Migration, Gender, and HIV Incidence in Rakai, Uganda

Background: Higher HIV prevalence is commonly observed among migrant population in sub-Saharan Africa, however the extent to which migration is a cause or consequence of HIV infection is largely unknown. Here, we use population-based, longitudinal survey data and assess HIV incidence among men and women migrating into communities in Rakai District, Uganda. Methodology: Prospective data from HIV-negative participants residing in thirty communities under continuous surveillance in the Rakai Community Cohort Study (RCCS) between 1999 and 2016 was used to assess the association between recent migration and HIV incidence. The RCCS is an open population-based census and cohort of adults aged 15-49 in rural southcentral Uganda. Recent in-migrants were classified as individuals who moved to a new community within the last two years with intention to stay and were identified through census. Newly HIV-positive individuals were considered incident HIV cases if they had an HIV negative test result at the prior survey allowing for one missed visit. Poisson regression with generalized estimating equations and robust variance estimators were used to estimate the incidence rate ratios (IRR) of HIV infection associated with recent migration for men and women visits with adjustment for demographics, sexual risk behaviors, and calendar time. Results: The association between HIV incidence and recent migration was assessed among 16,165 HIV-negative individuals of which 55% (n=8,789) were women and 28% (n=4529) were classified as recent migrants. Participants contributed 69,231 person-visits at which 851 incident HIV events were identified (n=357 in men; n=492 in women). Compared to long-term residents, risk of HIV-infection was statistically significantly elevated among migrant women relative to long-term residents before and after adjustment for potential confounders (IRR=2.10, 95%CI:1.62-2.73; adjIRR=1.81, 95%CI: 1.37-2.41). Similar risk of HIV with migration was found among men (IRR=1.82, 95%CI: 1.17-2.86); adjIRR=1.80, 95%CI: 1.14-2.82). We found no significant differences in the association between migration and HIV by calendar time in our analyses. Conclusion: Our Data suggests that the earliest years after migration is associated with increased risk of HIV acquisition in men and women. These findings highlight the need for timely interventions targeted to migrant population to reduce HIV incidence in sub-Saharan Africa

Individual and partnership characteristics associated with consistent condom use in a cohort of cisgender men who have sex with men and transgender women in Nigeria

This study reports on the individual and partnership characteristics that influence consistent condom use in cisgender men who have sex with men (MSM) and transgender women (TGW) attending trusted community centers that provide HIV prevention and treatment services in Nigeria. Adults assigned male at birth who reported anal sex with male partners who enrolled between March 2013–2019 and had information about at least one male sexual partner were included in these analyses. At enrollment and follow-up visits every 3 months for up to 18 months, participants were administered detailed questionnaires that collected information about demographics, sexual practices, HIV risk behaviors, and characteristics and behaviors of their partners in the previous year (at enrollment) or the preceding 3 to 6-months (at follow-up visits). Logistic regression models with generalized estimating equations were used to assess the odds ratio (OR) and 95% confidence intervals (CI) of individual, partner, and partnership characteristics associated with consistent condom use (CCU). A participant was defined as consistently using condom if they reported always using condoms all the time they had insertive, receptive or both types of anal sex with a male partner. At the individual level, CCU was positively associated with higher education, disclosure of key population status to a healthcare worker and negatively associated with poor access to condoms. At the partner and partnership level, CCU was associated with partners with higher education (aOR: 1.36; 95% CI: 1.07–1.72), casual relationships (aOR: 1.22; 95% CI: 1.11–1.34) and relationships in which partners encouraged the participant to use condoms with other partners (aOR: 1.14; 95% CI: 1.02–1.28). Relationships in which the partner was married to a woman and/or the partner’s HIV status positive or unknown were negatively associated with CCU. These findings suggest that individuals in relationships where partners were more open and encouraged safer sex were more likely to consistently use condoms. HIV prevention programs should consider leveraging communication to sexual partners to encourage condom use as this may support condom use with other sexual partners. Given sustained and growing HIV and STI epidemics among MSM and TGW, even with pre-exposure prophylaxis scale-up, it is crucial to continue to study optimal implementation strategies to increase condom use.https://doi.org/10.1186/s12889-021-11275-

Migration, Gender, and HIV Incidence in Rakai, Uganda

Background: Higher HIV prevalence is commonly observed among migrant population in sub-Saharan Africa, however the extent to which migration is a cause or consequence of HIV infection is largely unknown. Here, we use population-based, longitudinal survey data and assess HIV incidence among men and women migrating into communities in Rakai District, Uganda. Methodology: Prospective data from HIV-negative participants residing in thirty communities under continuous surveillance in the Rakai Community Cohort Study (RCCS) between 1999 and 2016 was used to assess the association between recent migration and HIV incidence. The RCCS is an open population-based census and cohort of adults aged 15-49 in rural southcentral Uganda. Recent in-migrants were classified as individuals who moved to a new community within the last two years with intention to stay and were identified through census. Newly HIV-positive individuals were considered incident HIV cases if they had an HIV negative test result at the prior survey allowing for one missed visit. Poisson regression with generalized estimating equations and robust variance estimators were used to estimate the incidence rate ratios (IRR) of HIV infection associated with recent migration for men and women visits with adjustment for demographics, sexual risk behaviors, and calendar time. Results: The association between HIV incidence and recent migration was assessed among 16,165 HIV-negative individuals of which 55% (n=8,789) were women and 28% (n=4529) were classified as recent migrants. Participants contributed 69,231 person-visits at which 851 incident HIV events were identified (n=357 in men; n=492 in women). Compared to long-term residents, risk of HIV-infection was statistically significantly elevated among migrant women relative to long-term residents before and after adjustment for potential confounders (IRR=2.10, 95%CI:1.62-2.73; adjIRR=1.81, 95%CI: 1.37-2.41). Similar risk of HIV with migration was found among men (IRR=1.82, 95%CI: 1.17-2.86); adjIRR=1.80, 95%CI: 1.14-2.82). We found no significant differences in the association between migration and HIV by calendar time in our analyses. Conclusion: Our Data suggests that the earliest years after migration is associated with increased risk of HIV acquisition in men and women. These findings highlight the need for timely interventions targeted to migrant population to reduce HIV incidence in sub-Saharan Africa

Use and acceptability of HIV self-testing among first-time testers at risk for HIV in Senegal

HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution