BACKGROUND Identifying cohorts of Caribbean women with HIV infection rates sufficient for inclusion in HIV vaccine efficacy trials has been challenging. HVTN 907 determined the feasibility of identifying and retaining a cohort of women at high risk for HIV acquisition by focusing recruitment on female sex workers (FSWs). METHODS HIV uninfected FSWs, residing in Haiti, Dominican Republic, and Puerto Rico, who reported unprotected sex and met previously described more stringent site-specific eligibility criteria, were eligible. Behavioral risk assessment, HIV counseling and testing, and pregnancy testing were performed at baseline, 6, 12, and 18 months. RESULTS Among 799 FSWs (264 from Dominican Republic, 334 from Haiti, and 201 from Puerto Rico), the median age was 26 years, with 54% having less than a high school education and 45% having a monthly household income of less than $US 100. Median number of male partners 6 months before screening was 200. Retention at 18 months was 93%. Twelve women became HIV infected, 9 from Haiti. The annualized HIV incidence was 1.07% (95% confidence interval: 0.55% to 1.87%). Pregnancy incidence was 22.5% (95% confidence interval: 21.9% to 29.5%). Statistically significant declines in risk behaviors occurred between screening and the 18-month visit assessment. DISCUSSION The HVTN 907 study identified a high-risk cohort of women with excellent retention for all 3 sites, despite major challenges especially in Haiti. These results show that a bridging study of a vaccine shown to be efficacious in other clade settings would be possible among FSWs in the region, particularly in Haiti.

Feasibility of Identifying a Female Sex Worker Cohort at High Risk of HIV Infection in the Caribbean for HIV Vaccine Efficacy Trials: Longitudinal Results of HVTN 907.

This paper explores the lived experiences of former NBA player Magic Johnson, and the late ‘Godfather of Gangsta Rap’ Eazy E to examine how their everyday realities as Black men with different soci...

https://www.tandfonline.com/doi/pdf/10.1080/13504630.2020.1823827

'When whites catch a cold, black folks get pneumonia': a look at racialized poverty, space and HIV/AIDS

Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented. 

/pdf/patterns-of-sexual-and-hiv-related-stigma-among-men-who-have-2ksmngoa.pdf

Patterns of sexual and HIV-related stigma among men who have sex with men and women living with HIV in Haiti

1 Dr Pape is professor of medicine at the Weill Medical College of Cornell University in New York, New York, and director of Les Centres GHESKIO in Port-au-Prince, Haiti. Dr Fitzgerald, assistant article editor, is associate professor of medicine at the Weill Medical College of Cornell University. The 2007 estimated prevalence of adult HIV infection in the Caribbean region was 1.1%. Prevalence rates in the large Caribbean countries ranged from 1.1% in the Dominican Republic to 3% in the Bahamas, with the highest rates in men who have sex with men, female sex workers, tuberculosis (TB) patients, crack-cocaine users, children living on the streets, and prisoners. HIV disease is the leading cause of death among Caribbean people aged 25 years to 44 years. There are an estimated 20,000 new infections per year, representing 2 new infections for every patient starting antiretroviral therapy. The CIPRA HT001 trial, which assessed 2006 World Health Organization guidelines for antiretroviral therapy initiation, showed substantial reduction of mortality and new-onset tuberculosis with treatment starting at CD4+ cell counts between 200/μL and 350/μL versus initiating at counts below 200/μL. However, in practice, CD4+ cell count at the start of treatment remains well below 200/μL in the majority of locales. Successes in the battle against HIV disease in the Caribbean include reduction in prevalence and mother-to-child transmission rates in some locales, increased use of antiretroviral therapy, increased use of condoms by female sex workers, and vastly improved safety of donated blood units. Much work remains to be done. This article summarizes a presentation by Jean William Pape, MD, at the International AIDS Society–USA continuing medical education program held in New York City, just weeks before the devastating earthquake in Haiti on January 12, 2010. The original presentation is available as a Webcast at www.iasusa.org. Perspective HIV Disease in the Caribbean

HIV Disease in the Caribbean.

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HIV Disease in the Caribbean.