The changing dynamics of HIV/AIDS during the COVID-19 pandemic in the Rohingya refugee camps in Bangladesh -a call for action

The COVID-19 pandemic has affected every country's health service and plunged refugees into the most desperate conditions. The plight of Rohingya refugees is among the harshest. COVID-19 has severely affected their existing HIV/STI prevention and management services and further increased the risk of violence and onward HIV transmission within the camps. In this commentary, we discuss the context and the changing dynamics of HIV/AIDS during COVID-19 pandemic, among the Rohingya refugee community in Bangladesh. What we currently observe is the worst crisis in the Rohingya refugee camps thus far. Because of being displaced, Rohingya refugees have increased vulnerability to HIV, STIs and other poor health outcomes. They have inadequate access to HIV testing, treatment, and care. Their host country has poor capacity to provide services. Complex economic, socio-cultural and behavioural factors exacerbate their poor access to HIV testing, treatment, and care. The unfolding COVID-19 pandemic has changed priorities in the Rohingya refugee camps so that more emphasis is being placed on COVID-19 prevention and treatment rather than other health issues. This exacerbates the already dire situation with HIV detection, management, and prevention among the refugees.Although the government of Bangladesh and different non-governmental organisations provide harm reduction, HIV care, and COVID-19 care to refugees, a comprehensive response is needed to maintain and strengthen health programs for refugees, for both HIV and COVID-19 care. This comprehensive response should include behavioural intervention, community mobilisation, and effective treatment and care. Without addressing the disadvantage of social conditions, it will be challenging to reduce the burden of HIV and COVID-19 among refugees. While the COVID-19 crisis is a global challenge, the international community has an obligation to improve the life, livelihood and health of those who are most vulnerable. Rohingya refugees are among them

Sexual and Reproductive Health of Rohingya Refugee People In Bangladesh: A Systematic Review Protocol

Background and Objective: Rohingya refugees are one of the most vulnerable population groups from any perspective, and that certainly includes their sexual and reproductive health and access to appropriate services. This review synthesizes SRH status and needs of Rohingya women of reproductive age, addressing their experiences in accessing services. Methods:Following PRISMA guidelines, this review employs quality assessment tools (Newcastle-Ottawa Scale, MMAT, Cochrane Risk of Bias). The search strategy will be comprehensive, spanning prominent databases such as PubMed, CINAHL, Embase, Web of Science, and Scopus. Additionally, a diligent search will extend to gray literature, reference lists, and citations. Synthesis: Employing a narrative synthesis approach, the data synthesis will encompass three critical domains: the SRH status and needs of Rohingya women, the barriers encountered in accessing SRH services, and the effectiveness of existing SRH interventions.Results:The review seeks to provide valuable insights for policymakers and healthcare practitioners, offering a foundation for evidence-based strategiesaimed at advancing SRH outcomes among Rohingya refugees in Bangladesh and similar Asian contexts. The review is registered in PROSPERO (CRD42023444386) for transparency and efficiency.Conclusion: Have been made to address the health and humanitarian needs of Rohingya refugees in Bangladesh, there is still limited knowledge about their SRH

Sexual and Reproductive Health of Rohingya Refugee People In Bangladesh: A Systematic Review Protocol

Background and Objective: Rohingya refugees are one of the most vulnerable population groups from any perspective, and that certainly includes their sexual and reproductive health and access to appropriate services. This review synthesizes SRH status and needs of Rohingya women of reproductive age, addressing their experiences in accessing services. Methods: Following PRISMA guidelines, this review employs quality assessment tools (Newcastle-Ottawa Scale, MMAT, Cochrane Risk of Bias). The search strategy will be comprehensive, spanning prominent databases such as PubMed, CINAHL, Embase, Web of Science, and Scopus. Additionally, a diligent search will extend to gray literature, reference lists, and citations. Synthesis: Employing a narrative synthesis approach, the data synthesis will encompass three critical domains: the SRH status and needs of Rohingya women, the barriers encountered in accessing SRH services, and the effectiveness of existing SRH interventions. Results: The review seeks to provide valuable insights for policymakers and healthcare practitioners, offering a foundation for evidence-based strategies aimed at advancing SRH outcomes among Rohingya refugees in Bangladesh and similar Asian contexts. The review is registered in PROSPERO (CRD42023444386) for transparency and efficiency. Conclusion: Have been made to address the health and humanitarian needs of Rohingya refugees in Bangladesh, there is still limited knowledge about their SRH

Potential and demonstrated impacts of the COVID-19 pandemic on sexually transmissible infections.

PURPOSE OF REVIEW: This review considers the potential and demonstrated impacts of SARS-CoV-2 on the sexually transmissible infection (STI)/HIV transmission. RECENT FINDINGS: COVID-19 increases the vulnerability of those at highest risk of acquiring STI/

Potential and demonstrated impacts of the COVID-19 pandemic on sexually transmissible infections: Republication.

PURPOSE OF REVIEW: This review considers the potential and demonstrated impacts of SARS-CoV-2 on the sexually transmissible infection (STI)/HIV transmission. RECENT FINDINGS: COVID-19 increases the vulnerability of those at highest risk of acquiring STI/HIV. Altered health-seeking behaviour, reductions in STI/HIV clinic capacity, service disruptions and redeployment of human resources to assist COVID-19 control efforts have impacted on STI/HIV control programmes. Reports of reduced STI incidence are emerging, but it is hard to determine whether this is real or due to decreased testing during COVID-19 lockdown periods. Fear of COVID-19 and implemented control measures have altered STI/HIV transmission dynamics. Sexual health services adapted to the pandemic by reducing face-to-face patient encounters in favour of telehealth and mail-based initiatives as well as more stringent triage practice. Many sexual health and HIV treatment services now operate at reduced capacity and experience ongoing service disruptions, which necessarily translates into poorer outcomes for patients and their communities. SUMMARY: In the short-term, COVID-19 related sexual behaviour change is driving STI/HIV transmission downwards. However, the impacts of the global COVID-19 response on sexual health-seeking behaviour and STI/HIV services threaten to drive STI/HIV transmission upwards. Ultimately, the expected rebound in STI/HIV incidence will require an appropriate and timely public health response. VIDEO ABSTRACT: http://links.lww.com/COID/A31

High adherence to HIV PrEP among clinic attendees over 12 months in the PRELUDE open-label demonstration project

Introduction: The efficacy of HIV pre-exposure prophylaxis (PrEP) depends upon adherence. Facilitated recall is a practical measure to monitor patients’ adherence to PrEP in clinical practice. Data from the PRELUDE Demonstration Project were used to investigate patterns and predictors of adherence to daily PrEP over 12 months. Methods: PRELUDE was an open-label study of high-HIV risk individuals taking PrEP in New South Wales, Australia. PrEP adherence was assessed quarterly for one year. Participants were asked by clinicians about the number of pills taken in the previous week (facilitated recall). Adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) for factors associated with daily adherence were calculated using generalised estimating equations for longitudinal data. Results: Of the 321 gay/bisexual men (GBM) enrolled in the study, 263 (82%) remained on study at month 12. Of these, 243 (92%) and 230 (87%) reported daily adherence (7 pills/week) at month and 12, respectively. Adherence declined by 10% during the study (aOR 0.90, 95%CI 0.84-0.95, p<0.001). In multivariate analysis, participants were more likely to report taking 7 pills in the previous week if they had engaged in group sex in the previous three months (aOR 1.33, 95%CI 1.15-1.53) or attended a private clinic (aOR 1.50, 95%CI 1.07-2.11). Conclusions: Among participants who completed one year of follow-up on PRELUDE, daily PrEP use was more likely among those at ongoing risk of HIV due to their behaviours. The moderate loss to follow-up in the cohort is not surprising, as individuals are not expected to remain on PrEP forever, but rather, during periods of risk. Combined, these results suggest that GBM in this study who are highly engaged with healthcare systems can identify times when they are at increased risk of contracting HIV and act accordingly, taking PrEP consistently as recommended during this time

How do gay serodiscordant couples in Sydney, Australia negotiate undetectable viral load for HIV prevention?

Many gay Australian serodiscordant couples are currently relying on an HIV-positive partner’s undetectable viral load (UVL) to practice condomless sex. For these couples, preventing HIV is often considered a mutual responsibility, yet they lack a formally endorsed strategy that helps them navigate ‘UVL for prevention’ (UfP) as a couple. Drawing on interviews with 21 Australian gay men representing 15 serodiscordant couples, we explored ‘the couple’ within serodiscordant HIV prevention. In learning to rely on UfP, couples were initially apprehensive as they navigated unfamiliar territory, but their concerns faded over time. Confidence in UfP was facilitated by repeated condomless sex without transmission, consistent test results, and being in a couple framed by trust, commitment, and familiarity. Gay male serodiscordant couples should be encouraged to negotiate clear, spoken ‘viral load agreements’ (VLAs) if they choose to rely on UfP