Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission

HIV self-testing (HIVST) is a potential strategy to overcome disparities in access to and uptake of HIV testing, particularly among key populations (KP). A literature review was conducted on the acceptability, values and preferences among KP. Data was analyzed by country income World Bank classification, type of specimen collection, level of support offered and other qualitative aspects. Most studies identified were from high-income countries and among men who have sex with men (MSM) who found HIVST to be acceptable. In general, MSM were interested in HIVST because of its convenient and private nature. However, they had concerns about the lack of counseling, possible user error and accuracy. Data on the values and preferences of other KP groups regarding HIVST is limited. This should be a research priority, as HIVST is likely to become more widely available, including in resource-limited settings.

/pdf/attitudes-and-acceptability-on-hiv-self-testing-among-key-wvgo9vg4ux.pdf

Attitudes and Acceptability on HIV Self-testing Among Key Populations: A Literature Review

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60833-3.pdf

HIV risk and preventive interventions in transgender women sex workers

Objectives The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational pre-exposure prophylaxis (PrEP) Cascade involving 5 stages based on the Transtheoretical Model of Change. Methods We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. Results Nearly all (89%) participants were sexually active in the past 3 months and 65% met Centers for Disease Control criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (stage 5). Conclusions The large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.

/pdf/uptake-of-hiv-pre-exposure-prophylaxis-prep-in-a-national-4nqzuvxphs.pdf

Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States

There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.

/pdf/economic-mental-health-hiv-prevention-and-hiv-treatment-2oajebmlar.pdf

Economic, Mental Health, HIV Prevention and HIV Treatment Impacts of COVID-19 and the COVID-19 Response on a Global Sample of Cisgender Gay Men and Other Men Who Have Sex with Men.

Introduction. Men who have sex with men (MSM) are disproportionately impacted by HIV globally. Easily accessible combination HIV prevention strategies, tailored to the needs of MSM, are needed to effectively address the AIDS pandemic. Methods and Materials. We conducted a cross-sectional study among MSM (n = 3748) from 145 countries from April to August 2012. Using multivariable random effects models, we examined factors associated with acceptability of preexposure prophylaxis (PrEP) and access to condoms, lubricants, HIV testing, and HIV treatment. Results. Condoms and lubricants were accessible to 35% and 22% of all respondents, respectively. HIV testing was accessible to 35% of HIV-negative respondents. Forty-three percent of all HIV-positive respondents reported that antiretroviral therapy was easily accessible. Homophobia, outness, and service provider stigma were significantly associated with reduced access to services. Conversely, community engagement, connection to gay community, and comfort with service providers were associated with increased access. PrEP acceptability was associated with lower PrEP-related stigma, less knowledge about PrEP, less outness, higher service provider stigma, and having experienced violence for being MSM. Conclusions. Ensuring HIV service access among MSM will be critical in maximizing the potential effectiveness of combination approaches, especially given the interdependence of both basic and newer interventions like PrEP. Barriers and facilitators of HIV service access for MSM should be better understood and addressed.

/pdf/access-to-basic-hiv-related-services-and-prep-acceptability-260yd605d6.pdf

Access to Basic HIV-Related Services and PrEP Acceptability among Men Who Have sex with Men Worldwide: Barriers, Facilitators, and Implications for Combination Prevention.

Sex workers have been among the populations most affected by HIV since the beginning of the epidemic, for reasons that include the number of sexual partners, unsafe working conditions, barriers to the negotiation of consistent condom use, and unequal access to health services. Laws, regulations and policies that criminalize sex work and discriminate against sex workers also increase their vulnerability and risk, as do violence, alcohol and drug use in some settings.

Implementing Comprehensive HIV/STI Programmes with Sex Workers:: Practical Approaches from Collaborative Interventions

for Men Who Have Sex with Men Findings from the 2012 Global Men’s Health and Rights Study (GMHR) In early 2012, the Global Forum on MSM & HIV (MSMGF) conducted the second biennial Global Men’s Health and Rights study (GMHR). Including both a global online survey component and focus group discussion component, the 2012 GMHR aimed to A) identify barriers and facilitators that affect access to HIV services for men who have sex with men (MSM), and B) place access to HIV services in the broader context of sexual health and lived experiences of MSM globally.

Access to HIV Prevention and Treatment for Men Who Have Sex with Men: Findings from the 2012 Global Men’s Health and Rights Study (GMHR)

Objectives: The health and prevention benefits of antiretroviral therapies (ART), delivered as part of comprehensive HIV care programs remain unrealized for men who have sex with men (MSM). This multilevel study explores the correlates of drop-off from the HIV care continuum in an international study of MSM, taking into account individual and regional differences in access to and utilization of care.
Methods: We conducted a study of the continuum of HIV diagnosis and care among 6095 MSM using data collected from an international online survey of MSM conducted in 2012. In this model of the HIV treatment cascade, we treated each point along the continuum as an outcome variable. We then investigated the relationships between clinical care outcomes and a set of demographic and psychosocial factors that were hypothesized to correlate with the outcomes using bivariate and multivariable statistical techniques.
Results: Among MSM living with HIV for longer than 12 months (n=632), 50%(n=319) were virologically suppressed. Among MSM recently infected with HIV (n=91), the proportion was relatively smaller at 33%. Significant correlates of being on ART and retained in care included: accessibility of HIV treatment; comfort with a healthcare provider; and engagement in a gay community. Perceptions of homophobia were negatively associated with being on ART and being retained in care.
Conclusions: These findings underscore the need for service delivery models that sensitively address HIV among MSM. Public health officials should adopt comprehensive HIV programs that include mutually reinforcing components and that address varying needs of MSM newly diagnosed and living with HIV. Comprehensive HIV programs must also support the critical role communities play in linking and retaining MSM into HIV services. Further studies validating the findings in country-specific contexts are warranted.

/pdf/hiv-treatment-cascades-that-leak-correlates-of-drop-off-from-1x26jxdpp8.pdf

HIV Treatment Cascades that Leak: Correlates of Drop-off from the HIV Care Continuum among Men who have Sex with Men Worldwide

Access to HIV Prevention Services and Attitudes about Emerging Strategies:: A Global Survey of Men Who Have Sex with Men (MSM) and their Health Care Providers

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