Abstract
IntroductionDespite 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.MethodsData 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.ResultsStudy 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%.ConclusionsThis 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.
Highlights
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
While recent studies have considered some interpersonal factors such as intimate partner violence (IPV), very little is known about the broader social and structural risk factors for HIV acquisition among key populations (KP) in Haiti. We address these gaps with data from a 2016 Priorities for Local AIDS Control Efforts (PLACE) study designed to provide a robust epidemiologic profile of HIV among KP in Haiti, with the following specific objectives: (1) estimate the population size of FSWs and MSM in Haiti; (2) estimate the population prevalence of HIV among FSWs, MSM and TGW; (3) describe the underlying vulnerabilities and behavioural factors associated with HIV in KP; and (4) describe the HIV care and treatment cascade among KP
It was challenging to recruit MSM, regardless of testing history, due to the stigma faced by the LGBTQ community in Haiti and a specific event that received national attention in September 2016 [35]. Notwithstanding these difficulties, we find that our HIV prevalence estimate among MSM is consistent with that reported by the 2014 Integrated Bio-Behavioural Survey (IBBS) when we restrict our data to construct a comparable study population that is (1) exclude participants from geographical departments not covered by the IBBS or between ages 15 and 17 years, and (2) group together MSM and TGW
Summary
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. We present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. Its progress will be limited as long as unmet needs remain among key populations (KP) disproportionately affected by HIV, including men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW). Of particular concern is the lack of data on virologic suppression among KP on ART in Haiti, which is necessary to measure progress against UNAIDS 90-90-90 targets [5]. Another gap is the lack of national and
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