The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study

Abstract

Introduction Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under‐represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. Methods Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. Results Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co‐infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one‐third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. Conclusions This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high‐impact interventions may include venue‐based, peer navigator‐led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.

Prevalence ofNeisseria gonorrhoeaeandChlamydia trachomatisin men having sex with men in Port-au-Prince, Haiti: a cross-sectional study

“…Although STIs were more prevalent in participants who reported inconsistent use of condom and lubricant, the differences were not statistically significant as also reported by others 35. Access to lubricant and other STI prevention services are lacking among MSM in Haiti which might explain the inconsistent use of lubricant 8…”

“…The Haitian Ministry of Health and Population (French acronym MSPP) reported a HIV prevalence of 12.9% among MSM in 2014 4 7. The recent results from the 2016 Priorities for Local AIDS Control Efforts study showed lower estimates of HIV prevalence of 2.2% (95% CI: 0.9% to 5.3%) among MSM 8. This discrepancy in estimates of HIV burden among MSM in Haiti in two different reports, 2 years apart, is a result of the difficulty to reach the MSM populations.…”

Biocultural approaches to transgender and gender diverse experience and health: Integrating biomarkers and advancing gender/sex research

“…MICBS are widely used in HIV-related research and more recently are being utilized in studies with TGD people (e.g., Madera et al, 2017). Specific MICBS include: DBS to assess systematic inflammation (Morgan, Taylor, Ryan, D'Aquila, & Mustanski, 2019), both DBS and saliva to access HIV incidence, prevalence and treatment efficacy (Flores, Brown, León, Sánchez, & Galea, 2018;Zalla, Herce, Edwards, Michel, & Weir, 2019), and finally DBS and hair samples to assess pre-exposure prophylaxis (PrEP) uptake and adherence (Gandhi et al, 2015(Gandhi et al, , 2017Marins et al, 2019). A number of studies have also established the feasibility of rapid HIV testing with TGD people with increased attention being paid to measuring the efficacy of PrEP (Grinsztejn et al, 2018).…”

Epidemiological profile and molecular genetic characterization of HIV-1 among female sex workers and elderly male clients in Guangxi, China

“…Many studies concerning the role of commercial sex intercourse in the HIV-1 epidemic have been based on classic epidemiological methods [12,13]. However, most of them lack direct genetic evidence of transmission linkages between FSWs and their clients or the influence of transmission relationships on the HIV-1 epidemic.…”