Risk Of HIV Exposure Research Articles

Examining concordance of sexual-related factors and PrEP eligibility with HIV risk perception among adolescent girls and young women: cross-sectional insights from DREAMS sites in Kenya, Malawi, and Zambia

BackgroundHIV risk perception is an important cognition for prevention, theoretically engendering service-seeking and risk-reduction behaviors, but its composition remains poorly understood. We examined country-specific correlates of self-appraised HIV exposure risk among sexually active adolescent girls and young women (AGYW, aged 15–24 years) without HIV in Kenya, Malawi, and Zambia. We also explored overlaps between self-appraised HIV exposure risk and pre-exposure prophylaxis (PrEP) eligibility to identify engagement opportunities.MethodsWe analyzed cross-sectional data (2016/2017) to estimate sexual-related correlates of self-appraised HIV exposure risk (likely vs. not, temporally framed as “ever”) using log-Poisson models with robust standard errors. For sexual-related factors with an unadjusted p ≤ 0.10, individual adjusted models were fitted, controlling for sociodemographic and cognitive factors with an unadjusted p ≤ 0.10. PrEP eligibility was defined using national guidelines; since conditional criteria are in Malawi’s (age-disparate sex + ever-pregnant) and Zambia’s (multiple partners + condomless sex) guidelines, we also assessed PrEP eligibility after decoupling these factors.ResultsFew AGYW reported likely HIV exposures (Kenya [N = 746]: 15.7%, Malawi [N = 1348]: 46.2%, Zambia [N = 349]: 9.5%) despite ubiquitous HIV risk (98.7%, 99.8%, and 98.9% of Kenyan, Malawian, and Zambian AGYW reported ≥ 1 sexual-related factor). However, the adjusted models found some actual-perceived risk concordance. Positive correlates of self-appraised likely HIV exposures included partner(s)’ likely HIV exposure (all countries); partner(s)’ unknown HIV status and other partners (Kenya, Malawi); STI symptoms and partner(s) living outside the community (Kenya); non-partner sexual violence (Zambia); and transactional sex, multiple partners, pre-coital alcohol use, and physical/sexual intimate partner violence (Malawi). Per national guidelines, PrEP eligibility criteria differentially identified HIV risk (Kenya: 93.6%, Malawi: 53.3%, Zambia: 44.6%), and self-appraised likely HIV exposures were low among PrEP-eligible AGYW (Kenya: 16.5%, Malawi: 48.5%, Zambia: 18.8%). Decoupling Malawi’s and Zambia’s conditional PrEP criteria could increase risk identification to > 85% and potential engagement by ~ 70% and ~ 30%, respectively.ConclusionsAGYW's HIV risk perceptions were mostly influenced by factors beyond their locus of control. Conditional PrEP eligibility criteria may inhibit AGYW’s access and uptake in some settings: countries should consider decoupling these factors to minimize barriers. Intersections between autonomy, behaviors, and perceptions among AGYW in gender-inequitable settings warrants further investigation.

Acceptability, facilitators, and barriers to a hypothetical HIV vaccine in the pre-exposure prophylaxis era

ABSTRACT Little is known about the pre-implementation context for a preventive HIV vaccine. We conducted interviews of individuals in Philadelphia recruited at Penn clinics and community-based organizations serving LGBTQ-identifying persons of color who 1) were cisgender men who had sex with men, or were transgender-identified, 2) had a sexually transmitted infection in the last 12 months, or sex with multiple partners within the last two weeks. We assessed acceptability, facilitators, and barriers to a hypothetical HIV vaccine using an integrated analysis approach. We interviewed 30 individuals between 2/2023-9/2023. Participants were supportive of an HIV vaccine and reported that they would strongly consider receiving one if one became available. Participants contextualized a hypothetical vaccine with the current HIV prevention context, primarily pre-exposure prophylaxis (PrEP), indicating that they would evaluate any future vaccine in comparison to their experience within the PrEP landscape. Reported facilitators for a hypothetical HIV vaccine included vaccine access, knowledge, and understanding; their risk for HIV exposure; and perceived benefits of the vaccine. Barriers included lack of understanding of the purpose of a vaccine, stigma surrounding HIV and sexual practices that may surface towards people who seek vaccination, and potential issues with effectiveness, side effects, or lack of availability.

Unawareness of partner risk factors thwarts implementation of USPSTF recommendations for HIV pre-exposure prophylaxis in primary care

ABSTRACT The United States Preventive Services Task Force recommends pre-exposure chemoprophylaxis for persons at high risk of HIV exposure. The optimal screening strategy for at-risk individuals in primary care is not known. We evaluated the strategy of universal screening and discussed challenges to the implementation of this recommendation in primary care. Around 430 of 500 (86%) screening surveys were completed. Mutual monogamy was common but monogamous partners with recent negative HIV testing were uncommon. Likewise, among heterosexually active men and women, inconsistent condom use was common. Such individuals would be on guideline for HIV pre-exposure prophylaxis (PrEP) if their partner was at risk for HIV exposure. None of these potentially at-risk individuals met the criteria for PrEP, but 13% lacked knowledge of their partners' sexual and behavioral risk factors, preventing a clear decision on whether PrEP should be used. Our screen identified no individuals who clearly met the guideline criteria for HIV PrEP. We conclude that universal screening for HIV PrEP in primary care is unlikely to be an efficient strategy; targeted screening is likely more appropriate. Moreover, the 2019 guidelines for heterosexually active men and women rely on information that is often unknown to the patient, which makes these guidelines difficult to implement. Future guidelines should address these problems.

Characteristics Associated with Pre-Exposure Prophylaxis Discussion and Use Among Transgender Women Without HIV Infection - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020.

CDC recommends pre-exposure prophylaxis (PrEP) for transgender women who have sex with men and who report sexual behaviors that place them at substantial ongoing risk for HIV exposure, including those who engage in nonsterile syringe sharing. Providing transgender women with access to PrEP is a critical strategy for reducing HIV acquisition and ending the HIV epidemic. Survey results from the National HIV Behavioral Surveillance Among Transgender Women were used to assess characteristics associated with past-year discussions of PrEP with a health care provider and PrEP use. Bivariate analyses were conducted to assess the association between covariates (sociodemographic, HIV-associated characteristics, and gender-affirming care) and each outcome, accounting for sampling design. All covariates that were statistically significant at p<0.05 in the bivariate analyses were included in multivariate models, and manual backward elimination was used to obtain final models that retained statistically significant covariates. Among 902 transgender women from seven urban areas in the United States without HIV infection in the analyses, 57% had recently discussed PrEP with a health care provider, and 32% recently had used PrEP. In the final multivariate model, the following subgroups of transgender women were more likely to report recent PrEP use: those who identified as Black or African American or Hispanic or Latina, had two or more sex partners in the past 12 months, had condomless sex in the past 12 months, reported their last sex partner was infected with HIV, had condomless sex with their last sex partner whose HIV status was positive or unknown, ever had transgender-specific health care, and currently had transgender-specific health insurance coverage. Participants who were less likely to have recently used PrEP were those who wanted to but were not currently taking hormones and those aged <40 years. Providing increased access to gender-affirming care and training health care providers who serve transgender women to incorporate PrEP into existing services might increase PrEP use among transgender women.

HIV preexposure prophylaxis treatment patterns in a national health plan population.

Medication nonadherence diminishes the benefits of preexposure prophylaxis (PrEP) for the 1.2 million Americans at risk for HIV exposure. To describe HIV PrEP treatment patterns among Medicare Advantage Prescription Drug (MAPD) plan and commercially insured beneficiaries. This retrospective cohort study identified patients aged 16 to 89 years with at least 1 dispensing of emtricitabine-tenofovir disoproxil fumarate from July 2012, through December 2020, or emtricitabine-tenofovir alafenamide from October 2019 through December 2020, and who were continuously enrolled at least 12 months prior to and following the earliest PrEP claim. Outcomes were HIV PrEP adherence measured by proportion of days covered (PDC) using 2 binary thresholds of 0.60 (4 doses/week) and 0.80 (5-6 doses/week) and duration of index treatment episode, total time on treatment, and total number of prescription fills. The study cohort of 707 (292 MAPD plan, 415 commercial) was predominantly made up of male patients (90.0%) and resided in the South (78.9%) with a mean age of 46.2 years (MAPD plan: 54.5, commercial: 40.4). Both populations engaged in high-risk sexual behavior (All: 18.7%, MAPD plan: 16.8%, commercial: 20.0%) and experienced sexually transmitted infections (All: 3.3%, MAPD plan: 2.1%, commercial: 4.1%). The mean index treatment episode length was 297.0 days (MAPD plan: 283.6, commercial: 306.5). Total time on treatment was 477.3 days (MAPD plan: 450.7, commercial 496.0). At 3 months, 84.9% (MAPD plan: 83.6%, commercial: 85.8%) and at 12 months, 58.7% (MAPD plan: 57.2, commercial: 59.8) of patients achieved a PDC of at least 0.80. At 3 months, 100.0% (MAPD plan: 100.0%, commercial: 100.0%), and at 12 months, 74.3% (MAPD plan: 70.2%, commercial: 76.9%) of patients achieved a PDC of at least 0.60. The cohort had a mean of 16.4 fills of 30 days (MAPD plan: 16.4, commercial: 16.3) supply. There is an opportunity for clinical programs to focus on improving longer-term PrEP adherence among individuals at risk for HIV exposure.

Mixed methods implementation research to understand success of intensive combination approach to roll back the epidemic in Nigerian adolescents) (iCARE Nigeria) HIV testing uptake and linkage to care among young men focusing on young men who have sex with men in Ibadan

BackgroundHIV seroprevalence in Nigeria is increasing among men who have sex with men (MSM) from 14% to 2007 to 23% in 2014, threatening progress towards ending the epidemic in the country. Expanding access to HIV testing and linkage to care for key populations, like young MSM (YMSM), is critical to end the HIV epidemic in Nigeria. The Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria) pilot intervention successfully implemented a combination of evidence-based interventions utilizing peer navigators and popular social media apps and platforms to reach young men at risk for HIV exposure, including YMSM. We conducted sequential mixed methods explanatory implementation research to expand on the previously reported effectiveness and implementation outcomes and to explore the determinants and strategies which contributed to primary study results.MethodsWe conducted key informant interviews and focus group discussions with 2 peer navigators and 3 study staff at the end of the pilot. We used directed content analysis to understand the quantitative results from the pilot. Using the Implementation Research Logic Model, we were able to identify and map strategies through mechanisms of action from barriers addressed to the reported implementation outcomes including feasibility, acceptability fidelity and adoption.ResultsWe found that iCARE Nigeria’s pilot intervention implementers reported high feasibility, acceptability fidelity and adoption were associated with implementation of strategies which addressed many challenging contextual factors, including social stigma, online social networking, legal barriers surrounding MSM behavior, and the COVID-19 pandemic. These strategies included integration of stakeholders’ interests, selection of experienced peer navigators including from the targeted population, training and supportive supervision using an implementation guide, ensuring safety (COVID and legal) and identification of clinics serving the targeted population.ConclusionMixed methods using implementation research frameworks provided insights into the strategies and barriers and facilitators they addressed which may explain the success of the pilot. These results can inform strategies needed to scale-up the intervention to youth including YMSM in other areas in Nigeria and the region.Trial registration ISRCTN: ISRCTN94590823, https://doi.org/10.1186/ISRCTN94590823

La santé sexuelle des hommes trans : entre problèmes de catégorisation et invisibilisation

Sexual minorities have been disproportionally impacted by the HIV-Aids epidemic. Their high prevalence motivated sexual health research that first focused on gay men, then trans women. Trans men have been considered at very low risk of exposition, Hence the scarce number of research about them. However, an emerging literature is showing diversified and surprising results regarding the reasons for their initial exclusion. This article seeks to establish the state of knowledge on trans men's sexual health through a French and international literature review. Trans men have a variety of partners, sexual and non-sexual practices (IDU) that leads to categorize them at high risk of HIV exposure. The proportion of trans men who are HIV positive still is difficult to assess. It is estimated to be high in the USA, and close to zero in France. Low screening rates, difficulties accessing health care, and identification problems in the very classification of people suggest that they might be more of them. Trans men also report discriminations in access to health care services, and specific health vulnerabilities. Gynecology and reproductive health are rarely even mentioned. Rethinking the categories used in research would produce a more accurate representation of the varied realities of trans people.

Efficacy of HIV and AIDS education programs in the Elmina fishing community in Ghana

One of the most important steps in HIV prevention is the provision of education to raise awareness to ensure individuals have a sufficient understanding of HIV and AIDS and encourage them to apply that knowledge. The study is based on an earlier descriptive cross-sectional study that sought a link between fishers’ mobility and their risk of HIV exposure in the Elmina fishing community in Ghana. The current paper focuses on initiatives taken within the study area to inform fishers about HIV and AIDS. Additionally, it analyzes the successes and challenges of these programs and offers suggestions for improvement. Public and community durbars, town hall meetings, radio and television transmission, film creation, and the distribution of IE&C materials are the main strategies utilized to carry out HIV and AIDS education. The results suggest that few fishers in the study area take part in programs, whiles projects on HIV and AIDS cannot be implemented consistently and effectively due to a lack of funding and delays in the delivery of government funds. To enable organizations whose mandates, relate to HIV and AIDS interventions to carry out the programs timely and fully, it is advised that government enhances its financing and ensures the timely and full release of program funds.

Impact of COVID-19 on the Belgian HIV epidemic: slowdown of HIV transmission and testing and adaptation of care

BackgroundTo gain insight into the impact of the COVID-19 pandemic and containment measures on the HIV epidemic and services, this study aims to describe HIV trends in 2020 and compare them with previous years.MethodsBelgian national HIV surveillance data 2017–2020 were analysed for trends in HIV testing, HIV diagnoses, VL measurements, ART uptake and PrEP purchase. Descriptive statistics from 2020 are compared to annual averages from 2017 to 2019 (proportional difference, %).ResultsIn 2020, 725 HIV infections were diagnosed in Belgium (− 21.5% compared to 2019). The decline was most pronounced during the first lockdown in April–May but also present in July–December. The number of HIV tests performed decreased by 17.6% in 2020, particularly in March–May and October–December (− 57.5% in April and -25.4% in November 2020 compared to monthly 2017–19 numbers). Diagnosis of acute HIV infections decreased by 47.1% in 2020 (n = 27) compared to 2019 (n = 51). Late HIV diagnoses decreased by 24.7% (95% CI [− 40.7%; -9.7%]) in 2020 compared to 2019. Of patients in care in 2019, 11.8% interrupted HIV care in 2020 compared to 9.1% yearly in the 3 previous years. The number of HIV patients with VL monitoring per month dropped in March–May 2020, whilst proportions of VL suppression and ART coverage remained above 86% and 98.5% respectively in 2020. PrEP purchases, number of purchasers and starters dropped during April–May 2020 (respectively − 45.7%, − 47.4%, − 77.9% in April compared to February 2020).ConclusionsThe significant decrease in HIV diagnoses in Belgium in 2020 coincided with the COVID-19 pandemic and following containment measures, particularly in April–May during the first lockdown. A slowdown of HIV transmission due to reduced HIV risk exposure is suggested by the halving in diagnosis of acute HIV infections in March-December 2020 compared to the previous year, and the adaptive decrease in PrEP use and PrEP initiation from April onwards. Despite a slight increase in HIV care interruptions, the indicators of quality of HIV care remained stable. Access to prevention, testing and care for all people living with HIV and at risk of acquiring HIV is a priority during and after times of pandemic.

What do adolescents value most and is this affected by HIV status? Aspirations and self-perceptions from a large cohort study in South Africa

ABSTRACT Hundreds of millions of adolescents across Africa face challenges in many areas of their lives, including elevated risk of HIV exposure and acquisition. Understanding the aspirations and self-perceptions of adolescents could play an important role in better targeting effective investments to break the cycle of adversity for adolescents and into their adulthood. Aiming to understand what adolescents value most for themselves and their future, we analysed and summarised cross-sectional data on the aspirations and self-perceptions of 1519 adolescents living in South Africa, overall and by HIV status. Outcomes were coded from participant responses to two open-ended questions: ‘What job do you want to do when you grow up?’ and ‘What are you most proud of about yourself?’. Associations with HIV status were then evaluated using multivariable logistic regression adjusting for six sociodemographic factors measured from the same cohort. The sample had a mean age of 14 years, 55% were female, and 70% were living with HIV. The five most common job aspirations were: ‘Health and Medical Science Professionals’ (28%), ‘Law Enforcement and Public Safety Professionals’ (14%), ‘Social Work Associate Professionals’ (12%), ‘Legal Professionals’ (9%), and ‘Education Institutions Teaching Professionals’ (6%). The top five themes for what adolescents were most proud of about themselves were ‘School performance’ (22%), ‘Outward appearance’ (15%), ‘Sports skills’ (12%), ‘Personality’ (11%), and ‘Behaviour at home/with elders’ (7%). Adjusted analysis showed no evidence that HIV status was associated with important differences in aspirations or self-perceptions. In conclusion, adolescents facing high levels of adversity in South Africa hold high value for their education and aspirations for their futures. Policies and initiatives should focus on meeting these aspirations as vehicles for development, independent of their HIV status. Therefore, more needs to be done to not just help adolescents survive but thrive into adulthood.

An mHealth Intervention to Improve Pre-Exposure Prophylaxis Knowledge Among Young Black Women in Family Planning Clinics: Development and Usability Study.

BackgroundYoung Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices.ObjectiveThe aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app.MethodsUsing user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app’s feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app.ResultsA total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=–6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80%) agreed that the app was easy to use, and 48 (96%) agreed that they found the information in the app easy to understand. Finally, 40 (80%) agreed that they had enjoyed using the app while waiting for their family planning visit.ConclusionsOur findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app’s impact on PrEP uptake.

Maximizing the Impact of Voluntary Medical Male Circumcision for HIV Prevention in Zambia by Targeting High-Risk Men: A Pre/Post Program Evaluation

A well-documented barrier to voluntary medical male circumcision (VMMC) is financial loss due to the missed opportunity to work while undergoing and recovering from VMMC. We implemented a 2-phased outcome evaluation to explore how enhanced demand creation and financial compensation equivalent to 3 days of missed work influence uptake of VMMC among men at high risk of HIV exposure in Zambia. In Phase 1, we implemented human-centered design-informed interpersonal communication. In Phase 2, financial compensation of ZMW 200 (~ US$17) was added. The proportion of men undergoing circumcision was significantly higher in Phase 2 compared to Phase 1 (38% vs 3%). The cost of demand creation and compensation per client circumcised was $151.54 in Phase 1 and $34.93 in Phase 2. Financial compensation is a cost-effective strategy for increasing VMMC uptake among high-risk men in Zambia, and VMMC programs may consider similar interventions suited to their context.

Fish-for-Sex (FFS) and risk of HIV Infection among Fishers in Elmina Fishing Community in Ghana

This paper is a follow-up to a cross-sectional study which employed mix-methods for data collection and analysis to investigate a relationship between mobility and HIV risks amongst 385 fishers in Elmina. It discusses the roles of men and women in fish-for-sex (FFS), reasons for such transactional sexual activity and its implications for HIV risk infection. The theory of gender and power has been utilized to explain gender dynamics in power inequalities, and their effects on interpersonal sexual relationships between males and females within the fishing community. The paper concludes sex-division of labour exists in the study area and thrives on socio-cultural norms and power inequalities, which mainly favours men, as it gives them the power to exploit women through the supply of fish. Another observation from the paper is that as long as the female fishers require capital for their fish trade and the male fishers have greater control over the supply of the fish, the women will have very little basis to negotiate for. The paper therefore establishes linkage between fish-for-sex relationship and risk of HIV exposure among fishers in Elmina. The paper recommends empowerment of female fishers by granting them trading capital to limit their overdependence on male fishers for capital, and prevent them from exchanging sex for fish. The paper also calls for the intensification of education by relevant agencies involved in HIV education on safe sex practices through the use of condoms in fishing communities.

Association between rectal gonorrhoea and HIV incidence in men who have sex with men: a meta-analysis

BackgroundIncidence of rectal gonorrhoea (GC) has been hypothesised as a correlate of HIV exposure in prevention trials of men who have sex with men (MSM). High rectal GC incidence in...

A randomized group antenatal care pilot showed increased partner communication and partner HIV testing during pregnancy in Malawi and Tanzania

BackgroundHIV testing at antenatal care (ANC) is critical to achieving zero new infections in sub-Saharan Africa. Although most women are tested at ANC, they remain at risk for HIV exposure and transmission to their infant when their partners are not tested. This study evaluates how an HIV-enhanced and Centering-based group ANC model-Group ANC+ that uses interactive learning to practice partner communication is associated with improvements in partner HIV testing during pregnancy.MethodsA randomized pilot study conducted in Malawi and Tanzania found multiple positive outcomes for pregnant women (n = 218) assigned to Group ANC+ versus individual ANC. This analysis adds previously unpublished results for two late pregnancy outcomes: communication with partner about three reproductive health topics (safer sex, HIV testing, and family planning) and partner HIV testing since the first antenatal care visit. Multivariate logistic regression models were used to assess the effect of type of ANC on partner communication and partner testing. We also conducted a mediation analysis to assess whether partner communication mediated the effect of type of care on partner HIV testing.ResultsNearly 70% of women in Group ANC+ reported communicating about reproductive health with their partner, compared to 45% of women in individual ANC. After controlling for significant covariates, women in group ANC were twice as likely as those in individual ANC to report that their partner got an HIV test (OR 1.99; 95% CI: 1.08, 3.66). The positive effect of the Group ANC + model on partner HIV testing was fully mediated by increased partner communication.ConclusionsHIV prevention was included in group ANC health promotion without compromising services and coverage of standard ANC topics, demonstrating that local high-priority health promotion needs can be integrated into ANC using a Group ANC+. These findings provide evidence that greater partner communication can promote healthy reproductive behaviors, including HIV prevention. Additional research is needed to understand the processes by which group ANC allowed women to discuss sensitive topics with partners and how these communications led to partner HIV testing.

Predictors of HIV Infection Risk among Health-Care Workers in Sub-Saharan Africa: A Systematic Review

The study set out to investigate the predictors of HIV infection risk among healthcare workers in SSA through a systematic review. The aim of the study was to identify, collect and systematically review and synthesize existing literature articles on the predictors of HIV infection risk among healthcare workers in SSA. The objectives of the study were to: determine the prevalence of health care workers’ exposure to HIV risky conditions in health care settings in SSA; identify selected predictors of HIV infection risk among Health care workers in SSA (major focus in Nigeria, South Africa, and Tanzania) and apply effective strategies to prevent issues associated with HIV infection risk among Health care workers. The study conceptualizes that HCWs in the SSA region are at risk of HIV infection due to factors related to lack of healthcare resources, their knowledge, attitude and practice, and barriers to reporting. The combined effect of these factors is that hoped to determine the propensity of HCWs to be infected by HIV/AIDS. The key themes guiding the systematic review were: risk to exposure to HIV among HCWs; lack of health care resources and facilities. The findings of the study confirmed all the three alternative study hypotheses that: there is a significant relationship between lack of health care resources and facilities and the risk of HIV infection among HCWs in SSA; there is a significant relationship between HCWs’ knowledge, attitude, and practice on HIV and their risk of HIV infection in SSA and; there is a significant relationship between barriers to reporting and the risk of HIV infection among HCWs in SSA. In this regard, the study found out that HCWs in SSA are at high risk of HIV exposure whilst working. In this regard, this is a result of lack of enough equipment, poor practices at work and barriers to reporting, including stigmatization and lack of well-stipulated reporting guidelines. As such, the following recommendations were made:: there is a need to increase funding in the health care sector to enhance access to the right equipment, microbicides, vaccination, and PEP for HCWs; there is a need for psychosocial support systems to make it easy for HCWs to report infection with ease and that; the government should adopt recommended global best standards to enhance protection of HCWs while at work in SSA. Two areas for further study were also recommended. As such, there is a need for studies on each of the study objectives, and; there is a need for a descriptive study on the topic under investigation in this study for correlation purposes.

Social Determinants of Transactional Sex in a Sample of Young Black and Latinx Sexual Minority Cisgender Men and Transgender Women

PurposeWe sought to explore characteristics and risk factors associated with transactional sex in a sample of young black and Latinx sexual minority cisgender men and transgender women of age 15 to 24 years who were living with or at high risk for HIV infection and whether these associations vary by gender identity and HIV status. MethodsA total of 454 black and Latinx sexual minority cisgender men and transgender women from Baltimore, MD; Philadelphia, PA; Washington, DC; and St. Petersburg/Tampa, Fl, were recruited to participate in a multisite study that included a 45-minute baseline Web-based survey and HIV-1 rapid testing. Bivariate analysis was used to explore factors associated with transactional sex. Factors significant at p-value <.20 in bivariate analysis were entered into a final logistic regression models; and models were further stratified by gender identity and HIV status. ResultsThe mean age was 21.3 (standard deviation = 2.5), with 14.7% (n = 65) identifying as transgender, and 103 youth (22.7%) reporting lifetime transactional sex. Transactional sex was associated with transgender identity, recent unstable housing in the last 12 months, poorer perceived financial well-being, coerced sex, and marijuana use. Differences were noted by gender identity and HIV status, with marijuana use associated with transactional sex in cisgender men and unstable housing and sexual coercion in youth living with HIV. ConclusionsYoung black and Latinx cisgender men and transgender women are at a high risk for engaging in transactional sex. Transactional sex may create a syndemic for HIV risk exposure through co-occurring and reinforcing conditions of unstable housing, violence, and substance use.

HIV treatment outcomes among newcomers living with HIV in Manitoba, Canada.

Despite the overrepresentation of immigrants and refugees (newcomers) in the HIV epidemic in Canada, research on their HIV treatment outcomes is limited. This study addressed this knowledge gap by describing treatment outcomes of newcomers in comparison with Canadian-born persons living with HIV in Manitoba. Clinical data from 1986 to 2017 were obtained from a cohort of people living with HIV and receiving care from the Manitoba HIV Program. Retrospective cohort analysis of secondary data was completed using univariate and multivariate statistics to compare differences in socio-demographic and clinical characteristics and treatment outcomes among newcomers, Canadian-born Indigenous persons, and Canadian-born non-Indigenous persons on entry into HIV care. By end of 2017, 86 newcomers, 259 Canadian-born Indigenous persons, and 356 Canadian-born non-Indigenous persons were enrolled in the cohort. Newcomers were more likely than Canadian-born Indigenous and non- Indigenous cohort participants to be younger and female and have self-reported HIV risk exposure as heterosexual contact. Average CD4 counts at entry into care did not differ significantly between groups. A higher proportion of newcomers was also diagnosed with tuberculosis within 6 months of entry into care (21%), compared with 6% and 0.6% of Canadian-born Indigenous non-Indigenous persons, respectively. Newcomers and Canadian-born non-Indigenous persons had achieved viral load suppression (< 200 copies/mL) at a similar proportion (93%), compared with 82% of Canadian-born Indigenous participants (p < 0.05). The distinct demographic and clinical characteristics of newcomers living with HIV requires a focused approach to facilitate earlier diagnosis, engagement, and support in care.

HIV Exposure through Heterosexual Contacts: Analysis of Demographic, Behavioral and Structural Risk Factors among Black Men in Ottawa and Windsor, Ontario

We determined the association of demographic, behavioral, and structural factors with risk of HIV exposure through heterosexual contact among Black men in Ottawa (n=210) and Windsor (n=156), Ontario. We applied hierarchical linear regression model in the analysis. Mean HIV exposure risk scores were Windsor (12.08±8.42) and Ottawa (17.16±11.80) in Ottawa (Scale = 48). Age, marriage, employment, masculinity, and condom attitudes were statistically significant (p &lt;0.05). Age groups (15-29 years and 40-49 years), traditional masculine ideology, and negative condom attitudes associated with increased risk of HIV exposure by heterosexual contact. Marriage and full-time employment associated with reduced risk of exposure the ACB heterosexual men.

Identifying factors increasing the risk of acquiring HIV among Egyptians to construct a consensus web-based tool for HIV risk assessment

Background Accurate information on HIV transmission risk is required to construct evidence-based risk reduction practices for individuals and to direct the provision of prevention strategies at the population level. HIV transmission risk assessment will help in identifying individuals at high risk of HIV infection and directing the provision of post exposure prophylaxis (PEP). Objective To identify the common risk factors for HIV transmission in the Egyptian community in order to construct a web-based HIV risk assessment tool. Methods Following a systematic review and meta-analysis of published literature on HIV transmission and risk factors, we retrieved the key determinants of HIV exposure risk. In parallel, we conducted a case control study to identify the common risk factors for HIV transmission in the Egyptian community. The identified risk factors were incorporated in weighted risk scoring models to allow the quantification of the risk of HIV acquisition. Results There were 38 determinants associated with HIV seropositivity [people living with HIV (PLWH)] among Egyptians compared to 34 risk factors identified in our meta-analysis. All the derived scores showed high accuracy for predicting HIV infection status [sensitivity, specificity, PPV and NPV of greater than 90.0%, (AUC = 0.998–1.000; p < .001)]. Conclusion Key drivers of HIV transmissions can be incorporated into a risk scoring model in order to quantify the risks of HIV acquisition. Such tools can facilitate the screening of PLWH and at-risk-individuals and direct interventions to halt HIV transmission.