Cumulative fractions of all new HIV infections prevented (medians and 95% credible intervals) among 15–59-year-olds in Côte d’Ivoire between 2015 and 2030 for different intervention scenarios compared to baseline scenario 1 as the counterfactual.

<p>(Details of the scenarios can be found in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002321#pmed.1002321.t001" target="_blank">Table 1</a>.) CFSW, client(s) of female sex workers; Gen Pop, general population; KP, key population(s); SC, scenario; UNAIDS, Joint United Nations Programme on HIV/AIDS.</p

Cumulative fractions of new HIV pediatric infections prevented (medians and 95% credible intervals) in Côte d’Ivoire between 2015 and 2030 for different intervention scenarios using the 2015 intervention coverage levels (scenario 1) as the counterfactual.

<p>(Descriptions of the scenarios can be found in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002321#pmed.1002321.t001" target="_blank">Table 1</a>). SC, scenario; UNAIDS, Joint United Nations Programme on HIV/AIDS.</p

Description of different intervention scenarios considered in Côte d’Ivoire over the 2015–2030 time period.

<p>Description of different intervention scenarios considered in Côte d’Ivoire over the 2015–2030 time period.</p

Predicted median relative change in annual number of new HIV infections among 15–59-year-olds in Côte d’Ivoire from 2015 to 2030 under different intervention coverage scenarios.

<p>The scenarios are detailed in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002321#pmed.1002321.t001" target="_blank">Table 1</a>. (SC1) Baseline: testing rate, antiretroviral therapy (ART) recruitment rate, and ART failure rate stable at their 2015 values; (SC2) current trends: observed increase in those 3 rates from 2010–2015 projected through 2020; (SC3) UNAIDS: 90-90-90 objective reached in 2020 and 95-95-95 in 2030; (SC4) delayed UNAIDS: 90-90-90 objective reached in 2025 and maintained to 2030; (SC5) UNAIDS 90-90-90 to 2030: 90-90-90 objective reached in 2020 and maintained to 2030, (SC6) UNAIDS in general population: 90-90-90 objective reached in 2020 and 95-95-95 in 2025 among the general population only; (SC7) UNAIDS in key populations (KP): 90-90-90 objective reached in 2020 and 95-95-95 in 2030 among FSW and MSM populations only; (SC8) UNAIDS in key populations and CFSW: 90-90-90 objective reached in 2020 and 95-95-95 in 2030 among MSM, FSW, and CFSW only; (SC9) UNAIDS plus condom use increases in key populations: 90-90-90 objective reached in 2020 and 95-95-95 in 2030 and a rise to 95% by 2020 of sexual acts protected by a condom among FSW and MSM; and (SC10) UNAIDS with condom drop in key populations: 90-90-90 objective reached in 2020 and 95-95-95 in 2030 and a decline by 25 percentage points of sexual acts protected by a condom among FSW and MSM. (95% credible intervals are not presented to ease visual interpretation.) CFSW, client(s) of female sex workers; FSW, female sex worker(s); Gen Pop, general population; MSM, men who have sex with men; SC, scenario; UNAIDS, Joint United Nations Programme on HIV/AIDS.</p

UNAIDS indicators under selected intervention scenarios among the population aged 15–59 years in Côte d’Ivoire (median with 95% credible intervals).

<p>The UNAIDS indicators from left to right are (A) proportion of HIV-positive individuals aware of their status (data from [<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002321#pmed.1002321.ref008" target="_blank">8</a>,<a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002321#pmed.1002321.ref014" target="_blank">14</a>], used for cross-validation), (B) proportion of those aware who are receiving antiretroviral therapy (ART) (the model was fitted to the proportion of HIV-positive individuals on ART), and (C) proportion of those on ART who are virally suppressed. The scenarios are as defined in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1002321#pmed.1002321.t001" target="_blank">Table 1</a>. (SC1) Baseline: testing rate, ART recruitment rate, and ART failure rate stable at their 2015 values; (SC2) observed increase in those 3 rates from 2010–2015 projected through 2020; (SC3) UNAIDS: 90-90-90 objective reached in 2020 and 95-95-95 in 2030; (SC4) delayed UNAIDS: 90-90-90 objective reached in 2025 and maintained to 2030; and (SC5) UNAIDS 90-90-90 to 2030: 90-90-90 objective reached in 2020 and maintained to 2030. AIS, AIDS Indicator Survey; DHS, Demographic Health Survey; SC, scenario; UNAIDS, Joint United Nations Programme on HIV/AIDS.</p

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis

<div><p>Introduction</p><p>Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries.</p><p>Methods and findings</p><p>Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January–August 2013), Côte d’Ivoire (March 2015–February 2016), The Gambia (July–December 2011), Lesotho (February–September 2014), Malawi (July 2011–March 2012), Senegal (February–November 2015), Swaziland (August–December 2011), and Togo (January–June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42–2.16, <i>p <</i> 0.001), rape (OR 1.95, 95% CI 1.63–2.36, <i>p <</i> 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12–1.52, <i>p <</i> 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05–2.90, <i>p <</i> 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49–2.19, <i>p <</i> 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65–2.87, <i>p <</i> 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments.</p><p>Conclusions</p><p>In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.</p></div

Participant characteristics (<i>N</i> = 4,586).

<p>Participant characteristics (<i>N</i> = 4,586).</p

HIV prevalence by country.

<p>HIV prevalence by country.</p

Multivariable logistic regression of odds of HIV infection.

<p>Multivariable logistic regression of odds of HIV infection.</p

Sexual risk and HIV/STIs among transgender women and cisgender MSM.

<p>Sexual risk and HIV/STIs among transgender women and cisgender MSM.</p