Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Int AIDS Soc. 2019 Jul;22(7):e25281. doi: 10.1002/jia2.25281.
INTRODUCTION: Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under-represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. METHODS: Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. RESULTS: Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co-infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one-third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. CONCLUSIONS: This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high-impact interventions may include venue-based, peer navigator-led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.
简介：尽管女性性工作者（FSW）、男男性行为者（MSM）和跨性别女性（TGW）感染艾滋病毒的风险更高，但在海地艾滋病毒文献中，这些人群的代表性不足。在这里，我们首次提供了海地 FSW、MSM 和 TGW 艾滋病毒流行率的全国代表性估计数，以及艾滋病毒护理和治疗的首个传播链。我们还研究了这些群体中艾滋病毒流行率的社会决定因素，并估计了海地 FSW 和 MSM 的人口规模。 方法：数据于 2016 年 4 月至 2017 年 2 月在海地的 10 个地理区域收集。利用地方艾滋病控制重点优先排序（PLACE）方法：（1）招募行为调查参与者；（2）为梅毒和艾滋病毒感染者提供快速检测、咨询和护理服务；（3）对艾滋病毒检测呈阳性的参与者使用干血斑测量病毒载量。 结果：研究参与者包括 990 名 FSW、520 名 MSM 和 109 名 TGW。FSW 的艾滋病毒流行率估计为 7.7%（95%CI 6.2%，9.6%），MSM 为 2.2%（0.9%，5.3%），TGW 为 27.6%（5.0%，73.5%）。梅毒检测呈阳性的参与者中，17%的 FSW、19%的 MSM 和 74%的 TGW 同时感染艾滋病毒。经济不稳定和亲密伴侣暴力（IPV）与 MSM 中的艾滋病毒显著相关；粮食不安全、经济不稳定和强奸史与 TGW 中的艾滋病毒显著相关。知道自己艾滋病毒感染状况的参与者不到三分之一，而知道自己感染状况的参与者中，超过四分之一没有接受治疗。虽然大约四分之三接受艾滋病毒治疗的 FSW 和 MSM 参与者的病毒载量得到抑制，但 TGW 参与者的病毒载量抑制率较低，仅为 46%。 结论：本研究表明，海地有必要针对重点人群开展预防和治疗艾滋病毒的针对性干预措施。潜在的高影响力干预措施可能包括基于场所的、由同伴导航员主导的艾滋病毒和梅毒检测和外联活动，以及改善对结构性暴力和 IPV 的筛查和病例管理。鉴于我们观察到 TGW 艾滋病毒感染率高得惊人，而且 TGW 中艾滋病毒病毒载量抑制率低，因此 TGW 迫切需要此类干预措施。
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