Engaging black sub-Saharan African communities and their gatekeepers in HIV prevention programs: Challenges and strategies from England

Objective:HIV infection is a sensitive issue in black communities[Serrant-Green L.Black Caribbean men,sexual health decisions and silences.Doctoral thesis.Nottingham School of Nurs-ing,University of Nottingham;2004].Statistics show black sub-Saharan African(BSSA)com-munities disproportionately constitute two-thirds of people with HIV[Heath Protection Agency.Health protection report:latest infection reports-GOV.UK;2013].African communities constitute 30%of people accessing HIV treatment in the United Kingdom yet represent less than 1%of the population[Health Protection Agency.HIV in the United Kingdom:2012 report;2012],[Depart-ment of Health.DVD about FGM.2012.Available from fgm@dh.gsi.gov.uk.].This article ex-plores the sociocultural challenges in engaging BSSA communities in HIV prevention programs in England and possible strategies to improve their involvement.Methods:Twelve focus group discussions and 24 semistructured interviews were conducted in a 2-year period with participants from the BSSA communities and sexual health services in the West Midlands,England.The research was supported by the Ubuntu scheme,a sexual health initia-tive working with African communities in Birmingham,England.Results:Ineffective engagement with African communities can hinder the effectiveness of HIV prevention programs.Skills and strategies sensitive to BSSA culture are important for success-ful implementation of prevention programs.HIV prevention programs face challenges including stigma,denial,and marginalized views within BSSA communities.Conclusion:Networking,coordination,and cultural sensitivity training for health profession-als are key strategies for engaging BSSA communities in HIV prevention programs.

Appraisal of Existing HIV/AIDs Prevention and Control Measures and Presentation of Innovative Strategies to End HIV/AIDS Epidemic by 2030

Background: Globally, UNAIDS report 2022 shows, there are 84.2 million people affected by HIV/AIDS and 40.1 million deaths from AIDS since the start of epidemic. In sub-Saharan Africa, women and girls accounted for 63% of all new HIV infections in 2021 with, six in seven new HIV infections among adolescents aged 15 - 19 years being girls. Key populations accounted for 70% of HIV infections globally in 2021, with 51% of these new HIV infections in sub-Saharan Africa. Reflecting on the 4 decades’ journey of HIV epidemic amidst local, national and international efforts, the UN target of ending AIDS as a public health threat by 2030 remains questionable unless new innovative ways are used. This study aimed at analyzing existing HIV/AIDS interventions, discuss UN interventions in line with ending HIV/AIDS by 2030 then, suggest and discuss new innovative ways of ending HIV scourge by 2030. Methods: Systematic literature review methodology was used to extract existing published information on HIV prevention strategies from 1981 to 2023. The articles were previewed by 2 experts for quality and grouped by intervention. Of the 637 articles accessed, on HIV prevention/control only 45 met the inclusion criteria. Data were synthesized using a narrative synthesis approach following standard guidelines on synthesis without meta-analysis. Descriptive analysis was done, strength and limitations were identified. UNAIDS recommendations for ending HIV/AIDS by 2030 identified and analyzed. New Innovations in HIV/AIDS were presented and discussed. The scope of the reviewed literature was limited to HIV preventive strategies practiced between 1981 and 2023. Results: Findings show that, Uganda’s HIV prevalence was at a peak in 1991 of 15% (30% among pregnant women in urban areas). ABC strategy is claimed to have turned sharply downward the prevalence through the mid-1990s and reached 5% (14% for pregnant urban women) by 2001. Analysis of the strategy showed that the achievements of the strategy could not be sustained, subsequently HIV prevalence rose again. This is because none of the ABC components can independently reduce HIV problem. In the real world, 100% abstinence has failed, condom use only reduces infection by 90% (WHO), and lifelong monogamy is impractical. Such limitations weaken ABC strategy. The study established that Post-exposure prophylaxis (PEP) i.e. taking HIV medicines within 72 hours (3 days) after a possible exposure to HIV infection is a safe, effective and a globally practiced HIV preventive intervention in emergency situations of HIV exposure. However, PEP is limited to care sought within 72 hours after exposure and yet timely access especially in rural areas and for key populations remains a big challenge. Oral PrEP was also identified as effective HIV preventive measure that can reduce HIV risk from sex by about 99% and from injection drug users by 74%. However, like PEP, timely access especially in rural areas and for key populations remains a big challenge. The UNAIDS 95-95-95 strategy (i.e. 95% of people know their HIV status, 95% with +HIV status be on sustained ART and 95% on ART get viral load suppression) formed the basis for setting the target of ending HIV/AIDS epidemic by 2030. However, our analysis shows that this target is unrealistic given the above highlighted limitations/ barriers in preventive measures and the unlikely perfect adherence (100%) to ART by all enrolled HIV positive persons. Conclusion: Ending HIV/AIDS by 2030 cannot be achieved by implementing the current preventing strategies and control measures. This study established that most of the existing HIV preventive strategies and control measures have a number of limitations. However, with sustained UN 95-95-95 strategy supplemented with additional innovative ways, there is hope that the UN dream of ending HIV/AIDS though not necessarily by 2030, can in the long run be achieved.

A Life-skills-based HIV/AIDS Prevention Education for Rural Students of Primary Schools in China:What Changed? What Have We Learned?

Objective To evaluate a four-hour life-skills-based HIV/AIDS prevention curriculum among 5th grade students in rural primary schools of Hainan province.Methods The study included two stages.Stage one （September 2006-May 2007） was a pre-post-quasi experimental design;a total of 2 413 students aged 9 to 14 years from fifth grade classes of nine primary schools completed a baseline survey （1 720 students were in the intervention group,693 in the control group）,and over 98% of them took part in a short survey.The experimental curriculum was provided to the intervention group.At stage two （September 2008）,a cross-sectional questionnaire was administered to 6 923 students in 7th grade classes of eight middle schools in the same study sites.There were 1 437 students in the intervention group when the curriculum was conducted.Results Students tended to score higher in areas of HIV/AIDS related knowledge and attitudes,if they were younger than average,lived in the county seat,had access to the internet,and their parents had completed higher levels of education.Path analysis showed that,after controlling for characteristics such as family and community factors,the total effects of curriculum on knowledge in the short-term model increased remarkably compared with the baseline,and maintained major contributions to knowledge in the mid-term model.The positive effect of knowledge on attitudes was significantly improved in the short-term model as well.Conclusion A life-skills based curriculum can improve HIV/AIDS related knowledge and self-perceived level of life-skills among primary school students in rural areas in a short time,and these positive effects can still be observed at least 2 years post participation in the curriculum.

Knowledge, Attitudes and Perceptions of Secondary School Teenagers towards HIV Transmission and Prevention in Rural and Urban Areas of Central Uganda

HIV/AIDS has remained a challenge in Uganda among adolescent despite the ABC strategy used globally to prevent HIV infection. The study assessed the knowledge, attitudes and perceptions of secondary school teenagers towards HIV transmission and prevention in rural and urban schools of central Uganda. A cross sectional study using self-administered questionnaires and structured interviews was used to collect data from adolescents in secondary schools in Kampala and Buikwe districts. Eight schools were randomly selected with 4 schools in each district. A total of 245 students from schools were recruited in the study with 120 and 125 students from urban Kampala and rural Buikwe district schools respectively. Data were analyzed using SPSS version 11. The results were expressed as percentages in a 2 × 2 tables. The mean age of the participants was 15.9 ± 2.5 years. Results showed that 95.1% participants had knowledge on HIV/AIDS in both urban and rural schools and 27.4% knew all the modes of HIV transmission. About 83.7% knew the ABC strategy for HIV prevention and 37.6% would talk about HIV/AIDS mainly with friends. For HIV cure, 62.0% of study participants reported non-cure and 24.9% were not sure. The remaining 13.1% of the study participants in both urban and rural schools reported that HIV can be cured. And the modes of curing HIV that were mentioned by participants included spiritual healing, transmitting it to others through sexual intercourse and that antiretroviral (ARVs) drugs can cure it as well as that it can be cured abroad. About 65.7% of participants reported recognition of one with HIV/ AIDS and by having red lips, being sickly;weight loss, skin rash and being very rich were mentioned. About 39.2% of the study participants mentioned that they cannot get infected with HIV and can’t contract HIV at all and 18.4% believed that chances of getting HIV infection were high. On perception and attitude on condoms and their use, participants reported that it is a sign of mistrust, reduces sexual pleasures and they are embarrassing to buy. Majority of the participants in both urban and rural schools had some knowledge on HIV/AIDS and the ABC strategy for HIV prevention. However, there was a knowledge gap on the various modes of HIV transmission and prevention. There was misconception of the participants on HIV/AIDS cure, condom use and on the chances of contracting HIV. About the source of HIV/AIDS information, majority of the participants were getting information on HIV/AIDS from friends of which some information was misleading. This false information could be the reason for the increased HIV prevalence reported among the adolescents in the schools. Generally, participants had some knowledge on HIV/AIDS though they had knowledge gap on HIV transmission and prevention.

Evaluating the Knowledge of HIV Transmission and Prevention of Mother to Child Transmission (PMTCT) of HIV among HIV-Positive Mothers Accessing Care in Military Hospital in Lagos, Nigeria

Introduction: The prevention of mother-to-child transmission (PMTCT) plays a major role in limiting the number of children being infected by HIV. There is dearth of studies that explored the knowledge of HIV transmission and PMTCT among women living with HIV. Methods: This was a cross-sectional, descriptive study of HIV-positive mothers receiving medical care at the adult antiretroviral therapy (ART) clinic, 68 Nigeria Army Reference Hospital Yaba. A pre-tested structured questionnaire was used to collect information from the subjects concerning their socio-demographic, knowledge of HIV transmission and mother-to-child transmission of HIV and preventive measures. SPSS v23 was used for data analysis. Results: Out of the 374 participants, 282 (75.4%) were aware that HIV can be transmitted to an unborn baby from the positive mother. Of these, 240 (85.1%) were well-informed that increase mother’s viral load can increase the chances of mother-to-child transmission. 268 (95%) understood that giving of antiretroviral drugs during and after pregnancy can lower transmission risk, while 254 (90.1%) saw the use of breast milk substitutes as another prevention strategy. There was statistically significant association between the respondents’ knowledge of PMTCT and their husbands’/partners’ awareness of their HIV status. Conclusion: In conclusion, our study demonstrated a good knowledge of HIV transmission, MTCT and PMTCT among women who were receiving ART in our centre. Disclosure is a significant factor found to be associated with PMTCT knowledge. More studies can also explore if the observations in our study with women living with HIV will be comparable in similar population in different settings.

A life course health development model of HIV vulnerabilities and resiliencies in young transgender women in Peru

Background Globally transgender women(TW)are at heightened vulnerability for HIV infection.In Lima Peru,sharp increases in HIV prevalence are seen among TW ages 25 years and older highlighting the need for early HIV prevention efforts for young TW.This study conducted in-depth qualitative interviews to elucidate the social and developmental contexts of HIV vulnerability for young TW in Lima Peru.Methods Between November 2019 and February 2020,young TW ages 16-24 years(n=21)in Lima Peru were purposively sampled using in-person(e.g.,face-to-face outreach)and online(e.g.,social media,networking websites)social network-based methods.Interviews were conducted in Spanish and a rapid qualitative analysis was conducted using a modified immersion crystallization methodology to identify themes.Results Five themes emerged,informing the conceptualization of a Life Course Health Development Model of HIV Vulnerabilities and Resiliencies:(1)interpersonal contexts(family,school,partners,sexual debut,trans mothers);(2)structural vulnerabilities(poverty,educational constraints,migration,hostile environments,sex work,police violence);(3)concomitant mental health and psychosocial factors(discrimination,violence,depression,suicidality,substance use,life hopes/dreams/future expectations);(4)gender affirmation processes(gender identity development,hormones,surgery,legal name/gender marker change);(5)HIV prevention and treatment barriers(PrEP uptake,HIV care,condom use,risk reduction).Conclusions Young TW experience formidable developmental challenges associated with transphobia,violence,and pre-maturely facing accelerated milestones.Developmentally and culturally appropriate interventions to mitigate HIV vulnerability in Peru are needed,including those that consider co-occurring stigma-related conditions in adolescence and young adulthood.

The potential impact of a“curative intervention”for HIV:a modelling study

Abstract Background:Efforts to develop an HIV“cure”(i.e.,an intervention leading to durable ART-free remission or eradication of HIV infection)have become better resourced and coordinated in recent years.Given,however,the availability of other interventions for prevention and treatment of HIV disease,it is unclear whether,to what extent,and under which circumstances a curative intervention would have an impact in ending the AIDS epidemic and which characteristics of its implementation would be most important.We designed a range of analyses to investigate these unknowns.Methods:We used a deterministic,compartmental model of HIV infection in South Africa to estimate the impact of a curative intervention.We first examined how its impact would be affected by the state of the epidemic at the time that it is introduced,by the timing and pace of scale-up,and by various targeting strategies.We then investigated the impact of a curative intervention relative to its ability to maintain viral suppression.Findings:To the extent that other interventions have failed to control the epidemic,i.e.,if incidence and AIDS deaths remain high,a curative intervention would result in a larger reduction in incidence.Earlier and faster scale-up allows for greater impact.We also found that a curative intervention would more efficiently reduce transmission if it is prioritised to those not able to obtain or remain on ART and to those aged 15-25 rather than older persons.On the other hand,an intervention that does not maintain viral suppression if the individual is exposed to re-infection could lead to an increase in HIV incidence.Conclusions:Our findings suggest that a curative intervention for HIV would have the greatest impact if the epidemic is not under control by 2030,particularly if the intervention is targeted to those who are more likely to transmit virus,and if it maintained durable viral suppression,even upon exposure to re-infection.These considerations underscore the need to carefully consider the“target product profiles”for an HIV cure in the context of how and where it would be used,and suggest that such profiles may require revision as the epidemic evolves in the coming years.

An Evidence-Based Management Approach to HIV/AIDS in Nigeria

Objectives: This paper seeks to examine the history of HIV/AIDS in Nigeria while presenting a clear picture of some of the issues that exist in service delivery. Lastly, this paper explores how an evidence-based management approach offers an effective set of tools to HIV/AIDS organizations. Methods: Content analysis and a qualitative desk review of the literature. Results: Findings from this paper reveal that through the use of evidence-based management, preconceived notions can be challenged so as to yield a diversity of thought and a more people-centered approach to public health delivery. This paper also shows that in the Nigerian setting, an evidence-based management framework can be a transformative tool in ensuring that key populations can receive critical care and treatment in the long run despite the uncertainty that might exist when it comes to funding and resources. Conclusions: Evidence-based management is a rigorous framework that can be used for understanding how a multitude of factors can position an organization to achieve its theory of change, which in turn can lead to sustainable impact in the long run. Incorporating the use of evidence in everyday organizational behavior involves not only looking at the manner in which data is aggregated, but also how it is disseminated. In order to ensure that the evidence is not manipulated, nonprofit organizations are often viewed as being best suited for collecting evidence since they are not heavily plagued by systemic corruption and political tides, compared to their government counterparts.

The effects of social networks on HIV risk behaviors among Vietnamese female sex workers:a qualitative study

Introduction Female sex workers(FSWs)experience heightened vulnerability to HIV and other health harms,and cross-border FSWs face additional challenges due to language issues,higher mobility,and weaker negotiation skills.Given the critical role of social network factors in HIV transmission,it is imperative to explore the social network characteristics of Vietnamese cross-border FSWs in China to enhance AIDS prevention and control.Methods We conducted semi-structured interviews with 22 Vietnamese FSWs in Hekou County,Yunnan Province from May to July 2018.The samples were selected using a purposive sampling strategy and stopped when reached theoretical saturation.Data collection and analysis were conducted iteratively to identify themes within the data.Participants reported their social relationships and how these relationships affected their HIV risk behaviours.All the interviews were recorded,transcribed verbatim,and reviewed.Thematic analysis was used to analyse the data.Results Among 22 Vietnamese FSWs,the median age was 23.5.Concerning social networks,interviews revealed that their social networks were composed of three components:Workplace networks(customer,boss,colleague),Hometown networks(spouse or boyfriend,family member,fellow villager),and Social institutions networks(Chi-nese social institutions network,Vietnamese social institutions network).None of these networks can simply sup-port or hinder Vietnamese FSWs’preventive high-risk HIV behaviours,and the impact is achieved through each network’s ways.Within the workplace network,the predominant influence is the ascendancy-submissiveness dynamic that exists among customers,bosses,and VFSWs.In the hometown network,familial responsibilities emerge as the principal factor impacting VFSWs.Meanwhile,within the social institution network,pivotal roles are played by the Chinese CDC and the Vietnamese government in the dissemination of HIV knowledge.Conclusions The social networks of Vietnamese female sex workers exert a dual impact on high-risk HIV behaviors.Interventions should be designed and tailored to address the specific contextual factors and challenges associated with social networks among cross-border FSWs in China and other similar settings.

Sunlenca■(Lenacapavir):A first-in-class,long-acting HIV-1 capsid inhibitor for treating highly multidrug-resistant HIV-1 infection

Lenacapavir,also known as GS-6207,under the brand name Sunlenca,was developed by Gilead Sciences Inc.It has been approved in the EU,Canada,and US for use alongside other antiretrovirals in adults with multidrug-resistant HIV infection and those who cannot otherwise establish an effective antiviral treat-ment regimen(Fig.1)1,2.The US Food and Drug Administration(FDA)approval is mainly based on the result of the phase II/III CAPELLA trial(NCT04150068)2.In the lenacapavir group,over 80%of patients with multidrug-resistant HIV-1 had fewer than 50 viral RNA copies per milliliter by week 26,and no serious adverse events related to the drug were reported 3,4.

Impact of community-based interventions on HIV knowledge, attitudes, and transmission

In 2012,an estimated 35.3 million people lived with HIV,while approximately two million new HIV infections were reported.Community-based interventions(CBIs)for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk,or already infected with,HIV.This paper evaluates the impact of CBIs on HIV knowledge,attitudes,and transmission.We included 39 studies on educational activities,counseling sessions,home visits,mentoring,women’s groups,peer leadership,and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence.Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge,attitudes,and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS(SMD:0.66,95%CI:0.25,1.07),protected sexual encounters(RR:1.19,95%CI:1.13,1.25),condom use(SMD:0.96,95%CI:0.03,1.58),and decreased frequency of sexual intercourse(RR:0.76,95%CI:0.61,0.96).Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication.We found very limited evidence on community-based management for HIV infected population and prevention of mother-to-child transmission(MTCT)for HIV-infected pregnant women.Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement.School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group.Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT,and various emerging models of care to improve morbidity and mortality outcomes.

Projected effectiveness of HIV detection during early infection and rapid ART initiation among MSM and transgender women in Peru: A modeling study

Background:The Sabes study,a treatment as prevention intervention in Peru,tested the hypothesis that initiating antiretroviral therapy(ART)early in HIV infection when viral load is high,would markedly reduce onward HIV transmission among high-risk men who have sex with men(MSM)and transgender women(TW).We investigated the potential population-level benefits of detection of HIV early after acquisition and rapid initiation of ART.Methods:We designed a transmission dynamic model to simulate the HIV epidemic among MSM and TW in Peru,calibrated to data on HIV prevalence and ART coverage from 2004 to 2011.We assessed the impact of an intervention starting in 2018 in which up to 50%of the new infections were diagnosed within three months of acquisition and initiated on ART within 1 month of diagnosis.We estimated the impact of the intervention over 20 years using the cumulative prevented fraction of new HIV infections compared to scenarios without intervention.Findings:Our model suggests that only 19%of the infected MSM and TW are virally suppressed in 2018 and 35%e40%of the new HIV infections are transmitted from contacts with acutely-infected partners.An intervention reaching 10%of all acutely infected MSM and TW is projected to prevent 13.3%[Uncertainty interval:11.9%e14.3%]of the new infections over 20 years and reduce HIV incidence in 2038 by 24%.Reaching 50%of all acutely infected MSM and TWwill increase the prevalence of viral suppression in 2038 to 59%and prevent 41%of expected infections over 20 years.Reaching 50%of the high-risk MSM and TW in acute phase would reduce HIV incidence in 2038 by 60%and prevent 36%of new infections between 2018 and 2038.Conclusions:Early detection of HIV infections and rapid initiation of ART among MSM is desirable as it would increase the effectiveness of the HIV prevention program in Peru.Targeting high-risk MSM and TW will be highly efficient.