HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub‐Saharan Africa: a systematic review and meta‐analysis

Kloek, Mariëlle; Bulstra, Caroline A.; Noord, Laura van; Al-Hassany, Lina; Cowan, Frances M; Hontelez, Jan A. C.

doi:10.1002/jia2.26022

Cited by 10 publications

(10 citation statements)

References 76 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stigma and discrimination remain important barriers to health equity. In sub-Saharan Africa, for example, HIV prevalence among MSM and transgender women is significantly higher than it is in the general population ( 18 ). Understanding the root causes including structural determinants of health for the observed differences and addressing potential factors leading to health disparities is essential to eliminate HIV as a global public health threat.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022

Chun¹,

Dirlikov²,

Cox³

et al. 2023

MMWR Morb. Mortal. Wkly. Rep.

View full text Add to dashboard Cite

Introduction In 2004, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), with CDC as a major U.S. government implementing agency, began providing HIV antiretroviral therapy (ART) worldwide. Through suppression of HIV viral load, effective ART reduces morbidity and mortality among persons with HIV infection and prevents vertical and sexual transmission. Methods To describe program impact, data were analyzed from all PEPFAR programs and from six countries that have conducted nationally representative Population-based HIV Impact Assessment (PHIA) surveys, including PEPFAR programmatic data on the number of persons with HIV infection receiving PEPFAR-supported ART (2004–2022), rates of viral load coverage (the proportion of eligible persons with HIV infection who received a viral load test) and viral load suppression (proportion of persons who received a viral load test with <1,000 HIV copies per mL of blood) (2015–2022), and population viral load suppression rates in six countries that had two PHIA surveys conducted during 2015–2021. To assess health system strengthening, data on workforce and laboratory systems were analyzed. Results By September 2022, approximately 20 million persons with HIV infection in 54 countries were receiving PEPFAR-supported ART (62% CDC-supported); this number increased 300-fold from the 66,550 reported in September 2004. During 2015–2022, viral load coverage more than tripled, from 24% to 80%, and viral load suppression increased from 80% to 95%. Despite increases in viral load suppression rates and health system strengthening investments, variability exists in viral load coverage among some subpopulations (children aged <10 years, males, pregnant women, men who have sex with men [MSM], persons in prisons and other closed settings [persons in prisons], and transgender persons) and in viral load suppression among other subpopulations (pregnant and breastfeeding women, persons in prisons, and persons aged <20 years). Conclusions and implications for public health practice Since 2004, PEPFAR has scaled up effective ART to approximately 20 million persons with HIV infection in 54 countries. To eliminate HIV as a global public health threat, achievements must be sustained and expanded to reach all subpopulations. CDC and PEPFAR remain committed to tackling HIV while strengthening public health systems and global health security.

show abstract

Section: Discussionmentioning

confidence: 99%

Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022

Chun¹,

Dirlikov²,

Cox³

et al. 2023

MMWR Morb. Mortal. Wkly. Rep.

View full text Add to dashboard Cite

show abstract

“…Systematic reviews and meta-analyses of population size, HIV prevalence, or antiretroviral treatment (ART) coverage encompassing sub-Saharan Africa (SSA) have 9 been conducted for FSW, 10,11 MSM, 12,13 PWID, 14,15 and TGW. 16,17 Several independent initiatives have been undertaken to consolidate key population surveillance data. [18][19][20][21] These efforts aim to monitor the state of the epidemic, evaluate programmes, and make recommendations on key population data reporting and quality thresholds.…”

Section: Introductionmentioning

confidence: 99%

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Stevens

Sabin

Garcia

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: HIV programmes in sub-Saharan Africa (SSA) require information about HIV among key populations to ensure equitable and equal access to HIV prevention and treatment. Surveillance has been conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender populations, but is not systematically included in national HIV estimates. We consolidated existing KP surveys to create national-level estimates of key population size, HIV prevalence, and ART coverage for mainland SSA. Methods: Key population size estimates (KPSE), HIV prevalence, and ART coverage data from 38 countries from 2010-2021 were collated from existing databases, deduplicated, and verified against primary sources. We used Bayesian mixed-effects regression to spatially smooth KPSE, and regressed subnational key population HIV prevalence and ART coverage against age/sex/year/province-matched total population estimates. Findings: We extracted 1449 unique KPSE datapoints, 1181 HIV prevalence datapoints, and 242 ART coverage datapoints. Countries had data for a median of five of the twelve population/outcome stratifications. Across countries, a median of 1.44% of urban women were FSW (interquartile range [IQR] 0.83-1.89%); 0.60% of urban men were MSM; and 0.16% of urban adults injected drugs (IQR 0.14-0.24%). HIV prevalence in all key populations was higher than matched total population prevalence. ART coverage was correlated with, but lower than, total population ART coverage. Across SSA, key populations were estimated as 1.1% (95%CI 0.7-1.9%) of the population but 5.1% (95%CI 3.2-10.3%) of all PLHIV aged 15-49 years. Interpretation: Key populations in sub-Saharan experience disproportionate HIV burden and somewhat lower ART coverage, underscoring need for focused prevention and treatment services. However, large heterogeneity and incomplete data availability limit precise estimates for programming and monitoring trends. Future efforts should focus on integrating and strengthening key population surveys and routine data within national HIV strategic information systems.

show abstract

“…Sexual minorities include individuals who are attracted to or have sexual contact with people of the same gender and gender minorities include individuals whose gender identity or expression is different from their sex assigned at birth 5. In Western and Central Africa, the HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) is 11 times and 8 times that of the general adult population, respectively 6. In Eastern and Southern Africa, the prevalence among both MSM and TGW is 2 times the general adult prevalence 6.…”

Section: Introductionmentioning

confidence: 99%

“…5 In Western and Central Africa, the HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) is 11 times and 8 times that of the general adult population, respectively. 6 In Eastern and Southern Africa, the prevalence among both MSM and TGW is 2 times the general adult prevalence. 6 These statistics highlight the importance of understanding and addressing the vulnerability to HIV-related morbidity and mortality SGM in SSA face.…”

Section: Introductionmentioning

confidence: 99%

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

Dada,

Abu-Ba’are,

Turner

et al. 2024

BMJ Open

View full text Add to dashboard Cite

ObjectivesSexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations.DesignScoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.Data sourcesPublic health and regional databases were searched in 2020 and 2022.Eligibility criteriaArticles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA.Data extraction and synthesisArticles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed.ResultsOf 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors.ConclusionIntersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.

show abstract

HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub‐Saharan Africa: a systematic review and meta‐analysis

Cited by 10 publications

References 76 publications

Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022

Vital Signs: Progress Toward Eliminating HIV as a Global Public Health Threat Through Scale-Up of Antiretroviral Therapy and Health System Strengthening Supported by the U.S. President’s Emergency Plan for AIDS Relief — Worldwide, 2004–2022

Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data 2010-2023

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

Contact Info

Product

Resources

About