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: Introduction: We sought to characterize social and structural drivers of HIV vulnerability for transgender women (TGW) in Zimbabwe, where TGW are not legally recognized, and explore differences in vulnerability by feminine presentation. Methods: A secondary analysis was conducted with a sub‐sample of participants recruited from a 2019 respondent‐driven sampling survey that comprised men who have sex with men, TGW and genderqueer individuals assigned male sex at birth, from two cities in Zimbabwe. Survey questionnaires captured information related to socio‐demographics, sexual and substance use behaviours, and social and structural barriers to HIV services. Secondary analyses were restricted to participants who identified as female, transfemale or transwomen (236/1538) and were unweighted. Descriptive statistics were used to calculate sample estimates and chi‐square and Fisher's exact tests were used to assess differences in vulnerability by feminine presentation. Results: Among 236 TGW, almost half (45.3%) presented as feminine in the 6 months preceding the survey and 8.5% had ever used hormones to affirm their gender identities. Median age among TGW was 23 years (interquartile range: 20–26). Feminine presenting TGW in our sample had higher prevalence of arrest (15.9% vs. 3.9%), rejection by family/friends (38.3% vs. 14.0%), employment termination (11.2% vs. 3.9%), employment refusal (14.0% vs. 3.9%), denial of healthcare (16.8% vs. 2.3%), physical, sexual or verbal harassment or abuse (59.8% vs. 34.1%), alcohol dependence (32.7% vs. 12.4%), recent transactional sex with a male or TGW partner (30.8% vs. 13.3%) and recent non‐injection drug use (38.3% vs. 20.2%) than non‐feminine presenting TGW (all p‐value Conclusions: Findings suggest that TGW, particularly feminine presenting TGW, experience social and structural inequities which may contribute to HIV vulnerability. Interventions aimed at addressing inequities, including trans competency training for providers and gender‐affirming, psychosocial and legal support services for TGW, might mitigate risk., INTRODUCTION Transgender people, including transgender women (TGW), are disproportionately affected by HIV [1–3] and face distinct challenges accessing HIV prevention and treatment services. In 2021, the relative risk of acquiring [...]

Introduction: Zimbabwe is scaling up pre-exposure prophylaxis (PrEP) for key populations, including men who have sex with men (MSM) and transgender women (TGW). To assess implementation and inform HIV programming, we evaluated gaps in PrEP awareness, uptake and use, and correlates of awareness and uptake among a sample of MSM, TGW and genderqueer individuals (GQ) in Harare and Bulawayo, Zimbabwe. Methods: Respondent-driven sampling was used to recruit 1194 MSM and 344 TGW/GQ aged >18 to participate in a cross-sectionalsurvey assessing HIV-related outcomes in 2019. Consenting participants completed a questionnaire on sociodemographic information, sexualrisk practices and engagement in HIV services and underwent HIV testing. Descriptive statistics were used to assess the PrEP cascade. Multiple logistic regression models were used to identify factors associated with PrEP awareness and uptake among HIV-negative participants. Data were unweighted as the sample did not reach convergence on key estimates. Results: Among the 1167 HIV-negative participants, most (79.2%) were MSM compared to TGW/GQ (20.8%). Median age was 24 years. Overall, 45.8% were aware of PrEP and of those, 31.3% had ever taken PrEP. Most (71.1%) reporting never taking PrEP were willing to start PrEP; the main reasons for never starting PrEP included not knowing where to access it (24.8%) and fearing side effects (20.4%). Among those who had ever taken PrEP, 74.9% had taken PrEP in the last 6 months; of these, 42.4% had taken PrEP the day of or day preceding the survey. Side effects represented the most common (59.5%) reason for discontinuing PrEP. MSM (adjusted odds ratio [aOR]: 2.5, 95% confidence interval [CI]: 1.8-3.6) and TGW/GQ in Harare (aOR: 3.1, 95% CI: 2.1-4.7), and TGW/GQ in Bulawayo (aOR: 2.4, 95% CI: 1.1-5.3) had higher awareness of PrEP than MSM in Bulawayo. Overall, TGW/GQ were more likely to have ever taken PrEP compared to MSM (aOR: 1.6, 95% CI: 1.01-2.4). Conclusions: Findings emphasize the need for tailored interventions to promote PrEP among key populations. As HIV programs in Zimbabwe continue to expand PrEP services, these data, including barriers to starting and continuing PrEP, can inform strategies to address gaps along the PrEP cascade. Keywords: PrEP; men who have sex with men; transgender people; HIV prevention; Africa; key and vulnerable populations, 1 | INTRODUCTION Zimbabwe has made substantial progress towards reaching the UNAIDS 95-95-95 targets: 87% of adult people living with HIV (PLHIV) are aware of their HIV status; of these, [...]

: Introduction: Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Methods: Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata. Results: Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. Conclusions: While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH, INTRODUCTION Persons living with HIV (PLWH), including those in low‐ and middle‐income countries, have experienced extended life expectancies due to the success of antiretroviral (ARV) therapies [1]. In 2014, the [...]

Background: Socioeconomic status (SES) impacts health outcomes. The Youth Risk Behavior Survey (YRBS), like many school-based data sources, lacks individual-level poverty information. We propose using school-level percentages of student eligibility for free/reduced-price meals (%FRPM) as a proxy for individual-level poverty. Methods: Using the New York City (NYC) 2009 YRBS, we created school-level poverty quartiles to append to individual YRBS records by ranking schools by %FRPM. We compared this with 2 other school-level poverty measures using students' home and school neighborhood-level poverty and measured the association of these 3 school-level proxies with individual's household income. Last, we evaluated health outcomes by race/ethnicity and poverty to demonstrate the importance of accounting for poverty. Results: The school-level measure that used %FRPM had the strongest association with household income. When the school-level individual poverty proxy was included in illustrative analyses using YRBS data, patterns by poverty within race/ethnicity emerged that were not seen when looking at race/ethnicity alone. Conclusions: Using a poverty measure to analyze school-based data will provide a better understanding of the impact of SES on health outcomes. Based on our evaluation, when individual-level information is not available, we propose using school-level %FRPM, which are publicly available throughout the United States.

People who inject drugs (PWID) are at a high risk for HIV. We conducted an evaluation of socio-demographic factors associated with injecting and sexual behaviour among PWID who had two or more visits at a drug outreach clinic in Cairo, Egypt from 2013 to 2017. Routinely collected information on socio-demographics and HIV risk behaviours were abstracted from client records. Bivariate analysis and logistic regression were conducted to evaluate associations between socio-demographics and HIV risk factors. All PWID who tested HIV-positive at the initial visit were excluded from analyses. PWID who were married were more likely to share needles or syringes in the last month of their baseline visit [adjusted odds ratio (aOR) = 4.3, 95% confidence interval (CI) = 1.4-13.1] as were unemployed PWID [aOR = 3.9, 95% CI = 1.5-10.3]. Married PWID were less likely to discontinue sharing needles/syringes [aOR = 0.4, 95% CI = 0.2-0.8] as were those living outside of the Shobra, downtown, and Imbabah districts within Greater Cairo [aOR = 0.2, 95% CI = 0.1-0.5]. No significant associations were found between socio-demographics and number of sex partners in the six months prior to the initial visit. At follow-up visit, 4.4% tested HIV-positive for an incidence rate of 3.9 per 100 person years. Sociodemographic factors should be considered when designing preventive services for PWID. [ABSTRACT FROM AUTHOR]

Background Due to concerns about the effects of the coronavirus disease 2019 (COVID-19 pandemic on health services, we examined its effects on human immunodeficiency virus (HIV) services in sub-Saharan Africa. Methods Quarterly data (Q1, 10/2019–12/2019; Q2, 1/2020–3/2020; Q3, 4/2020–6/2020; Q4, 7/2020–9/2020) from 1059 health facilities in 11 countries were analyzed and categorized by stringency of pandemic measures. We conducted a difference-in-differences assessment of HIV service changes from Q1–Q2 to Q3–Q4 by higher vs lower stringency. Results There was a 3.3% decrease in the number HIV tested from Q2 to Q3 (572 845 to 553 780), with the number testing HIV-positive declining by 4.9% from Q2 to Q3. From Q3 to Q4, the number tested increased by 10.6% (612 646), with an increase of 8.8% (23 457) in the number testing HIV-positive with similar yield (3.8%). New antiretroviral therapy (ART) initiations declined by 9.8% from Q2 to Q3 but increased in Q4 by 9.8%. Across all quarters, the number on ART increased (Q1, 419 028 to Q4, 476 010). The number receiving viral load (VL) testing in the prior 12 months increased (Q1, 255 290 to Q4, 312 869). No decrease was noted in VL suppression (Q1, 87.5% to Q4, 90.1%). HIV testing (P <.0001) and new ART initiations (P =.001) were inversely associated with stringency. Conclusions After initial declines, rebound was brisk, with increases noted in the number HIV tested, newly initiated or currently on ART, VL testing, and VL suppression throughout the period, demonstrating HIV program resilience in the face of the COVID-19 crisis. [ABSTRACT FROM AUTHOR]

We calculated population-based tuberculosis (TB) rates among HIV-infected persons in New York City from 2001 through 2005 using data from the city's TB and HIV/AIDS surveillance registries, and we examined those rates using linear trend tests and incidence rate ratios (IRRs). HIV-infected individuals had 16 times the TB rate of a 'non-HIV' population (HIV status negative or unknown; IRR=16.0; 95% confidence interval=14.9, 17.2). TB rates declined significantly among the US-born HIV-infected population ([P.sub.trend] < .001) but not among the foreign-born HIV-infected population ([P.sub.trend] = .355). Such disparities must be addressed if further declines are to be achieved. (Am J Public Health. 2010;100:1031-1034. doi: 10.2105/AJPH.2009.177725)

A determination of the incidence of squamous intraepithelial lesions (SILs) in HIV-seropositive women with normal cytology results, by baseline human papillomavirus (HPV) DNA results is done. The results suggest that similar cervical cancer screening practices would be applicable to both HIV-seronegative and HIV-seropositive women.

A breast cancer early detection program in Eswatini using clinical breast exam improved nurses' evaluation skills. PURPOSE: Breast cancer (BC) is detected at late stages in sub-Saharan Africa. We piloted a BC early-detection program in Eswatini aimed at increasing breast health knowledge and clinical skills. We also aimed to determine the proportion of patients with breast abnormalities who completed referral to breast specialty clinics. METHODS: Nurses and counselors from five human immunodeficiency virus and/or antiretroviral therapy clinics underwent training in BC and clinical breast examination (CBE). We compared knowledge and skill examinations completed before, immediately after, and 90 days after training. Nurses then screened female clinic patients ≥ 18 years for breast symptoms, examined those with symptoms, and referred women with CBE abnormalities to a surgeon or the national breast clinic. Consenting women were contacted at 30 and 60 days after screening to determine if they had completed referral. RESULTS: In 2019, 44 nurses underwent training. Median scores (interquartile range) on pretraining, immediate post-training, and 90-day post-training knowledge examinations were 17.5 (16-19), 20 (19-21), and 20 (19-21), respectively. Median scores (interquartile range) on pretraining, immediate post-training, and 90-day post-training skills examinations were 10 (7-11), 23 (21.5-25), and 23 (22-24), respectively. Compared with pretraining scores, post-training scores were significantly improved (P <.0001 for all comparisons). From June 2019 to April 2020, a total of 9,502 clinic patients were screened for breast symptoms: 150 (2%) underwent CBE, 93 (62%) were referred for further evaluation, and 88 (97%) were included in the study. Of those, 54 (61%) completed referral. Referral completion was not associated with age, employment, relationship status, or prior experiences related to BC. CONCLUSION: The program's training curriculum improved breast health knowledge and clinical skills. Efforts are needed to improve patients' receipt of recommended evaluation for breast abnormalities. [ABSTRACT FROM AUTHOR]