Male partners of female sex workers: The intersectional risk environment of HIV/AIDS in a Kampala informal settlement

Schmidt‐Sane, Megan

doi:10.1016/j.socscimed.2022.114873

Cited by 4 publications

(3 citation statements)

References 44 publications

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“…Health and clinical services are also integrated with efforts to reduce structural vulnerabilities, including experiences of harassment, violence, and fear of seeking healthcare, through community empowerment, psycho-social and legal supports, and sensitization and training for police and healthcare workers [26]. These programs have been designed and refined with ongoing community leadership and engagement, allowing them to better meet the specific needs of key populations, for whom barriers to engagement in HIV care often intersect with drivers of HIV risk, including economic insecurity, mobility, stigma, discrimination, and criminalization [4,[8][9][10][11]29]. Our data-informed modeling of cascade scale-up in Eswatini confirms that such an equity-focused approach to ART cascade scale-up can maximize prevention impacts, and accelerate overall reductions in HIV incidence.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, available data suggest that cascade attainment is often lower among subpopulations at greater risk of HIV acquisition and/or transmission, including key populations, younger men and women, and highly mobile populations [5,7]. These inequalities can be driven by systemic barriers to engagement in care faced by marginalized populations, which intersect with individual, network, and structural determinants of HIV risk, such as economic insecurity, mobility, stigma, discrimination, and criminalization [8][9][10][11]. Moreover, cascade data may be lacking entirely for subpopulations experiencing the greatest barriers to care -i.e., the lowest ART cascades likely remain unmeasured [7].…”

Section: Introductionmentioning

confidence: 99%

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Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini

Knight,

Ma,

Sithole

et al. 2024

Preprint

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Background. Inequalities in the antiretroviral therapy (ART) cascade across subpopulations remain an ongoing challenge in the global HIV response. Eswatini achieved the UNAIDS 95-95-95 targets by 2020, with differentiated programs to minimize inequalities across subpopulations, including for female sex workers (FSW) and their clients. We sought to estimate additional HIV infections expected in Eswatini if cascade scale-up had not been equal, and under which epidemic conditions these inequalities could have the largest influence. Methods. Drawing on population-level and FSW-specific surveys in Eswatini, we developed a compartmental model of heterosexual HIV transmission which included eight subpopulations and four sexual partnership types. We calibrated the model to stratified HIV prevalence, incidence, and ART cascade data. Taking observed cascade scale-up in Eswatini as the base-case - reaching 95-95-95 in the overall population by 2020 - we defined four counterfactual scenarios in which the population overall reached 80-80-90 by 2020, but where FSW, clients, both, or neither were disproportionately left behind, reaching only 60-40-80. We quantified relative additional cumulative HIV infections by 2030 in counterfactual base-case scenarios. We further estimated linear effects of viral suppression gap among FSW and clients on additional infections by 2030, plus effect modification by FSW/client population sizes, rates of turnover, and HIV prevalence ratios. Findings. Compared with the base-case scenario, leaving behind neither FSW and nor their clients led to the fewest additional infections by 2030: median (95% credible interval) 13.3 (9.2, 18.7)% vs 26.7 (19.7, 33.8)% if both were left behind - a 104 (50, 167)% increase. The effect of lower cascade on additional infections was larger for clients FSW, and client population size, turnover, and prevalence ratios were the largest modifiers of both effects. Interpretation. Inequalities in the ART cascade across subpopulations can undermine the anticipated prevention impacts of cascade scale-up. As Eswatini has shown, addressing inequalities in the ART cascade, particularly those that intersect with high transmission risk, could maximize incidence reductions from cascade scale-up. Funding. Natural Sciences and Engineering Research Council of Canada; Ontario Ministry of Colleges and Universities; Canadian Institutes of Health Research; National Institute of Allergy and Infectious Diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini

Knight,

Ma,

Sithole

et al. 2024

Preprint

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“…Bars are often social and economic cornerstones of urban communities, particularly in informal settlements. 35 Bars are spaces where people gather, gain information about current events, and sometimes sleep overnight. Greater Kampala has very high rates of alcohol use, 36 and in its informal SSHAP contact -Olivia Tulloch oliviatulloch@anthrologica.com www.socialscienceinaction.org 8…”

Section: Bars and Bar Workersmentioning

confidence: 99%

Key Considerations for RCCE in the 2022 Ebola Outbreak Response in Greater Kampala, Uganda

Kaawa-Mafigiri¹,

Schmidt‐Sane²,

Hrynick³

2022

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On 20 September 2022, an outbreak of the Sudan strain of Ebola Virus Disease – SVD – was announced as the first laboratory-confirmed patient was identified in a village in Mubende District in central Uganda. Uganda’s Ministry of Health (MoH) activated the National Task Force and developed and deployed a National Response Plan, which includes the activation of District Task Forces. The target areas include the epicentre (Mubende and Kassanda districts) and surrounding areas, as well as Masaka, Jinja and Kampala cities. This is of great concern, as Kampala is the capital city with a high population and linkages to neighbouring districts and international locations (via Entebbe Airport). It is also a serious matter given that there has been no outbreak of Ebola before in the city. This brief details how Risk Communication and Community Engagement (RCCE) activities and approaches can be adapted to reach people living in Greater Kampala to increase adoption of preventive behaviours and practices, early recognition of symptoms, care seeking and case reporting. The intended audiences include the National Task Force and District Task Forces in Kampala, Mukono, and Wakiso Districts, and other city-level RCCE practitioners and responders. The insights in this brief were collected from emergent on-the-ground observations from the current outbreak by embedded researchers, consultations with stakeholders, and a rapid review of relevant published and grey literature. This brief, requested by UNICEF Uganda, draws from the authors’ experience conducting social science research on Ebola preparedness and response in Uganda. It was written by David Kaawa-Mafigiri (Makerere University), Megan Schmidt-Sane (Institute of Development Studies (IDS)), and Tabitha Hrynick (IDS), with contributions from the MoH, UNICEF, the Center for Health, Human Rights and Development (CEHURD), the Uganda Harm Reduction Network (UHRN), Population Council and CLEAR Global/Translators without Borders. It includes some material from a SSHAP brief developed by Anthrologica and the London School of Economics. It was reviewed by the Uganda MoH, University of Waterloo, Anthrologica, IDS and the RCCE Collective Service. This brief is the responsibility of SSHAP.

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Navigating Stigma in Romantic Relationships Where One or Both Partners Sell Sexual Services

Benoit,

Koenig,

Mellor

et al. 2024

The Journal of Sex Research

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Male partners of female sex workers: The intersectional risk environment of HIV/AIDS in a Kampala informal settlement

Cited by 4 publications

References 44 publications

Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini

Quantifying the impact of cascade inequalities: a modelling study on the prevention impacts of antiretroviral therapy scale-up in Eswatini

Key Considerations for RCCE in the 2022 Ebola Outbreak Response in Greater Kampala, Uganda

Navigating Stigma in Romantic Relationships Where One or Both Partners Sell Sexual Services

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