CROI 2016 Abstract eBook

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Oral Abstracts

170

Location and Population: Response to theWho andWhere in the HIV Epidemic Peter Ghys , UNAIDS, Geneva, Switzerland

The effectiveness of most elements of the AIDS response is well known, and applying that response can end the AIDS epidemic by 2030. A key element is reaching the right people with the right programmes and services. In the early years of the response populations that needed to be reached by programmes were characterised as general population, high risk groups, and bridge populations. Recent developments in data collection for key populations, in development and application of epidemiological models, in use of facility- based data and in mapping and visualisation techniques allow a much more precise picture of the location of populations that need to be reached with services. Currently available surveillance tools will be reviewed, including integrated bio-behavioural surveys for key populations, sentinel surveillance among pregnant women, national population-based surveys, and case-based surveillance. Current methods and data sources for programmatic monitoring and related data systems will be reviewed. Regarding epidemiological results, examples of local size estimates and estimates of HIV prevalence will be presented for men who have sex with men, sex workers, people who inject drugs; as well as sub-national gender and age-specific estimates of HIV prevalence and incidence. Regarding programme gaps, examples will be given of sub-national PLHIV’s awareness gaps, ART gaps, male circumcision gaps, and condom programme gaps. Future developments include geospatial epidemiological models, more precise estimation of local programmatic gaps including for key population programmes, VMMC and condom programming. 171 HIV in Fishing Communities: Prevalence, Incidence, Risk Factors, and Interventions Zachary A. Kwena ; LakeVictoria Consortium for Health Research, Kenya Med Rsr Inst, Kisumu, Kenya As the world coalesces around achieving WHO’s 90-90-90 targets, initial steps are focused on finding and shutting down sources of new infections. We sought to describe the burden, risk factors and potential prevention interventions for HIV infections in fishing communities. This largely involves syntheses of published findings as well as findings from recent studies in the fishing communities. Some of the recent studies were conducted under the umbrella of Lake Victoria Consortium for Health Research which has a mission of improving the health of the fishing communities that inhabit the Lake Victoria shoreline and islands in Kenya, Tanzania and Uganda (http://www.wavuvi.org/about- wavuvi-concern). HIV prevalence is variable across fishing villages and gender. In Kenya, HIV prevalence range from 14.2% in Busia to 37.4% in Homa Bay. Women are more affected (37.5%) compared to men (29.4%). HIV prevalence in Uganda range from 22% to 29%with gender differences. HIV prevalence in women is reported to reach 40% in some communities. Overall HIV prevalence in Tanzania is 7.6%with gender and regional differences. The prevalence is higher in women (11%) compared to men (6.3%) and higher in Kagera region (12.5%) compared to Mwanza (7.3%) and Mara (6%). HIV incidence is also variable across different communities. In Uganda, incidence range from 3.39 to 4.9 and seem to increase with age and alcohol consumption. In Kenya, HIV incidence vary from 4.2 to 9.3% and seem to depict regional variations. Risk factors for HIV infection include: age at sexual debut, multiple and transactional sexual partnerships, alcohol consumption and low condom use. The risky behaviors are precipitated by high number of women in fishing villages, scarcity of fish, high cash flow, high fisherfolk mobility and culture of risk denial. Potential interventions include: reaching the fishermen with late night radio prevention messages, synchronizing opening and closing of health clinics with fisherfolk availability, targeting couples for interventions to reduce risky behaviors, and empowering women to own boats to reduce their interactions with men over fish. Fishing communities experience high HIV burden that exhibit gender and regional variations. The high burden results from personal, interpersonal and environmental factors. Identifying appropriate HIV interventions in these communities require thorough understanding of their high risk social environment. 172 Sex, Stigmas, and Systems: Global Issues in HIV Among Young MSM LaRon E. Nelson , Univ of Rochester, Rochester, NY, USA The burden of new HIV continues to disproportionately impact young MSM. In the United States and Canada MSM under age 25 represent the majority of new infections. Young Black MSM in the United States are overrepresented in the number of new cases and continue to be the group with the largest percent increases in new infections. In other regions of the world, such as sub-Saharan Africa, data is only now beginning to emerge regarding the scope of the HIV epidemic in MSM. More research is being conducted to better understand the mechanism by which stigmas contribute to age-disparities in HIV infection and HIV outcomes of MSM around the world. Various forms of stigma include HIV stigma, stigma against same-gender sexual practices and identities, and stigma directed towards MSM who do not conform to masculine gender norms. The sexualities of MSMmay be further stigmatized for those who also engage in sexual practices with cisgender and/or transgender women. The intersections of these various stigmas have the potential to be very powerful barriers to moving young MSM along the HIV continuum of care, including diagnosis. Recent research also suggests that stigmas—conceptualized as a source of chronic environmental stress—may exert a physiological load on body systems and consequently have negative impacts on clinical outcomes for HIV-infected individuals. Moreover, the experiences of these stigmas are not limited to social situations but also manifest themselves in clinic and program environments where young MSM are expected to receive care and support. Health systems-level anti-stigma intervention approaches are needed that target healthcare providers and personnel to create healthcare environments that support the autonomy and human rights of youth who are MSM. There is also a need for models of care that reduce the frequency with which young MSM are exposed to environments that they experience as stigmatizing. Models of care that decentralize access to health care such as telehealth and mobile-app enabled platforms for care engagement and coordination have the potential to increase access and utilization of HIV prevention and treatment services for young MSM. These and other types of healthcare systems transformations are necessary in order to optimize the impact of biomedical prevention and treatment technologies for young MSM. 173 HIV and Migrants Julia Del Amo , Inst de Salud Carlos III, Madrid, Spain Migrants have been long identified as one of the populations with highest vulnerability to HIV infection and its consequences. Migrants encompass heterogeneous groups of persons with different migration drivers - economic, social, political, cultural and environmental - as well as with distinct risk-contexts for HIV infection. Some migrant groups have a disproportionate burden of HIV infection which often exhibits distinct gender patterns. The relative contribution of migrants to national epidemics varies across the world, the highest being in Europe and Asia. Between 2007 and 2012 nearly two-fifths of all HIV cases reported in the European Union/European Economic Area were of migrant origin; the commonest being Sub-Saharan Africa, other European countries and Latin-America & The Caribbean. The epidemiological patterns of HIV in these migrants resembles that of the countries of origin; with a highly feminized and fundamentally heterosexually acquired epidemic in migrants from Sub-Saharan Africa and a very high proportion of Men who have sex with Men (MSM) among the cases from Latin-America. HIV infection can be acquired in the pre and post-migration phases as well as in the migratory transit; circular migration is of relevance in some settings such as the US/Mexican border. There is increasing evidence of the higher risk of HIV acquisition among migrant MSM in the post- migration phase, highlighting the sexual diversity of the migrant population.Most migrant groups, particularly the undocumented, experience difficulties to access HIV testing and health care. Further, in most countries undocumented migrants are not entitled to antiretroviral treatment (ART). As a consequence, late HIV diagnosis and presentation are commoner among migrants who also exhibit lower CD4 cell counts at ART initiation and poorer immunological and virological responses. Access to ART is one of the pillars of the end of AIDS UNAIDS strategy. It has been firmly established how early HIV diagnosis and linkage to care are beneficial at individual and community levels but this all relies in universal and equitable access to ART. Finally, effective implementation of large-scale treatment programs cannot be achieved without a global commitment to guarantee access to ART for all persons living with HIV which does not leave a subset of the population behind. 174 Global Epidemiology of HIV Infection in Adolescents Annette H. Sohn , TREAT Asia, Bangkok, Thailand Global HIV surveillance estimates variably categorize adolescents (10-19 years) with children (<15 years), youth (15-24 years), and non-adults (<25 years). At the end of 2013, there were 2.1 million adolescents living with HIV (ALHIV), 220,000 of whom had been newly infected that year. In 2014, there were 3.9 million youth with HIV, of whom 2.8 million

Oral Abstracts

69

CROI 2016