Is contact between men who have sex with men and non‐governmental organizations providing harm reduction associated with improved HIV outcomes?

Abstract

Objectives There is a high prevalence of HIV (5.2% in 2018) among men who have sex with men (MSM) in Ukraine. HIV testing, condom provision and facilitated linkage to HIV treatment have been funded by various bodies through non‐governmental organizations (NGOs). We investigated whether contact with these NGOs was associated with improved prevention and treatment outcomes among MSM in Ukraine. Methods Data were taken from four rounds of integrated bio‐behavioural surveys among MSM in Ukraine (2011, N = 5950; 2013, N = 8101; 2015, N = 4550; 2018, N = 5971) including HIV testing combined with questionnaire responses. Data were analysed using mixed‐effect regression models, which estimated associations between being an NGO client and behavioural, HIV testing and HIV treatment outcomes, adjusted for demographic factors. Results Those MSM who were NGO clients were more likely than non‐clients to have been HIV tested in the last year [adjusted odds ratio (aOR) = 7.01, 95% confidence interval (CI): 6.45–7.62] or ever (aOR = 11.00, 95% CI: 9.77–12.38), to have used a condom for the last anal sex act (aOR = 1.32, 95% CI: 1.21–1.43), and to have recently either bought or received condoms (aOR = 21.27, 95% CI: 18.01–25.12). HIV‐positive MSM were more likely to have contact with NGOs (aOR = 1.61, 95% CI: 1.39–1.86). Among the HIV‐positive MSM, those who were NGO clients were more likely to be registered at an AIDS centre (aOR = 2.24, 95% CI: 1.61–3.11) and to be on antiretroviral treatment (aOR = 2.20, 95% CI: 1.51–3.20). Conclusions In Ukraine, being in contact with MSM‐targeted NGOs is associated with better outcomes for HIV prevention, testing and treatment, suggesting that NGO harm reduction projects for MSM have had a beneficial impact on reducing HIV transmission and morbidity.

Impact and cost-effectiveness of non-governmental organizations on the HIV epidemic in Ukraine among MSM

“…There has been limited research on Ukraine’s HIV epidemic among MSM. Our previous study used in this analysis found that NGOs were associated with beneficial outcomes among MSM( 10 ), agreeing with other research( 35 ). An MSM modelling study in Poland found that immediate initiation of HIV treatment was cost-saving from the public perspective( 36 ).…”

“…MSM become clients of NGOs at time-varying rates from 2003 and cease contact with NGOs at a constant rate. HIV-positive MSM become NGO clients at a higher rate due to NGO efforts to link HIV-positive MSM to care; our previous analyses show a higher proportion of NGO clients are HIV-positive than for non-NGO clients( 10 ).…”

“…In our previous analyses of the MSM IBBS data, being an NGO client was associated with( 10 ): Increased condom usage during their last anal intercourse (Odds ratio [OR] 1.32; 95% confidence interval: 1.21-1.43), Increased HIV testing in last year (OR 7.01; 6.45-7.62), Increased coverage of ART (OR 2.20; 1.51-3.30). …”

“…Condom use can reduce the transmission of HIV among MSM( 6 , 7 ), while ART renders HIV untransmissible if people’s viral loads are undetectable( 8 , 9 ). In our previous epidemiological analyses utilising four national integrated bio-behavioural surveys (IBBS) among MSM in Ukraine, we found that being in contact with MSM-targeted NGOs was associated with increased condom use and HIV testing, and greater likelihood of being on ART( 10 ).…”

“…Although the recent invasion by Russia has radically changed Ukraine’s priorities, it is still important to show the benefit of these interventions to emphasise that services should still provide for the needs of this sub-population, and to show the potential implications of not doing so. To this end, we utilise findings from our previous epidemiological analyses( 10 ) within a mathematical modelling framework to evaluate the impact and cost-effectiveness of MSM-targeted NGO activities on the Ukrainian HIV epidemic among MSM.…”