National HIV Prevention Program Research Articles

CDC-Funded HIV Testing Services Outcomes in Ending the HIV Epidemic in the U.S. (EHE) and Non-EHE Jurisdictions, 2021.

Ending the HIV Epidemic in the U.S. (EHE) aims to end the HIV epidemic by focusing on 57 jurisdictions most impacted by HIV. Using 2021 data from the National HIV Prevention Program Monitoring and Evaluation system, we calculated distributions of CDC-funded HIV tests and HIV testing services outcomes in EHE and non-EHE jurisdictions. We conducted chi-square tests and robust Poisson regression to compare differences in outcomes. Of the 1,753,873 tests conducted, a greater proportion were conducted in EHE (65.7%) versus non-EHE (34.3%) jurisdictions (p<0.001). Greater number of persons newly diagnosed were identified in EHE (n=5,861) versus non-EHE (n=2,329) jurisdictions; newly diagnosed positivity was higher in EHE (0.5%) versus non-EHE (0.4%; PR=1.31, 95% CI: 1.25-1.38) jurisdictions. Among persons newly diagnosed, there were no differences in proportion of linkage to care within 30 days in EHE jurisdictions (77.9%) versus non-EHE jurisdictions (77.1%; PR=1.01, 95% CI: 0.95-1.07). Proportion of persons newly diagnosed interviewed for partner services was lower in EHE (69.0%) versus non-EHE (84.8%; PR=0.81, 95% CI: 0.76-0.87) jurisdictions. CDC-funded HIV testing services in EHE jurisdictions conducted more HIV testing and diagnosed more persons. Jurisdictions can further expand HIV testing and related services to continue striving toward EHE goals.

CDC-Funded HIV Testing and Undiagnosed HIV Infection in Ending the HIV Epidemic in the U.S. Jurisdictions.

Approximately 13% of persons with HIV (PWH) are unaware of their status. To help end HIV, it is important to understand the relationship between the rates of HIV testing and undiagnosed HIV infection. Ending the HIV in the U.S. (EHE) jurisdictions. Using 2021 data from the National HIV Surveillance System and the National HIV Prevention Program Monitoring and Evaluation system, we calculated estimated rates of undiagnosed HIV infections per 100,000 population and rates of CDC-funded HIV tests per 1,000 population. We assessed the association between the two rates using Spearman's rank correlation. We also calculated a rank difference between the two rates for each EHE jurisdiction to help identify jurisdictions with greater unfilled needs for HIV testing. Overall, CDC-funded HIV tests per 1,000 population were positively associated with estimated rate of undiagnosed HIV infection per 100,000 population (rho=0.55, p<0.001). EHE jurisdictions with the greatest magnitude of negative rank differences (i.e., higher undiagnosed HIV infection per 100,000 population and lower CDC-funded HIV tests per 1,000 population) were Prince George's County, MD; Mecklenburg County, NC; Hudson County, NJ; Bronx County, NY, and Hamilton County, OH. In general, CDC-funded HIV testing is being conducted in jurisdictions with the greatest needs. However, we also found large discrepancies between CDC-funded HIV testing and undiagnosed HIV infection rates for some jurisdictions. These jurisdictions may want to identify barriers to their HIV testing services and expand their programs to ensure that all PWH in their jurisdictions are diagnosed.

Depressive Symptoms among People Living with HIV Attending ART Centers of Lumbini Province, Nepal: A Cross-Sectional Study.

Depression is a common mental disorder and is a leading cause of disability globally. Depressive symptoms among people living with HIV can be a significant barrier to ART initiation and thus lead to poor ART adherence. Global studies have found the prevalence of depressive symptoms among people living with HIV ranges from 12 to 63%. The real scenario of Nepal still needs to be explored. Thus, this study aimed to identify the prevalence and predictors of depression in individuals with HIV. An institutional-based cross-sectional study was carried out from August to December 2020 among 406 people living with HIV attending ART centers in Lumbini province. Participants were selected using a systematic random sampling technique and surveyed with a structured questionnaire consisting of sociodemographic variables, HIV AIDS-related variables, and 21 items Beck Depression Inventory tool. The odds ratio was used as the ultimate measure of association, with a 95% confidence interval computed to establish statistical significance. A multivariate regression analysis was carried out to identify the final predictors of depressive symptoms. The study found that 26.8% of the respondents had depressive symptoms. Those who were literate (AOR = 0.24, 95% CI: 0.10-0.61), in the poorest wealth quintile (AOR = 7.28, 95% CI: 2.22-23.87), initiated ART within 12 months (AOR = 1.88, 95% CI: 1.03-3.42), had CD4 cell counts below 200 (AOR = 2.50, 95% CI: 1.54-4.06), and had a time difference of 3 months or less between HIV diagnosis and ART initiation (AOR = 0.50, 95% CI: 0.29-0.86) were independently associated with depressive symptoms. Routine screening for depressive symptoms should be integrated into national HIV prevention and control programs for people living with HIV. An enabling environment should be created to facilitate the rapid enrollment of individuals newly diagnosed with HIV in ART services, thereby reducing the time gap between HIV diagnosis and ART initiation.

The associations of income and Black-White racial segregation with HIV outcomes among adults aged ≥18 years-United States and Puerto Rico, 2019.

To examine associations between Index of Concentration at the Extremes (ICE) measures for economic and racial segregation and HIV outcomes in the United States (U.S.) and Puerto Rico. County-level HIV testing data from CDC's National HIV Prevention Program Monitoring and Evaluation and census tract-level HIV diagnoses, linkage to HIV medical care, and viral suppression data from the National HIV Surveillance System were used. Three ICE measures of spatial polarization were obtained from the U.S. Census Bureau's American Community Survey: ICEincome (income segregation), ICErace (Black-White racial segregation), and ICEincome+race (Black-White racialized economic segregation). Rate ratios (RRs) for HIV diagnoses and prevalence ratios (PRs) for HIV testing, linkage to care within 1 month of diagnosis, and viral suppression within 6 months of diagnosis were estimated with 95% confidence intervals (CIs) to examine changes across ICE quintiles using the most privileged communities (Quintile 5, Q5) as the reference group. PRs and RRs showed a higher likelihood of testing and adverse HIV outcomes among persons residing in Q1 (least privileged) communities compared with Q5 (most privileged) across ICE measures. For HIV testing percentages and diagnosis rates, across quintiles, PRs and RRs were consistently greatest for ICErace. For linkage to care and viral suppression, PRs were consistently lower for ICEincome+race. We found that poor HIV outcomes and disparities were associated with income, racial, and economic segregation as measured by ICE. These ICE measures contribute to poor HIV outcomes and disparities by unfairly concentrating certain groups (i.e., Black persons) in highly segregated and deprived communities that experience a lack of access to quality, affordable health care. Expanded efforts are needed to address the social/economic barriers that impede access to HIV care among Black persons. Increased partnerships between government agencies and the private sector are needed to change policies that promote and sustain racial and income segregation.

CDC-Funded HIV Testing Services Outcomes and Social Determinants of Health in Ending the HIV Epidemic in the U.S. Jurisdictions.

We performed an ecological analysis to examine associations between CDC-funded HIV testing services outcomes and social determinants of health (SDOH) among Ending the HIV Epidemic in the U.S. jurisdictions. Using National HIV Prevention Program Monitoring & Evaluation (2020) and American Community Survey (2016-2020) data, we ran robust Poisson models (adjusted for race/ethnicity). In healthcare settings, a 10% absolute increase in percentage without health insurance was associated with a 40% lower prevalence of newly diagnosed positivity (aPR = 0.60, 95% CI: 0.43-0.83); a $5,000 increase in median household income (aPR = 1.04, 95% CI: 1.03-1.06) and a 10% absolute increase in percentage unemployed (aPR = 1.80, 95% CI: 1.31-2.46) were associated with 4% and 80%, respectively, higher prevalence of percentage linked to HIV medical care within 30 days of diagnosis (i.e., linkage). In non-healthcare settings, a 10% absolute increase in percentage with less than high school diploma (aPR = 0.53, 95% CI: 0.29-0.96) was associated with a 47% lower prevalence of newly diagnosed positivity, whereas a 10% absolute increase in percentage without health insurance (aPR = 1.92, 95% CI: 1.29-2.88) was associated with a 92% higher prevalence of newly diagnosed positivity; a 10% absolute increase in percentage with less than high school diploma was associated with a 35% lower prevalence of linkage (aPR = 0.65, 95% CI: 0.43-0.97). Addressing SDOH in HIV prevention programs will play an important role in ending the HIV epidemic.

Modeling time taken to HIV testing and uptake of test results: extension of the PWP model to handle time-dependent covariates

Improving HIV testing among the populations at high risk is one of the first steps to achieving the Sustainable Development Goal target of ending AIDS by 2030. This study aims to develop multivariate statistical models to describe the HIV testing behavior of most at-risk populations. HIV testing data of 5667 Female Sex Workers (FSWs) registered with the National HIV Prevention Programme in 10 districts of Sri Lanka during 2016 and 2017 were modeled using univariate and multivariate survival analysis techniques. As the proportional hazard assumption was violated, the Prentice Williams & Peterson (PWP) model was extended to include time-dependent covariates. The results show that the PWP gap time model and all univariate Cox Proportional Hazard Models generated consistent results. However, a higher number of effects of factors and their interactions were detected in the gap time model than in univariate models. The gap time model generated more precise estimates with lower standard errors compared to the total time model. The study concludes that the PWP model can be extended to handle time-dependent covariates. The PWP gap model is the more appropriate technique to model the time taken for HIV testing and subsequent clinic visit to uptake test results among Most at-risk Populations.

HIV Positivity, Linkage to Medical Care, Interview for Partner Services, and Pre-Exposure Prophylaxis Awareness and Referral Among Men Who Have Sex With Men Tested in Non-healthcare Settings in the United States, 2019.

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. This study reports data on HIV testing program outcomes among MSM tested for HIV in non-healthcare settings in the United States. We analyzed Centers for Disease Control and Prevention's National HIV Prevention Program Monitoring and Evaluation data collected in 2019. Descriptive and multivariate robust Poisson regression analyses were conducted to summarize the patterns of HIV testing program outcomes [ie, positivity, linkage to HIV medical care within 30 days of diagnosis, interview for partner services (PS), and pre-exposure prophylaxis (PrEP) awareness and referral] by demographic characteristics, HIV prevalence, and testing site type. A total of 123,251 HIV tests were conducted among MSM; of these, 1773 (1.4%) were newly diagnosed with HIV. Among MSM newly diagnosed with HIV, 75% were linked to HIV medical care and 80% were interviewed for PS. Among MSM who tested HIV-negative, 63% were aware of PrEP and 47% of those who were eligible for PrEP were referred to PrEP providers. Referral or linkage to services varied by demographic characteristics or other factors. Linkage to HIV medical care and interview for PS among MSM newly diagnosed with HIV in non-healthcare settings were below national or funding program targets. Most MSM with risk factors for HIV infection were not referred to PrEP providers. Expanded efforts to address barriers to equitable access to services may help improve HIV-related outcomes among MSM and contribute to ending the HIV epidemic in the United States.

Modeling time taken to HIV testing and uptake of test results: application of extended PWP model

Improving HIV testing among the most at risk populations (MARP) is one of the first steps to achieve the Sustainable Development Goal target of ending AIDS by 2030. Factors affecting time taken to HIV testing and subsequent clinic visits to uptake the test result are important inputs for development of HIV prevention programmes. This study aims to develop multivariate statistical models to describe HIV testing behavior of MARP. HIV testing data of 5667 Female Sex Workers registered with the National HIV Prevention Programme in 10 districts of Sri Lanka during 2016 and 2017 were modelled using univariate and multivariate survival analysis techniques. Results showed that the Prentice, Williams & Peterson gap time model (PWPGTM), and all univariate Cox Proportional Hazard Models together generated consistent results. However, higher number of effects of the factors and interaction effects were detected in the PWPGTM compared to other models. Further, PWPGTM generated more precise estimates with lower standard errors. In all the models, most of the factors were identified as time dependent covariates. Study concludes that the extended PWPGTM is the more appropriate technique to model time taken to HIV testing and subsequent clinic visit to uptake of test results among MARP.

HIV Preexposure Prophylaxis Awareness and Referral to Providers Among Hispanic/Latino Persons - United States, 2019.

Hispanic or Latino* (Hispanic) persons are disproportionately affected by HIV in the United States. In 2019, Hispanic persons accounted for 18% of the U.S. population, but for 29% of new diagnoses of HIV infection (1). The Ending the HIV Epidemic in the U.S. (EHE) initiative aims to reduce new HIV infections by 90% by 2030 (2). Preexposure prophylaxis (PrEP), medication taken to prevent acquisition of HIV, is an effective strategy for preventing HIV infection.† To examine PrEP awareness and referral to providers among Hispanic persons, CDC analyzed 2019 National HIV Prevention Program Monitoring and Evaluation HIV testing data. Approximately one quarter (27%) of Hispanic persons tested for HIV at CDC-funded sites (n = 310,954) were aware of PrEP, and 22% of those who received a negative HIV test result and were eligible for referral (111,644) were referred to PrEP providers. PrEP awareness and referrals among Hispanic persons were lower compared with those among non-Hispanic White persons. Among Hispanic persons, significant differences were found in PrEP awareness and referrals by age, gender, race, population group, geographic region, and test setting. HIV testing programs can expand PrEP services for Hispanic persons by implementing culturally and linguistically appropriate strategies that routinize PrEP education and referral, collaborating with health care and other providers, and addressing social and structural barriers.

Contributions of Community-Based Organizations Funded by the Centers for Disease Control and Prevention's HIV Testing Program.

HIV testing is a critically important first step in preventing and reducing HIV transmission. Community-based organizations (CBOs) are uniquely positioned to provide HIV testing and other prevention services to populations disproportionately affected by HIV infection. The purpose of this analysis was to assess CDC-funded health department (HD) and CBO testing programs during 2012-2017, including the number of tests and HIV positivity. This is an analysis of National HIV Prevention Program Monitoring and Evaluation HIV testing data submitted between 2012 and 2017 to CDC. Sixty-one CDC-funded state and local HDs in the United States, Puerto Rico, and the US Virgin Islands and between 122 and 175 CDC-funded CBOs, depending on the year. Persons who received HIV testing at CDC-funded CBOs and HDs. The number of HIV tests and positivity at CBOs were compared with HDs overall and to HDs in non-health care settings that, like CBOs, include HIV risk data and are in similar locations. CBOs accounted for 7625 (8%) new diagnoses but conducted only 3% of the almost 19 million CDC-funded HIV tests from 2012 to 2017. Newly diagnosed HIV positivity at CBOs (1.4%) was nearly 3 times the new positivity at HDs overall (0.5%) and twice that of new positivity at HDs in non-health care settings (0.7%). A higher proportion of tests at CBOs were conducted among groups at risk, and new HIV positivity was higher for most demographic and population groups than new HIV positivity at HDs in non-health care settings. These findings demonstrate the essential role CDC-funded CBOs have in reaching, testing, and diagnosing groups at high risk for acquiring HIV infection.

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.

Who’s that SMARTgirl? Reaching Cambodian Female Entertainment and Sex Workers with HIV Prevention Services

Engagement in prevention services is crucial to reducing HIV risk among female entertainment and sex workers (FESW), and SMARTgirl is the national social marketing HIV prevention program for Cambodian women engaged in sex and entertainment work. Informed by the Behavioral Model of Vulnerable Populations, three multivariate logistic regression analyses examined correlates of three indices of engagement along the SMARTgirl HIV prevention continuum: (1) receipt of outreach services (past 3months); (2) being registered as a SMARTgirl member; and (3) SMARTgirl club attendance (past year). Among the 1077 FESW enrolled in nine Cambodian provinces, women working in a brothel or freelance (adjusted odds ratio [aOR] 2.48; 95% CI 1.44-4.26) and those exchanging sex for drugs during the past 3months (aOR 0.45; 95% CI 0.25-0.81) had significantly lower odds of contact with a SMARTgirl outreach worker. Women who reported having more than ten sexual partners in the past 3months (aOR 0.54; 95% CI 0.32-0.89) and those who reported binge alcohol use (aOR 0.53; 95% CI 0.29-0.98) had significantly lower odds of being registered as SMARTgirl members. Exchanging sex for drugs was also associated with increased odds of attending a SMARTgirl club (aOR 2.03; 95% CI 1.04-3.98). Novel methods to deliver HIV prevention services are warranted to more effectively reach FESW who exchange sex for drugs, engage in binge alcohol use, report a greater number of sexual partners, and those not working in established work venues.

Multilayered Stigma and Vulnerabilities for HIV Infection and Transmission: A Qualitative Study on Male Sex Workers in Zimbabwe.

Male sex workers are marginalized in most societies due to intersectional stigma between prostitution and homosexuality. In Zimbabwe, a proliferation of male sex workers in major cities such as Harare and Bulawayo has been reported. However, there is a shortage of studies that explore their lives. The current qualitative study aims to describe the practices of sex work, life contexts, and HIV risks and vulnerabilities based on in-depth interviews among 15 male sex workers in Bulawayo. Our studies suggest that the stigma against male sex workers comes from diverse sectors including culture (“homosexuality is un-African, introduced by the Whites”), religion (“same sex is a sin before the God”), law and police (“homosexuality is illegal in Zimbabwe. Engaging in it can send one to prison”), media (“the media is hostile to sex workers particularly men as we are regarded as abnormal and unclean”), and their family (“should they get to know about it, they will disown me”). In this context, male sex workers were excluded from national HIV prevention and treatment programs. They had limited knowledge and many misconceptions about HIV. The stigma and discrimination from health-care providers also discouraged them from health seeking or HIV testing. The non-disclosure to female partners of convenience and sexual relations further increased their vulnerabilities to HIV infection and transmission. Current efforts to address the HIV epidemic should pay attention to male sex workers and tackle the intersecting stigma issues. male sex workers need support and tailored HIV prevention and treatment services to improve their HIV prevention practices, health, and well-being.

Changes in HIV prevention programme outcomes among key populations in Kenya: Data from periodic surveys.

The Kenya National AIDS and STI Control Programme (NASCOP) conducted annual polling booth surveys (PBS) in 2014 and 2015 to measure outcomes from the national HIV prevention programme for key populations (KPs), comprising behavioural, biomedical and structural interventions. KPs included female sex workers (FSWs), men who have sex with men (MSM) and people who inject drugs (PWID). We compared survey results from the first and second rounds. Comparing the second to the first round, significantly more FSWs (93% vs. 88%, p<0.001) and MSM (77% vs. 58%, p<0.001) reported condom use at last sex with a paying client, and at last anal sex among MSM (80% vs. 77%, p<0.05) and PWID (48% vs. 27%, p<0.01). However, condom use with regular partners remained low, at less than 53% for FSWs and 69% for MSM. Among PWID, there was a significant increase in use of new needles and syringes at last injection (93% vs. 88%, p<0.001), and a significant decrease in reported non-availability of clean needles (23% vs. 36%, p<0.001). The number of overdoses in the past six months reduced significantly but remained high (40% vs. 51%, p<0.001). FSWs and MSM reported significantly higher HIV testing, and in all KP groups, over 93% reported ever having been tested for HIV. Among the respondents self-reporting to have tested HIV positive (24% of FSW, 22% of MSM and 19% of PWID), 80% of FSWs, 70% of MSM, and 73% of PWID reported currently taking antiretroviral therapy (ART). While the experience of forced intercourse by partners declined among FSWs (18% vs. 22%, p<0.01) and MSM (13% vs. 17%, p<0.01), more FSWs reported violence by law enforcement personnel (49% vs. 44%, p<0.001). These findings provide valuable information on the programme’s progress, and a signpost for the integrated behavioural, biomedical and structural interventions to achieve their HIV prevention targets.

Sustainability Capacity of HIV Programs in National Capital Region, Philippines

&lt;span lang="EN-US"&gt;Across all the regions in the Philippines, the National Capital Region (NCR) got the highest percentage (37%) for HIV newly diagnosed cases based from the July-August 2017 HIV/AIDS and ART Registry of the Philippines’ report. The National HIV, AIDS, and STI Prevention and Control Program (NASPCP) of the Department of Health (DOH) lead the different health services in the prevention of HIV transmission. Anchored with the NASPCP, different HIV programs of DOH’s selected partner institutions and organizations within NCR continuously exist. However, due to the increase on the number of newly diagnosed HIV cases in the country, ensuring its sustainability through assessing the different domains of their program was in need to be studied. This article was based from an undergraduate thesis study which aimed to assess the sustainability capacity of HIV programs among DOH’s selected partner institutions and organizations within NCR, Philippines, scoping the eight domains specifically the environmental support, funding stability, partnerships, organizational capacity, program evaluation, program adaptation, communications, and strategic planning. The study used a quantitative approach; 17 government institutions specifically city health offices and 13 non-government HIV-related organizations for a total of 30 respondents. Survey method was utilized using the standardized Program Sustainability Assessment Tool adapted from the Washington University in St. Louis. Based from the results and findings of the study, generally, all the domains were leaning either in great and greater extent as verbally interpreted. From the conclusion, all the domains of the HIV programs of the respondents were sustainable. However, the study recommended to the DOH and all the HIV program implementers the developed and proposed narrative-type action plan. By that means, future researchers can assess again and see if the NCR achieved the vision of the Health Sector Plan for HIV and STI for the year 2015-2020 to have zero new infections, zero discrimination, and zero AIDS-related deaths.&lt;/span&gt;

Effects of exposure to an intensive HIV-prevention programme on behavioural changes among female sex workers in Nairobi, Kenya

While Kenya has had a long-standing national HIV-prevention programme, evidence on the level of exposure to its interventions and related effects on behavioural changes among female sex workers (FSWs) is limited. Using cross-sectional behavioural data collected in 2013 from 1 357 FSWs aged 18 years and above in Nairobi, Kenya, this study explores the relationship between FSW programme exposure levels and behavioural outcomes including condom use, sexually transmitted infection (STI)-treatment, and empowerment measures like disclosure of self-identity and violence reporting. We categorised programme exposure levels as none, moderate and intensive. Multivariate logistic regression was used for analysis. Overall, 35% of the FSWs were not exposed to any HIV prevention programme, whereas about 24% had moderate and 41% had intensive exposure. FSWs having intensive programme exposure had a higher likelihood of using condoms consistently with occasional clients (AOR: 1.57; 95% CI: 1.08–2.31) and seeking treatment for STIs (AOR: 3.37; 95% CI: 1.63–7.02) compared to FSWs with no or moderate exposure. Intensive programme exposure was also associated with higher self-disclosure of sex-work identity (AOR: 1.63; 95% CI: 1.19–2.24), reporting of violence to police (AOR: 2.45; 95% CI: 1.03–5.84), and negotiation of condom use at last sex when the client was under the influence of alcohol (AOR: 1.63; 95% CI: 0.94–2.82). Although HIV prevention programmes in Kenya have been underway for over a decade, programme efforts were largely focused on saturating the coverage (intervention breadth). Strategies should now focus on ensuring improved quality of contacts through intensified programme exposure (intervention depth) to enhance gains in behavioural change among FSWs and preventing the burden of HIV infection among them.

“I am the man”: Meanings of masculinity in perceptions of voluntary medical adult male circumcision for HIV prevention in South Africa.

Despite significant financial and human resources mobilized to manage current infections and prevent new cases HIV prevalence remains high in South Africa. The intractability of HIV has resulted in calls for the implementation of novel HIV prevention strategies (UNAIDS 2013) such as Voluntary Medical Adult Male Circumcision (VMAMC) as a part of a comprehensive HIV prevention intervention. Whether traditionally practiced or not male circumcision is powerfully implicated in meanings of masculinity in South Africa. The national rollout of VMAMC tensions traditional masculinity against various biomedical apprehensions particularly in the language and logic of HIV prevention. As such this paper explores how this tension is negotiated in participants perceptions of VMAMC as a South African public health intervention. Semistructured repeat interviews conducted with 30 adult men from Johannesburg were analyzed using a Straussian grounded theory approach. Three primary categories revealed that meanings of masculinity within the context of VMAMC are underpinned (a) by adopting an active role in the fight against HIV in South Africa (b) as understanding the tension between tradition and medicine and/or (c) by using tradition as a means to reappropriate or reject the practice. These categories suggest that the removal of the foreskin cannot simply be reduced to a biomedical practice on or related to male bodies assumed to be unmediated by culture and history. These findings hold significant implications for the implementation of a national VMAMC HIV prevention program in South Africa.

Notification following new positive HIV test results.

Client notification of a new HIV diagnosis is critical for timely access to treatment and reduction in behaviours associated with HIV infection. It is also an important input in HIV transmission and disease progression models. We used national, Centers for Disease Control and Prevention-funded HIV testing events data collected through the National HIV Prevention Program Monitoring and Evaluation system to update estimates of the proportion of newly identified HIV-positives notified of their status. We compared estimates from 2008 to 2010 across test technologies, settings, and HIV risk groups. In 2010, notification following a positive rapid test was 99.6% compared with 99.3% in 2008. Notification following a positive conventional test was 81.5% in 2010 compared with 80.8% in 2008. To realise the full promise of early HIV diagnosis and treatment for the prevention of additional HIV cases, efforts to ensure prompt notification following a new HIV diagnosis will be crucial.

The COBATEST network: a platform to perform monitoring and evaluation of HIV community-based testing practices in Europe and conduct operational research

ABSTRACTThe European project “HIV community-based testing practices in Europe” (HIV-COBATEST) has contributed to the establishment of a network of community-based voluntary counselling and testing services (CBVCTs) that monitors and evaluates HIV testing activity in the communities. The objective of this paper is to describe the data that have been collected during 2014 by the COBATEST network in order to provide an insight into testing activity of CBVCTs in Europe. Members of the CBVCT network share common instruments for data collection and data entry. The network has a common database that allows global data analysis and comparison between different centres. In 2014, 40 CBVCTs of 18 European countries were participating in the network, and, from those, 20 CBVCTs were using the common COBATEST data collection tools. In these 20 CBVCTs, a total of 9266 HIV screening tests were performed on 8554 people, of which 1.58% (135/8554) were reactive and 51.1% (69/135) confirmed positive. Five cases were false positives, and 84.1% (58/69) of the confirmed positive cases were linked to care. Most of the tested individuals were men (70.8%), between 21 and 35 years of age (57.6%) and natives (67.1%). A higher proportion of men who had sex with men (MSM) (38.8%; 3267/8554) were tested compared to heterosexual men (27.7%) and women (23.5%). Rapid blood test was used in 78.5% of the cases and mostly performed in CBVCT offices (88.3%). Among sex workers (SWs), the percentage of reactive screening tests was particularly high (4.0%), especially among male SWs (7.7%) as compared to other risk groups, such as MSM (3.1%). The COBATEST network contributes to the availability of standardized information about the activity and impact of CBVCT centres in Europe. This information and standardized tools can help improve these services and inform decision-makers to better contextualize these interventions within their national HIV-prevention programmes.

Knowing your HIV/AIDS response: A pilot test of a new service mapping toolkit in Ghana

Background“Knowing” an HIV response in a country is a complex undertaking. This requires knowing what actions key implementers in all sectors (government, non-government, public, and private) are deploying; what populations they serve; what the reach of these programs are, amongst others. AimWe aimed to pilot test a set of newly developed data collection tools referred to as the Know Your Response (KYR) toolkit in Ghana. The KYR toolkit addresses three key concepts that are critical for an improved understanding of the HIV-prevention response in terms of location, scale, and needs. Materials and methodsData were collected on HIV programming being undertaken in each of the 16 metropolitan, municipal, and district assemblies (MMDAs) in the Greater Accra region of Ghana. Analysis and dissemination of data includes the generation of univariate and bivariate tabulations as well as production of maps of HIV services using Geographic Information System (GIS) technology. ResultsThe toolkit was successful in collecting a great deal of data that describe, at the district level, who is working in HIV prevention, what interventions they are providing, where these interventions are being provided, and to whom the interventions are being targeted. The data generated allows for mapping and understanding of the scope and scale of the HIV-prevention response at the district level. It also identifies challenges and opportunities for scaling the exercise nationally. ConclusionsThe study provides information needed to guide prioritization, and/or adjustment of the national HIV-prevention programs and interventions being carried out in the Greater Accra region.