HIV Prevention Programs Research Articles

Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa

Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15–59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from an antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.

Reduction in injection risk behaviors after implementation of a syringe services program, Miami, Florida

IntroductionSyringe services programs (SSPs) are evidence-based HIV prevention programs for people who inject drugs. However, not all SSPs operate evidence-based syringe distribution models, such as needs-based distribution. This study aims to provide preliminary evidence from the IDEA SSP on changes in injection risk behaviors over time, and to examine factors, including syringe coverage, associated with injection risk behavior trajectories over time under a one-for-one syringe distribution model. MethodsWe used a prospective observational study design to generate a cohort of SSP clients who completed three behavioral assessments at SSP service visits between December 2016 and January 2020 (N = 115). The study used generalized estimating equations (GEE) to examine the relationship between covariate measures and the primary outcomes. The primary outcomes were 1) sharing of any injection equipment (e.g. syringes, needles, cookers, cottons) in the previous 30 days (yes/no) and 2) reusing of needles/syringes in the previous 30 days (yes/no). ResultsMen were more likely to report reusing syringes (aRR = 1.15, 95% CI: 1.01–1.37) and those who reported injecting in public were less likely to report reusing syringes (aRR = 0.90, 95% CI: 0.82–0.99). HCV-positive clients had a 62% reduction in sharing injection equipment and those who reported public injection had a 62% increase in sharing injection equipment over time. Most importantly, increasing syringe coverage was associated with a decrease in both sharing injection equipment (aRR = 0.42, 95% CI: 0.25–0.72) and reusing syringes (aRR = 0.79, 95% CI: 0.66–0.95). ConclusionThis study provides preliminary evidence of reductions in injection-related risk behaviors from the IDEA SSP and highlights potential high priority groups, such as people experiencing homelessness, that may need additional intervention. In addition, improving syringe coverage among SSP clients may be an important factor in reducing behaviors that place individuals at risk for contracting HIV and HCV.

HIV Prevention and Treatment Cascades Among Female Sex Workers in Benin, West Africa.

Benin has a long-standing history of HIV prevention programs aimed at female sex workers (FSWs). We used data from a national survey among FSWs (2017) to assess the prevention and care cascades in this population. Female sex workers were recruited through cluster sampling of sex work sites. A questionnaire was administered, and HIV tested. HIV-positive participants were asked to provide dried blood spots and were tested for antiretroviral and viral load. We assessed 2 prevention cascades (HIV testing and safer sex) and the treatment cascade, using a combination of self-reported and biological variables. Mean age of the 1086 FSWs was 30 years. Half of them were Beninese, and two-thirds had a primary school education level or less. Almost all FSWs had ever heard of HIV/AIDS. More than half (79.1%) had ever been tested, and 84.1% of the latter had been tested in the last year. In the previous 6 months, 90.1% were exposed to prevention messages. Women exposed to any HIV prevention message reported a higher level of consistent condom use in the last month (69.0%) than those who were not (48.5%, P < 0.0001). HIV prevalence was 7.7%. Among HIV-positive women, 60.6% knew their status; among those, 90.5% were on antiretroviral and 81.8% of them had a suppressed viral load. Despite long-standing HIV prevention programs for FSWs, the prevention indicators were often low. Linkage to care was good, viral suppression was suboptimal, but knowledge of HIV-positive status was low. Exposing women to prevention messages is necessary, as to increase HIV testing.

Reimaging an AIDS free generation: Examining youth and young adults' personal agency and its association with HIV testing.

Exploring youth and young adult's agency may be a way to increase HIV testing and help end the HIV epidemic. We used data from the National Survey of Teens and Young Adults (15-24) on HIV/AIDS (N=1,437). Data were collected from September 21-October 1, 2012. The sample included 748 girls and 689 boys; and the mean age is 20years (SD: 3.02). Youth and young adults completed a 40-question survey on attitudes and knowledge about HIV. Using a multivariable logistic regression analysis, study findings suggest that focusing on protective health behaviors like the role youth can play in ending the epidemic and hearing about an AIDS-free generation were both associated with an increase in HIV testing. Our study finds that enhancing the role and influence of personal agency can inform HIV prevention and intervention programs that are specific to youth.

Key Population Hotspots in Nigeria for Targeted HIV Program Planning: Mapping, Validation, and Reconciliation.

BackgroundWith the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions.ObjectiveWe aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort.MethodsIn August 2018, 261 trained data collectors from 36 key population–led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President’s Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population–defining behaviors. Hotspots were visited by data collectors, and each hotspot’s name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots.ResultsA total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals.ConclusionsThe number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population–led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses.

Successful integration of HIV pre-exposure prophylaxis into a community-based HIV prevention program for female sex workers in Kolkata, India.

We assessed the impact of pre-exposure prophylaxis (PrEP) in the context of a community-based HIV program among female sex workers (FSWs) in Kolkata, India. This was an open-label, uncontrolled demonstration trial. HIV seronegative FSWs over 18 years were eligible. Participants were administered daily tenofovir/emtricitabine (TDF-FTC) with follow-up visits at months 1, 3, 6, 9, 12, and 15. Drug adherence was monitored by self-report, and a random subset of participants underwent plasma TDF testing. 843 women were screened and 678 enrolled and started on PrEP. Seventy-nine women (11%) did not complete all scheduled visits: four women died of reasons unrelated to PrEP and 75 withdrew, for a 15-month retention rate of 89%. Self-reported daily adherence was over 70%. Among those tested for TDF, the percentage of women whose level reached ≥40 ng/mL was 65% by their final visit. There were no HIV seroconversions, and no evidence of significant changes in sexual behavior. This study demonstrated the feasibility and effectiveness of PrEP for FSWs in Kolkata, with very high levels of adherence to PrEP and no HIV seroconversions. The integration of PrEP into an existing community-based HIV prevention program ensured community support and facilitated adherence.

Understanding HIV and associated risk factors among religious groups in Zimbabwe

BackgroundThe influence of religion and belief systems is widely recognized as an important factor in understanding of health risk perception and myths in the general fight against the HIV pandemic. This study compares the understanding of HIV risk factors and utilization of some HIV services among religious groups in Zimbabwe.MethodsWe conducted secondary data statistical analysis to investigate the understanding of HIV and associated risk factors among religious groups in Zimbabwe using 2015–2016 Zimbabwe Demographic and Health Survey (ZDHS) data. We began by investigating associations between understanding of HIV and associated risk factors among religious groups. A multivariate stepwise backward elimination method was carried out to explore factors determining understanding of HIV risk after controlling for confounding factors using the most recent ZDHS data (2015–2016).ResultsThe results from the three surveys showed that, in general apostolic sector had low understanding of HIV and associated risk factors compared to other religious groups. Analysis of the 2015–2016 ZDHS data showed that women belonging to the apostolic sector were less likely to know where to get an HIV test odds ratio (OR) and 95% confidence interval, 0.665 (0.503–0.880) and to know that male circumcision reduces HIV transmission OR 0.863 (0.781–0.955). Women from this group had no knowledge that circumcised men can be infected if they do not use condoms OR 0.633 (0.579–0.693), nor that it is possible for a healthy-looking person to have HIV, OR 0.814 (0.719–0.921). They would not buy vegetables from a vendor with HIV OR 0.817 (0.729–0.915) and were less likely to support that HIV positive children should be allowed to attend school with HIV negative children OR 0.804 (0.680–0.950). Similar results were obtained for men in the apostolic sector. These men also did not agree that women were justified to use condoms if the husband has an Sexually Transmitted Infection (STI) OR 0.851 (0.748–0.967).ConclusionsOur results suggest that apostolic sector lack adequate knowledge of HIV and associated risk factors than other religious groups. Targeting HIV prevention programmes by religious groups could be an efficient approach for controlling HIV in Zimbabwe.

Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men.

The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21-50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant's own or study-provided mobile phone. Individual differences variables were measured by participants' completing questionnaires measuring effortful control and urgency, and the participant's self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol's effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol's effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.

Did sexual behaviour differences between HIV infection and treatment groups offset the preventative biological effects of ART roll-out in Zimbabwe?

Declines in HIV incidence have been slower than expected during the roll-out of antiretroviral treatment (ART) services in sub-Saharan African populations suffering generalized epidemics. Using data from a population-based, open cohort HIV sero-survey (2004–13), we found evidence for initial reductions in sexual activity and multiple sexual partnerships, followed by increases during the period of ART scale-up in areas of high HIV prevalence in Manicaland, east Zimbabwe. Recent population-level increases in condom use were also recorded, but largely reflected high use by the rapidly growing proportion of HIV-infected individuals on treatment. Sexual risk behaviour increased in susceptible uninfected individuals and in untreated (and therefore more infectious) HIV-infected men, which may have slowed the decline in HIV incidence in this area. Intensified primary HIV prevention programmes, together with strengthened risk screening, referral, and support services following HIV testing, could help to maximize the impact of ‘test-and-treat’ programmes in reducing new infections.

Sexual Mixing and HIV Transmission Potential Among Greek Men Who have Sex with Men: Results from SOPHOCLES

HIV incidence among men who have sex with men (MSM) in Greece remains unchanged despite effective response to a recent outbreak among people who inject drugs (PWID). Network factors are increasingly understood to drive transmission in epidemics. The primary objective of the study was to characterize MSM in Greece, their sexual behaviors, and sexual network mixing patterns. We investigated the relationship between serostatus, sexual behaviors, and self-reported sex networks in a sample of MSM in Athens, Greece, generated using respondent driven sampling. We estimated mixing coefficients (r) based on survey-generated egonets. Additionally, multiple logistic regression was used to estimate adjusted odds ratios (AOR) and to assess relationships between serostatus, sexual behaviors, and sociodemographic indicators. A sample of 1,520 MSM participants included study respondents (n = 308) and their network members (n = 1,212). Mixing based on serostatus (r = 0.12, σr = 0.09–0.15) and condomless sex (r = 0.11, σr = 0.07–0.14) was random. However, mixing based on sex-drug use was highly assortative (r = 0.37, σr = 0.32–0.42). This study represents the first analysis of Greek MSM sexual networks. Our findings highlight protective behavior in two distinct network typologies. The first typology mixed assortatively based on serostatus and sex-drug use and was less likely to engage in condomless sex. The second typology mixed randomly based on condomless sex but was less likely to engage in sex-drug use. These findings support the potential benefit of HIV prevention program scale-up for this population including but not limited to PrEP.

Declines in HIV prevalence in female sex workers accessing an HIV treatment and prevention programme in Nairobi, Kenya over a 10-year period.

Empirical time trends in HIV prevalence in female sex workers (FSWs) are helpful to understand the evolving HIV epidemic, and to monitor the scale-up, coverage, and impact of ongoing HIV prevention and treatment programmes. Serial HIV prevalence study. We analyzed time trends in HIV prevalence in FSWs accessing services at seven Sex Worker Outreach Programme (SWOP) clinics in Nairobi from 2008 to 2017 (N = 33 560). The Mantel--Haenszel test for trend and independent samples Kruskal--Wallis test were used to analyze categorical and continuous variables, respectively. Multivariable binomial regression was used to estimate prevalence ratios/year, adjusting for several covariates. HIV prevalence decreased over time in all age groups. This was particularly evident among FSWs less than 25 years of age; HIV was 17.5% in 2008-2009, decreasing to 12.2% in 2010-2011, 8.3% in 2012-2013, 7.3% in 2014-2015, and 4.8% in 2016-2017 (P < 0.0001). Over time, FSWs reported increased condom use, particularly with regular partners, more frequent prior HIV testing, and were less likely to report a history of vaginal discharge (P < 0.0001). In adjusted analyses compared with 2008, HIV prevalence decreased in 2011 (aPR 0.64; 95% CI: 0.46-0.90), 2012 (aPR 0.58; 95% CI: 0.41-0.81), 2013 (aPR 0.53; 95% CI: 0.38-0.73), 2014 (aPR 0.48; 95% CI: 0.34-0.67), 2015 (aPR 0.50; 95% CI: 0.35-0.70), 2016 (aPR 0.40; 95% CI: 0.28-0.57), and 2017 (aPR 0.33; 95% CI: 0.22-0.50). HIV prevalence has decreased among FSW accessing SWOP in Nairobi, Kenya. This decline is consistent with the scale-up of HIV prevention and treatment efforts, both in FSWs and in the general population.

HIV Testing Correlates: U.S. and Foreign Born High-Risk Black Heterosexual Men.

In the U.S., Black men are disproportionately affected by HIV, with some of the highest HIV incidence rates and lowest rates of HIV testing. We examined correlates of HIV testing and knowledge among participants of the Barbershop Talk with Brothers (BTWB) project, an HIV prevention program targeting high-risk sexual behaviors amongBlack heterosexual men in Brooklyn, New York.Specifically, we examined differences between U.S. vs. foreign-born status and HIV testing rates, HIV knowledge, and socio-demographic factors. Of the 855 men included, the mean age was 33years and 35.0% were foreign-born. Lifetime HIV testing was reported at 84%, with greater proportion of U.S. vs foreign-born men reporting lifetime (88.6% vs. 75.0%) and recent testing (68.6% vs. 51.0%), p < 0.001. Among foreign-born men, recent HIV testing was associated with lower stigma and greater HIV transmission knowledge than those un-tested. The authors recommend tailored approaches to increasing HIV testing in Black communities, based on nativity and social factors.

Suicidality among gender minorities in Karnataka, South India

BackgroundIt is argued that Indian gender minorities displayed differential mental health problems and suicide attempts. Hence, the study was intended to understand the prevalence of anxiety, depression and suicidality among this group, specifically those living in a metropolitan city in South India.MethodsThe data was generated from a cross-sectional study that employed a structured questionnaire to collect information about experiences of anxiety, depression and suicidal behavior among gender-diverse individuals in Bangalore, the capital city of Karnataka state. The study used stratified simple random sampling of eligible individuals who were 18 years of age and older and who were enrolled in an HIV prevention program implemented for gender-diverse individuals run by the Karnataka Health Promotion Trust and the University of Manitoba at the time of the study (2012). Bivariate and multivariate analyses were used to assess the relative contribution of various factors that affect suicide ideation or actual attempts among the gender diverse participants.ResultsResults showed that 62% whose main source of income was Basti (socially sanctioned practice of begging), 52% of Hijras, 56% who lived with their Gurus, 58% who were not happy with their physical appearance, 55% who consumed alcohol daily, and 63% who experienced high depression had ever thought of or attempted suicide in the month prior to the survey. However, multivariate analysis showed that respondents who were not happy with their physical appearance and thought of changing it had significantly higher odds (AOR = 2.861; CI 1.468,5.576; p = 0.002) of either having thoughts that it was better being dead or wished they died. Similarly, those who experienced high depression, their odds of either having had thoughts of or having attempted suicide increased by three times (AOR = 3.997; CI 1.976, 8.071; p < 0.000).ConclusionsIt is observed that a high percentage of gender minorities had attempted suicide or thought of suicide during the month preceding the data collection. The findings bring new insights on the proximate determinant of physical appearance on the suicidality of gender minorities assigned male at birth and appropriate to account for this while addressing the mental health issues.

Qualitative analysis of financing HIV and AIDS program in Health Office of Jayawijaya District, Papua Province

ObjectiveThe purpose of this study is to see the financing of HIV and AIDS prevention programs in Jayawijaya District, Papua Province. MethodThis study used a qualitative research design with a case study approach. ResultsThe results of this study indicate that the source of HIV and AIDS prevention programs in the Jayawijaya Health Office comes from the Government (Special Autonomy Fund) and the State Budget (BOK Funds at Puskesmas) and assistance from international NGOs with a very large amount every year. ConclusionsThis study concludes that HIV and AIDS from the APBN and APBN data should be reviewed to improve with the decreasing number of donor agencies assisting in the Jayawijaya District. So that the HIV and AIDS program in Jayawijaya Regency, Papua Province, is reliable, balanced with a comprehensive coping program strategy.

Assessing sexual practices and beliefs among university students in Khartoum, Sudan; a qualitative study

ABSTRACT University students in Sudan are more at risk of contracting HIV than the general population, due to a high rate of sexual activity and low uptake of preventive measures such as condoms. Hence, they are considered an important target for HIV prevention programmes. This study explored students` beliefs about abstinence and pre-marital sex. Thirty semi-structured individual interviews were conducted, based on constructs from the Integrated Change (I-Change) Model. The study sample included 16 (53%) male and 14 (47%) female university students. Their average age was 21.2 years (Range 18–27 and SD 2.5). Both sexual abstainers (N = 19) and sexually active students (N = 11) perceived HIV severity and susceptibility. Most of the participants had a positive attitude towards abstinence. However, sexually active students also perceived some advantages of engaging in sexual practices, such as sexual pleasure and proving adulthood. Sexually active students more often mentioned being influenced in their sexual practices by their peers than by their families. Sexually active students reported lower self-efficacy to refrain from sex than abstainers. Interventions that seek to promote abstinence among those willing to achieve this should stress the advantages of abstinence from sex until marriage, offer tools to resist peer pressure and enhance self-efficacy to abstain. These findings can be used to develop comprehensive HIV prevention programmes that primarily promote abstinence among university students who are not yet sexually active but also consider promoting condom use and other safer-sex practices among those who are sexually active. These interventions should also be gender-sensitive to address the needs of both male and female students.

Patterns of Online and Offline Partnering, Partnership Characteristics, and Condomless Sex Among Adolescent Sexual Minority Males in the USA.

Online partner-seeking among adolescent sexual minority males (ASMM) has been associated with condomless anal sex. Two hypotheses may explain this association: that online venues facilitate HIV transmission risk behavior more than offline venues (accentuation), or that individuals who tend to engage in these behaviors are more likely to seek partners online (self-selection). We examined these hypotheses in 700 13-18year-old ASMM who completed the baseline survey of an effectiveness trial of an HIV prevention program in 2018-2020. The survey assessed demographic, sexual, and venue characteristics of male anal sex partnerships in the past 3months. Many participants (83%) reported ≥ 1 online-met partner; most were met via sexual networking applications and were older than offline-met partners. Having met partners online, but not whether a particular partner was met online, was associated with greater odds of receptive condomless sex. Findings support the self-selection hypothesis, which has implications for HIV prevention in ASMM.

HIV Testing and Receiving Test Results by the Female Sex Workers; Retrospective Study using Data from Sri Lanka National HIV Prevention Programme

<strong>Introduction: </strong>Improving HIV testing among Key Populations (populations at high risk) is the first step to achieve 90:90:90 treatment targets. Studying the time taken to HIV testing and subsequent clinic visits to uptake the test results provide important inputs for development of HIV prevention programmes. <strong> </strong> <strong>Objectives: </strong>This study aims to understand the pattern of HIV testing behavior of Female Sex Workers (FSWs) over the time and provide recommendations for development of HIV prevention programmes for FSWs <strong> </strong> <strong>Methods: </strong>HIV testing data of 5,667 FSWs registered with national HIV prevention programme in 10 Districts of Sri Lanka during 2016 and 2017 were analyzed using, survival data analysis techniques and extended Prentice, Williams &amp; Peterson (PWP) gap time model. <strong> </strong> <strong>Results: </strong>Time taken to acceptance of HIV test is more dependent on individual factors of FSWs whereas uptake of test result is less dependent on individual factors. Youth FSWs take more time to accept an HIV test. FSWs who are operating in Districts out of Colombo, use condoms, reported undergone HIV testing before join the programme, take more time for HIV testing and uptake test results. FSWs with high partner exchange rate (therefore at high risk) are less likely to complete both events and take more time for testing. Interaction between FSW typology and condom use was found with the use of PWP model. <strong> </strong> <strong>Conclusion: </strong>High risk FSWs are more reluctant for HIV testing and uptake of test results. Factors identified in the study as associated with time taken for both events can be taken into account in planning future HIV preventions programs among FSWs.

102. Improving Implementation of HIV Pre-exposure Prophylaxis: Lessons Learned from Young Women in Rural South Africa

BackgroundYoung women in South Africa are at particularly high risk for acquiring HIV, yet implementation of HIV prevention programmes in rural settings lags. We examined the experiences and perceptions of young women initiating pre-exposure prophylaxis (PrEP) in a rural setting under real-world programmatic conditions, in order to strengthen future PrEP delivery to this population.MethodsYoung women initiating PrEP in Msinga, a municipality in KwaZulu-Natal province, were interviewed about their motivation to start PrEP and their experiences in taking PrEP. Interviews were conducted at PrEP initiation and longitudinally as they returned to clinic monthly for medication refills.ResultsAmong seventeen sexually active at-risk young women (IQR 18–22.5 years old) who initiated PrEP, 71% lived in a household receiving a government grant, 24% had history of an STI and 71% reported inconsistent condom use. All participants disclosed PrEP use to a family member, but only 20% informed their male sexual partner. All expressed uncertainty regarding their partners’ sexual activities as a primary motivation for PrEP initiation. Social support from family and friends as well as interacting with other young women taking PrEP were identified as important facilitators. Barriers to PrEP included lack of community awareness about PrEP, limited clinics offering PrEP, HIV stigma, and logistics of accessing healthcare facilities. Young women valued a peer PrEP champion to facilitate and maintain successful engagement in care, as well as patient-centered PrEP delivery models that allow for care outside traditional clinic facilities.ConclusionInput from young women has the potential to significantly enhance and expand PrEP implementation. Tailored implementation efforts should include strengthening the role of community health workers, improving community-wide PrEP education, empowering women within their relationships, facilitating skill building for PrEP disclosure to partners, incorporating community PrEP champions, and developing alternative PrEP delivery models including community-based delivery.Disclosures All Authors: No reported disclosures

Community-Based Testing and Factors Associated with HIV among Men Who Have Sex with Men (MSM) in Haiti between 2015 and 2018

Men who have sex with men (MSM) are an HIV key population in Haiti. However, little data exists on that population and on factors associated with this infection. Our study carried out the factors associated with HIV-positive screening among MSM in a community-based rapid testing program in Haiti between 2015 and 2018. Among the 1416 MSM screened, a third reported that it was their very first HIV test and 7.0% had an HIV-positive test. With a median age of 25 years old [21-29], over half of them were living in urban areas (60.7%) and were in financial precarious conditions (68.6%). Multivariate analysis showed that two factors were significantly associated with an HIVpositive result: having had an STI in the last 12 months, strengthened by psychoactive drug use; transactional sex practice in the last 12 months, strengthened by the age between 18 and 20 years old. These results should be taken into account when developing and implementing targeted and comprehensive HIV prevention programs and services for young MSM in Haiti.

Overview of HIV Risk Reduction Interventions among Adolescents - A Call to Evaluate the HIV Education Curriculum in Nigeria

Background: Adolescence is typically a period of experimentation, new experiences, and vulnerability which influences their HIV risk behaviours. Some may out-grow many risk behaviors, yet prevention efforts are needed to reduce the risk of HIV infection during this period. Knowledge about risk is not sufficient for the prevention of HIV risk behavior. This review examines the existing types of education targeted at reducing HIV risk and their application to adolescents for optimal outcome.&#x0D; Methodology: Keywords from objectives of review were used to search for related literatures through online libraries of national and international journals. Out of 60 related studies initially generated, 38 literatures were selected for review.&#x0D; Results: School-based health services should ideally be complementary rather than replacement option for the provision of health care services for adolescents. Interventions to improve HIV knowledge and reduce risky sexual behaviour may need to specifically target adolescents. The types of HIV risk reduction education intervention among adolescents is classified into peer-based and health provider-based education. Given the complexity of factors that contribute to risk behavior, prevention efforts that focus exclusively on knowledge are unlikely to be successful. Effective school-based (youth-targeted) HIV prevention programs, which typically rely on principles of social cognitive (Learning) theory could be employed to bridge the gap.&#x0D; Conclusion and Recommendations: With this in mind, a comprehensive review of the Family life and HIV education (FLHE) programme in Nigerian secondary schools is long overdue.