Abstract
Tijuana, Mexico, has a concentrated HIV epidemic among overlapping key populations (KPs) including people who inject drugs (PWID), female sex workers (FSW), their male clients, and men who have sex with men (MSM). We developed a dynamic HIV transmission model among these KPs to determine the extent to which their unmet prevention and treatment needs is driving HIV transmission. Over 2020–2029 we estimated the proportion of new infections acquired in each KP, and the proportion due to their unprotected risk behaviours. We estimate that 43.7% and 55.3% of new infections are among MSM and PWID, respectively, with FSW and their clients making-up < 10% of new infections. Projections suggest 93.8% of new infections over 2020–2029 will be due to unprotected sex between MSM or unsafe injecting drug use. Prioritizing interventions addressing sexual and injecting risks among MSM and PWID are critical to controlling HIV in Tijuana.
Highlights
HIV still causes significant global morbidity [1]
We estimated the proportion of new infections that are prevented across all key populations (KPs) if for each KP in turn, both the risks of becoming infected and infecting others were removed over 2020–2029; equivalent to a perfect intervention making that KP not infectious or susceptible to infection
For each risk behaviour, we estimated the proportion of new HIV infections prevented over 2020–2029 if the risk of HIV transmission for each risk behaviour was removed over that time period; equivalent to a perfect intervention making that risk behaviour fully protected
Summary
HIV still causes significant global morbidity [1]. Marginalised populations including men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID) experience the highest disease burden [1]. It is a global priority to quantify the contribution of these key populations (KPs) to on-going HIV transmission and identify interventions to reduce this risk [2,3,4]. Mexico, is situated on a major drug trafficking route to the US [5]. Sex work is tolerated by police within Tijuana’s zona roja [6, 7], with this area having a. AIDS and Behavior (2021) 25:3814–3827 thriving drug market [8]. There is considerable MSM living in Tijuana [9]
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