HIV epidemic among key populations in west Africa

Djomand, Gaston; Quaye, Silas; Sullivan, Patrick S.

doi:10.1097/coh.0000000000000090

Cited by 91 publications

(82 citation statements)

References 50 publications

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“…Our results show how the contribution of different risk groups to HIV acquisition and transmission has evolved over time in Côte d'Ivoire, mirroring the maturation of the HIV epidemic and past interventions. As for other epidemics driven by unprotected sex work 56,57 , commercial sex contributed markedly to HIV transmission early in the HIV epidemic. This contribution diminished with time, however, partly due to rising condom use by FSW, reflecting the importance of sustaining FSW interventions 50,58,59 .…”

Section: Discussionmentioning

confidence: 98%

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Maheu‐Giroux

Vesga

Diabaté

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction Understanding the impact of past interventions and how it affected transmission dynamics is key to guiding prevention efforts. We estimated the population-level impact of condom, antiretroviral therapy (ART), and prevention of mother-to-child transmission activities on HIV transmission and the contribution of key risk factors on HIV acquisition and transmission. Methods An age stratified dynamical model of sexual and vertical HIV transmission among the general population, female sex workers (FSW), and men who have sex with men (MSM) was calibrated to detailed prevalence and intervention data. We estimated the fraction of HIV infections averted by the interventions, and the fraction of incident infections acquired and transmitted by different populations over successive 10-year periods (1976-2015). Results Overall, condom use averted 61% (95% Credible Intervals: 56-66%) of all adult infections during 1987-2015 mainly due to increases by FSW (46% of infections averted). In comparison, ART prevented 15% (10-19%) of adult infections during 2010-2015. As a result, FSW initially (1976-1985) contributed 95% (91-97%) of all new infections, declining to 19% (11-27%) during 2005-2015. Older men and clients mixing with non-FSW are currently the highest contributor to transmission. MSM contributed ≤4% of transmission throughout. Young women (15-24 years; excluding FSW) did not transmit more infection than they acquired. Conclusion Early increases in condom use, mainly by FSW, have substantially reduced HIV transmission. Clients of FSW and older men have become the main source of transmission whereas young women remain at increased risk. Strengthening prevention and scaling-up of ART, particularly to FSW and CFSW, is important.

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Section: Discussionmentioning

confidence: 98%

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Maheu‐Giroux

Vesga

Diabaté

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…MSM face high levels of stigma as a result of their sexual practices, including verbal, physical, and psychological abuse (5). High levels of sexual behavior stigma may act as a barrier to HIV testing and care for MSM, and this is particularly problematic in countries with concentrated key population epidemics where anti-gay legislation erects further barriers (6–10). In some parts of Nigeria, homosexual activity between men is punishable by death (11).…”

Section: Introductionmentioning

confidence: 99%

Online Sex-Seeking Among Men who have Sex with Men in Nigeria: Implications for Online Intervention

et al. 2016

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The TRUST/RV368 project was undertaken to apply innovative strategies to engage Nigerian MSM into HIV care. In this analysis we evaluate characteristics of online sex-seekers from the TRUST/RV368 cohort of 1,370 MSM in Abuja and Lagos. Logistic regression and generalized estimating equation models were used to assess associations with online sex-seeking. Online sex-seeking (n=843, 61.5%) was associated with participation in MSM community activities, larger social and sexual networks, and higher levels of sexual behavior stigma. In addition, online sex-seeking was associated with testing positive for HIV at a follow-up visit (Adjusted Odds Ratio [aOR]=2.02, 95% Confidence Interval [CI]=1.37, 2.98) among those who were unaware of or not living with HIV at baseline. Across visits, online sex-seekers were marginally more likely to test positive for chlamydia/gonorrhea (aOR=1.28, 95% CI=0.99, 1.64). Online sex-seekers in Nigeria are at increased risk for HIV/STIs but may not be benefiting from Internet-based risk reduction opportunities.

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“…Hardest hit by the HIV/AIDS pandemic is sub-Saharan Africa where the disease continues to devastate communities, thereby rolling back decades of economic development [2, 3]. Nigeria, the most populous country in this region has an estimated 3.2 million people living with HIV disease, (national HIV prevalence of 3.4%), and carries the second highest burden of HIV/AIDS in the world [1].…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Selected Populations for HIV-1 Vaccine Cohort Development in Nigeria

et al. 2016

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Development of a globally effective HIV-1 vaccine will need to encompass Nigeria, one of the hardest hit areas, with an estimated 3.2 million people living with HIV. This cross-sectional Institutional Review Board (IRB) approved study was conducted in 2009–12 at four market sites and two highway settlements sites in Nigeria to identify and characterize populations at high risk for HIV; engage support of local stakeholders; and assess the level of interest in future vaccine studies. Demographic, HIV risk data were collected by structured interviewer-administered questionnaires. Blood samples were tested on site by HIV rapid diagnostic tests, followed by rigorous confirmatory testing, subtype evaluation and testing for HBV and HCV markers in a clinical reference laboratory. Of 3229 study participants, 326 were HIV infected as confirmed by Western Blot or RNA, with a HIV prevalence of 15.4%-23.9% at highway settlements and 3.1%-9.1% at market sites. There was no observable correlation of prevalence of HIV-1 (10.1%) with HBV (10.9%) or HCV (2.9%). Major HIV-1 subtypes included CRF02_AG (37.5%); G (27.5%); G/CRF02_AG (25.9%); and non-typeable (8.9%), with 0.3% HIV-2. Univariate analysis found age, gender, marital status, level of education, and sex under substance influence as significant risk factors for HIV (p<0.001). Educating and winning the trust of local community leadership ensured high level of participation (53.3–77.9%) and willingness to participate in future studies (95%). The high HIV prevalence and high risk of HIV infection at highway settlement and mammy markets make them well suited for targeting future vaccine trials in Nigeria.

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HIV epidemic among key populations in west Africa

Cited by 91 publications

References 50 publications

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Changing Dynamics of HIV Transmission in Côte d'Ivoire: Modeling Who Acquired and Transmitted Infections and Estimating the Impact of Past HIV Interventions (1976–2015)

Online Sex-Seeking Among Men who have Sex with Men in Nigeria: Implications for Online Intervention

An Evaluation of Selected Populations for HIV-1 Vaccine Cohort Development in Nigeria

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