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从一般到具体:在撒哈拉以南非洲的艾滋病毒应对中超越普通人群。

From general to specific: moving past the general population in the HIV response across sub-Saharan Africa.

机构信息

FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA.

Kenya Medical Research Institute, Kilifi, Kenya.

出版信息

J Int AIDS Soc. 2020 Oct;23 Suppl 6(Suppl 6):e25605. doi: 10.1002/jia2.25605.


DOI:10.1002/jia2.25605
PMID:33000913
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7527769/
Abstract

INTRODUCTION: As the HIV field evolves to better serve populations which are diverse in risk and access to services, it is crucial to understand and adapt the conceptual tools used to make sense of the HIV pandemic. In this commentary, we discuss the concept of general population. Using a synthetic and historical review, we reflect on the genesis and usage of the general population in HIV research and programme literature, pointing to its moral connotations and its impact on epidemiologic reasoning. DISCUSSION: From the early days of the HIV pandemic, the category of general population has carried implicit normative meanings. General population represented those people considered to be undeserving of HIV acquisition, and therefore deserving of a response. Framing the HIV epidemic in sub-Saharan Africa as a generalized epidemic primarily affecting the general population has contributed to the exclusion of men who have sex with men from epidemic responses. The usage of this category has also masked heterogeneity among those it includes; the increasing focus on the use of interventions such as circumcision and HIV treatment as general population HIV prevention approaches has been marked by a lack of attention to heterogeneity among beneficiaries. CONCLUSIONS: We recommend that the term general population be retired from the field's lexicon. HIV programmes should strengthen their capacity to describe the heterogeneity of those they serve and plan their interventions accordingly. To increase the efficiency and impact of the HIV response, it is urgent to stratify the category of general population by risk. Sexual networks are a promising basis for this stratification.

摘要

简介:随着 HIV 领域的发展,以更好地服务于风险和服务获取多样化的人群,理解和适应用于理解 HIV 大流行的概念工具至关重要。在这篇评论中,我们讨论了一般人群的概念。通过综合和历史回顾,我们反思了一般人群在 HIV 研究和规划文献中的起源和用法,指出了其道德内涵及其对流行病学推理的影响。 讨论:从 HIV 大流行的早期开始,一般人群类别就带有隐含的规范意义。一般人群代表那些被认为不值得感染 HIV 的人,因此值得做出回应。将撒哈拉以南非洲的 HIV 流行情况描述为主要影响一般人群的广泛流行,导致男男性行为者被排除在流行应对之外。该类别的使用还掩盖了其包括的人群中的异质性;越来越关注将干预措施(如割礼和 HIV 治疗)作为一般人群的 HIV 预防方法,却缺乏对受益人群异质性的关注。 结论:我们建议将术语“一般人群”从该领域的词汇中删除。HIV 规划应加强其描述所服务人群异质性的能力,并相应地规划其干预措施。为了提高 HIV 应对的效率和影响,迫切需要按风险对一般人群进行分层。性网络是这种分层的一个有前途的基础。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/525f/7527769/e55ed611f03c/JIA2-23-e25605-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/525f/7527769/e55ed611f03c/JIA2-23-e25605-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/525f/7527769/e55ed611f03c/JIA2-23-e25605-g001.jpg

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本文引用的文献

[1]
HIV-1 Transmission Patterns Within and Between Risk Groups in Coastal Kenya.

Sci Rep. 2020-4-21

[2]
Disclosure of Same-Sex Sexual Practices to Family and Healthcare Providers by Men Who Have Sex with Men and Transgender Women in Nigeria.

Arch Sex Behav. 2021-5

[3]
Genetic clustering analysis for HIV infection among MSM in Nigeria: implications for intervention.

AIDS. 2020-2-1

[4]
The arc of HIV epidemics in sub-Saharan Africa: new challenges with concentrating epidemics in the era of 90-90-90.

Curr Opin HIV AIDS. 2019-9

[5]
The disconnect between individual-level and population-level HIV prevention benefits of antiretroviral treatment.

Lancet HIV. 2019-7-19

[6]
Getting to grips with the HIV epidemic in Russia.

Curr Opin HIV AIDS. 2019-9

[7]
HIV testing and the HIV care continuum among sub-Saharan African men who have sex with men and transgender women screened for participation in HPTN 075.

PLoS One. 2019-5-31

[8]
Informing HIV Prevention Programs for Adolescent Girls and Young Women: A Modified Approach to Programmatic Mapping and Key Population Size Estimation.

JMIR Public Health Surveill. 2019-4-1

[9]
Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy.

Int J STD AIDS. 2019-5

[10]
Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response.

J Int AIDS Soc. 2018-7

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