HIV in men who have sex with men in sub-Saharan Africa

Sabin, Miriam Lewis; Lazarus, Jeffrey V.; Frescura, Luisa; Gill, Wayne; Mahy, Mary

doi:10.1016/s1473-3099(12)70150-0

Cited by 6 publications

(5 citation statements)

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“…The growing body of literature characterizing the epidemiology of HIV among MSM in Africa consistently reports a high prevalence of HIV in addition to an increased risk of HIV transmission [3,4]. An understudied population which is often considered to be nested within the greater MSM population are MSW, who have been identified to be at even greater risk of HIV infection compared to the general MSM population [28,29].…”

Section: Resultsmentioning

confidence: 99%

“…Despite extraordinary progress in HIV treatment coverage and in expanding access to HIV prevention services, the epidemics of West, Central, East and Southern Africa continue in 2020, with incidence rates too high to achieve epidemic control in many countries and populations [1]. Across Africa, prevalence burdens and incidence rates remain highest among “key populations” including women and men who sell or trade sex, men who have sex with men (MSM), people who inject drugs (PWID), transgender women who have sex with men and prisoners and detainees [1‐10]. These groups, often clustered together as key populations, account for the large majority of new infections in West, North and Central Africa, and an estimated 25% of new infections in East and Southern Africa, despite representing relatively small proportions of those overall populations [1].…”

Section: Introductionmentioning

confidence: 99%

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Overview of the epidemiological conditions of HIV among key populations in Africa

Jin¹,

Restar²,

Beyrer³

2021

J Int AIDS Soc

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Introduction Despite extraordinary progress in HIV treatment coverage and expanding access to HIV prevention services and that multiple African countries are on track in their efforts to reach 90‐90‐90 goals, the epidemic continues to persist, with prevalence and incidence rates too high in some parts of the continent to achieve epidemic control. While data sources are improving, and research studies on key populations in specific contexts have improved, work on understanding the HIV burdens and barriers to services for these populations remains sparse, uneven and absent altogether in multiple settings. More data have become available in the last several years, and data published in 2010 or more recently are reviewed here for each key population. This scoping review assesses the current epidemiology of HIV among key populations in Africa and the social and political environments that contribute to the epidemic, both of which suggest that without significant policy reform, these epidemics will likely continue. Results and discussion Across Africa, the HIV epidemic is most severe among key populations including women and men who sell or trade sex, men who have sex with men, people who inject drugs, transgender women who have sex with men and prisoners and detainees. These groups account for the majority of new infections in West and Central Africa, and an estimated 25% of new infections in East and Southern Africa, despite representing relatively small proportions of those populations. The HIV literature in Africa emphasizes that despite significant health needs, key populations experience barriers to accessing services within the healthcare and legal justice systems. Current shortcomings of surveillance systems in enumerating key populations impact the way funding mechanisms and resources are allocated and distributed. Adapting more equitable and epidemiologically sound frameworks will be necessary for current and future HIV programming investments. Conclusions Through this review, the available literature on HIV epidemiology among key populations in Africa brings to light a number of surveillance, programmatic and research gaps. For many communities, interventions targeting the health and security conditions continue to be minimal. Compelling evidence suggests that sweeping policy and programmatic changes are needed to effectively tackle the persistent HIV epidemic in Africa.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Overview of the epidemiological conditions of HIV among key populations in Africa

Jin¹,

Restar²,

Beyrer³

2021

J Int AIDS Soc

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“…Improving the working conditions of FSW and engaging them in healthcare [ 63 – 65 ] is paramount for controlling the epidemic in the region in the short and long term [ 66 , 67 ]. Similarly, MSM contributed disproportionately to the proportion of infections acquired and transmitted and should be a priority for national HIV programmes in the region [ 68 – 70 ]. Contextual information on risks and interventions among this population is becoming available, providing valuable guidance for programme design and implementation [ 71 – 76 ].…”

Section: Discussionmentioning

confidence: 99%

The Incidence Patterns Model to Estimate the Distribution of New HIV Infections in Sub-Saharan Africa: Development and Validation of a Mathematical Model

et al. 2016

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BackgroundProgrammatic planning in HIV requires estimates of the distribution of new HIV infections according to identifiable characteristics of individuals. In sub-Saharan Africa, robust routine data sources and historical epidemiological observations are available to inform and validate such estimates.Methods and FindingsWe developed a predictive model, the Incidence Patterns Model (IPM), representing populations according to factors that have been demonstrated to be strongly associated with HIV acquisition risk: gender, marital/sexual activity status, geographic location, “key populations” based on risk behaviours (sex work, injecting drug use, and male-to-male sex), HIV and ART status within married or cohabiting unions, and circumcision status. The IPM estimates the distribution of new infections acquired by group based on these factors within a Bayesian framework accounting for regional prior information on demographic and epidemiological characteristics from trials or observational studies. We validated and trained the model against direct observations of HIV incidence by group in seven rounds of cohort data from four studies (“sites”) conducted in Manicaland, Zimbabwe; Rakai, Uganda; Karonga, Malawi; and Kisesa, Tanzania. The IPM performed well, with the projections’ credible intervals for the proportion of new infections per group overlapping the data’s confidence intervals for all groups in all rounds of data. In terms of geographical distribution, the projections’ credible intervals overlapped the confidence intervals for four out of seven rounds, which were used as proxies for administrative divisions in a country. We assessed model performance after internal training (within one site) and external training (between sites) by comparing mean posterior log-likelihoods and used the best model to estimate the distribution of HIV incidence in six countries (Gabon, Kenya, Malawi, Rwanda, Swaziland, and Zambia) in the region. We subsequently inferred the potential contribution of each group to transmission using a simple model that builds on the results from the IPM and makes further assumptions about sexual mixing patterns and transmission rates. In all countries except Swaziland, individuals in unions were the single group contributing to the largest proportion of new infections acquired (39%–77%), followed by never married women and men. Female sex workers accounted for a large proportion of new infections (5%–16%) compared to their population size. Individuals in unions were also the single largest contributor to the proportion of infections transmitted (35%–62%), followed by key populations and previously married men and women. Swaziland exhibited different incidence patterns, with never married men and women accounting for over 65% of new infections acquired and also contributing to a large proportion of infections transmitted (up to 56%). Between- and within-country variations indicated different incidence patterns in specific settings.ConclusionsIt is possible to reliably predict the distribution of ...

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“…In many African countries where data are available, MSM HIV prevalence is similar to or higher than the PWID population 4. Due to the lack of research and low levels of advocacy for African MSM populations, the need for MSM-oriented interventions and calls for improved country-level HIV surveillance have recently been highlighted as important research priorities 5–7…”

Section: Introductionmentioning

confidence: 99%