Potential Impact of Integrated Stigma Mitigation Interventions in Improving HIV/AIDS Service Delivery and Uptake for Key Populations in Senegal

Abstract

Background:Men who have sex with men (MSM) and female sex workers (FSW) are consistently shown to have a higher burden of HIV compared with other adults in Senegal. This study, HIV Prevention 2.0, evaluates the impact of the 3-tiered integrated stigma mitigation interventions (ISMIs) approach to optimizing HIV service delivery for key populations in Senegal.Methods:Baseline assessment includes a questionnaire and biological testing for HIV. A proportion of participants enrolled into a 24-month longitudinal cohort with questionnaires and biological testing every 3 months. In these preliminary analyses, ISMIs are evaluated from participants in the cohort through uptake of HIV services and implementation outcomes.Results:Overall, 724 MSM and 758 FSW participated in the baseline assessment. HIV prevalence is 30.2% (n = 219/724) among MSM and 5.3% (n = 40/758) among FSW. Fear of seeking health services among MSM is 17.7% (n = 128/724) at baseline, 10.5% (n = 18/172) at month 3, and 9.8% (n = 10/102) at month 6 (P < 0.004); and among FSW is 21.9% (n = 166/758) at baseline, 8.1% (n = 15/185) at month 3, and 10.7% (n = 18/168) at month 6 (P < 0.001). Overall, 63.9% (n = 62/97) of MSM and 82.5% (n = 118/143) of FSW agreed that the intervention is effective in addressing stigma; however, loss to follow-up was 41.1% among MSM and 10% among FSW.Conclusion:Baseline data reinforce the need for stigma mitigation interventions, combined with enhanced linkage and retention to optimize HIV treatment. Preliminary results show high levels of HIV-related risk determinants and suggest the potential utility of the ISMI to decrease perceived stigma relating to engagement in HIV prevention, treatment, and care services among key populations in Senegal.

Estimating the contribution of key populations towards the spread ofHIVin Dakar, Senegal

“…Such interventions, on their own and in combination with ART scale‐up have been shown to be effective , cost‐effective and feasible among MSM, and so their expansion should not be delayed. As same‐sex practices remain criminalized in Senegal, and MSM face discrimination , it is also important that effective stigma mitigation interventions are combined with these interventions to ensure their effectiveness .…”

“…Such interventions, on their own and in combination with ART scale-up have been shown to be effective [46,[50][51][52][53], cost-effective [54,55] and feasible among MSM, and so their expansion should not be delayed. As same-sex practices remain criminalized in Senegal, and MSM face discrimination [56], it is also important that effective stigma mitigation interventions are combined with these interventions to ensure their effectiveness [25]. Our findings suggest little impact is achieved from reducing risk or increasing ART coverage among other population subgroups, including FSW, further emphasizing the need to focus new interventions on MSM.…”

“…Senegal has a low HIV prevalence among adults (0.4% in 2016) [19], thought to be due to a comprehensive response to the epidemic [20]. Nevertheless, the HIV burden among KP is much higher (5.9% in FSW and 29.7% in MSM in 2016) [21][22][23][24][25][26][27]. Despite the low prevalence of HIV in the adult population and high prevalence among KP, current estimates suggest that commercial sex and sex between men contribute little (<15%) to existing HIV transmission in Senegal [3,8], although these estimations were limited as they did not incorporate the dynamic aspect of transmission.…”

Consistent Condom Use Among Men Who Have Sex With Men in Lomé and Kara, Togo

“…[1][2][3] Even across concentrated and generalized HIV epidemics in West African countries, *2 in 10 MSM in Burkina Faso, 1 in 10 MSM in The Gambia, and 1 in 4 MSM in Benin and Senegal are living with HIV. [4][5][6][7][8] In the more generalized HIV epidemics in the same region, where HIV consistently exceeds 1% among pregnant women, 9 the relative increase in the burden of HIV among MSM compared with other populations is more pronounced, such is the case of Cote d'Ivoire, which has reported up to 16 times higher HIV prevalence among MSM compared with the broader population. 2,[10][11][12][13][14] MSM have been defined as MSM, regardless of whether or not they also have sex with woman or have a personal or social gay or bisexual identity.…”

Health Communication and the HIV Continuum of Care

“…Lyons et al 11 described “ The potential impact of integrated stigma mitigation interventions in improving HIV/AIDS service delivery and uptake for key populations in Senegal .” Men who have sex with men (MSM) and female sex workers (FSW) in Senegal were the target populations for the HIV Prevention 2.0 study that assessed the impact of an integrated stigma mitigation intervention to optimize HIV service delivery in Senegal. Over 24 months, 758 FSW and 724 MSM participated in the baseline assessment.…”