Risks, Vulnerabilities, and Burden of HIV among Key Populations in West and Central Africa

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This document summarizes a systematic review of HIV prevalence among key populations in West and Central Africa. The review identified 76 studies reporting HIV prevalence among female sex workers (34.9%), men who have sex with men (17.7%), people who inject drugs (3.8%), and clients of sex workers (7.3%). It also discusses the history of epidemiological research on key populations in the region and increasing drug trade in West Africa. The author proposes convening a panel to discuss the types of evidence, policies, and programmatic approaches needed to improve HIV outcomes for key populations in West and Central Africa.

Health & Medicine

RISKS, VULNERABILITIES,
AND BURDEN OF HIV
AMONG KEY
POPULATIONS IN WEST
AND CENTRAL AFRICA
Stefan Baral, MD MPH FRCPC
Department of Epidemiology, Johns Hopkins School of Public Health

West and Central Africa
Overview
 West Africa is the most
populous region of SSA: ~245
million people.
 Central African countries
chosen: 111 million people
(356 million total)
 West (and Central) Africa has
a distinct epidemiology of HIV
compared to East and South
Africa: concentrated, mixed
and borderline generalized

Systematic Review of HIV among
Key Populations in West and
Central Africa
995 titles found
781 titles excluded
110 duplicates
671 not related to PWID,
MSM, FSW, or countries
92 titles excluded
92 did not have quantitative
data or prevalence data on
PWID, MSM or FSW
122 full articles reviewed
214 abstracts reviewed
Article division: FSW (89), clients of FSW
(6), PWID (4), MSM (13), MSW/FSW (1),
No data (9)
46 excluded due to lack of information on
sampling approach, secondary analysis of
previously reported data, or not meeting
inclusion criteria
76 full articles with prevalence data included
Source: Papworth et al. Epidemiology of HIV/AIDS among female sex workers, their clients, men who have sex with men, and people who
inject drugs in West and Central Africa, JIAS, 2013. Forthcoming

History of Key Population
Studies
Source: Papworth, Ceesay, Thiam-Niangoin, Diouf, Drame, Baral. Epidemiology of HIV among female sex workers, their clients, men who
have sex with men and people who inject drugs in West and Central Africa, JIAS, 2014

Key Populations in West And Central
Africa
Key Population
Pooled HIV
prevalence
(%)
95%
Confidence
Interval (%)
Pooled
Sample
Size, n=
N=Living
with HIV
Female sex workers (FSW) 34.9 34.4-35.4 41270 14,388
Men who have sex with
men (MSM) 17.7 16.5-18.9 3714 656
People who inject drugs
(PWID) 3.8 2.8-4.8 1459 56
Clients of FSW 7.3 6.6-8.0 5986 435
Source: Papworth et al. Epidemiology of HIV/AIDS among female sex workers, their clients, men who have sex with men, and people who
inject drugs in West and Central Africa, JIAS, 2013. Forthcoming

Special Issue of JAIDS
 23 Manuscripts
 Nearly 100 Authors Representing 18 WCA
countries
 Epidemiology, Prevention Science, Mathematical
Modeling, Social Science, Cost-Effectiveness,
among others
 Populations covered including
 Sex Workers
 Gay men and other men who have sex with men
 People who inject drugs
 People living with HIV

Potential Considerations for
Panel
 Evidence
 What type of evidence is most useful from your perspective improving HIV-related
health outcomes for key populations in West and Central Africa
 What should be priorities for the next generation of research and programs for key
populations in the region
 Policy
 What are functional policy level recommendations that you have for improving HIV-
related outcomes for key populations.
 What do you see as the relationship between policies and health outcomes specifically
in the region and can you use an example
 How do the more concentrated HIV epidemics among key populations as compared to
other reproductive age adults in West and Central Africa affect policy and advocacy
approaches in the region
 Programs
 What should be included as core components of HIV prevention programs for key
populations in West and Central Africa
 Are there countries in the region that could handle test and suppress (viral load)
approaches for key populations

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Risks, Vulnerabilities, and Burden of HIV among Key Populations in West and Central Africa

1. RISKS, VULNERABILITIES, AND BURDEN OF HIV AMONG KEY POPULATIONS IN WEST AND CENTRAL AFRICA Stefan Baral, MD MPH FRCPC Department of Epidemiology, Johns Hopkins School of Public Health

2. West and Central Africa Overview  West Africa is the most populous region of SSA: ~245 million people.  Central African countries chosen: 111 million people (356 million total)  West (and Central) Africa has a distinct epidemiology of HIV compared to East and South Africa: concentrated, mixed and borderline generalized

3. Systematic Review of HIV among Key Populations in West and Central Africa 995 titles found 781 titles excluded 110 duplicates 671 not related to PWID, MSM, FSW, or countries 92 titles excluded 92 did not have quantitative data or prevalence data on PWID, MSM or FSW 122 full articles reviewed 214 abstracts reviewed Article division: FSW (89), clients of FSW (6), PWID (4), MSM (13), MSW/FSW (1), No data (9) 46 excluded due to lack of information on sampling approach, secondary analysis of previously reported data, or not meeting inclusion criteria 76 full articles with prevalence data included Source: Papworth et al. Epidemiology of HIV/AIDS among female sex workers, their clients, men who have sex with men, and people who inject drugs in West and Central Africa, JIAS, 2013. Forthcoming

4. History of Key Population Studies Source: Papworth, Ceesay, Thiam-Niangoin, Diouf, Drame, Baral. Epidemiology of HIV among female sex workers, their clients, men who have sex with men and people who inject drugs in West and Central Africa, JIAS, 2014

5. History of Key Population Studies Source: Papworth, Ceesay, Thiam-Niangoin, Diouf, Drame, Baral. Epidemiology of HIV among female sex workers, their clients, men who have sex with men and people who inject drugs in West and Central Africa, JIAS, 2014

6. Key Populations in West And Central Africa Key Population Pooled HIV prevalence (%) 95% Confidence Interval (%) Pooled Sample Size, n= N=Living with HIV Female sex workers (FSW) 34.9 34.4-35.4 41270 14,388 Men who have sex with men (MSM) 17.7 16.5-18.9 3714 656 People who inject drugs (PWID) 3.8 2.8-4.8 1459 56 Clients of FSW 7.3 6.6-8.0 5986 435 Source: Papworth et al. Epidemiology of HIV/AIDS among female sex workers, their clients, men who have sex with men, and people who inject drugs in West and Central Africa, JIAS, 2013. Forthcoming

7. Increasing Drug Trade in West Africa

8. Special Issue of JAIDS  23 Manuscripts  Nearly 100 Authors Representing 18 WCA countries  Epidemiology, Prevention Science, Mathematical Modeling, Social Science, Cost-Effectiveness, among others  Populations covered including  Sex Workers  Gay men and other men who have sex with men  People who inject drugs  People living with HIV

9. Potential Considerations for Panel  Evidence  What type of evidence is most useful from your perspective improving HIV-related health outcomes for key populations in West and Central Africa  What should be priorities for the next generation of research and programs for key populations in the region  Policy  What are functional policy level recommendations that you have for improving HIV- related outcomes for key populations.  What do you see as the relationship between policies and health outcomes specifically in the region and can you use an example  How do the more concentrated HIV epidemics among key populations as compared to other reproductive age adults in West and Central Africa affect policy and advocacy approaches in the region  Programs  What should be included as core components of HIV prevention programs for key populations in West and Central Africa  Are there countries in the region that could handle test and suppress (viral load) approaches for key populations

Risks, Vulnerabilities, and Burden of HIV among Key Populations in West and Central Africa

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