la confiance des partenaires prévoit l'utilisation du préservatif, et si les associations potentielles ont intervenu par l'auto-efficacité générale, parmi une cohorte d'adolescents sexuellement actifs dans le comté de Meru au Kenya. Nous avons également cherché à découvrir les associations entre la situation socioéconomique, la résilience et la confiance des partenaires pour augmenter la compréhension de confiance envers son partenaire sexuel. Les analyses de médiation, stratifiés selon le sexe, révèlent que l'utilisation du préservatif est prédite par l'auto-efficacité et la confiance des partenaires chez les femmes, mais pas chez les hommes. La résilience psychologique élevée prédit une faible confiance des partenaires chez les deux sexes. La confiance des partenaires était plus faible chez les femmes interrogées qui n'étaient pas alphabétisées, mais n'a pas varié de manière significative par rapport à l'alphabétisation chez les hommes. Les gains mensuels précédents déclarés ne sont pas significativement associés à la confiance des partenaires chez les hommes ou les femmes. Les présents résultats confirment une étude plus approfondie sur la confiance des partenaires, et son association avec les comportements sexuels de protection. En outre, les interventions ciblant l'utilisation du préservatif chez les femmes peuvent bénéficier de mesures visant à accroître la sensibilisation du comportement sexuel du partenaire ...

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Focusing the HIV response through estimating the major modes of HIV transmission: a multi-country analysis

Cited by 100 publications

References 19 publications

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Innovative Strategies for Scale up of Effective Combination HIV Prevention Interventions in Sub-Saharan Africa

Self-Efficacy Mediates the Association between Partner Trust and Condom Usage among Females but not Males in a Kenyan Cohort of Orphan and Vulnerable Youth

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