CROI 2017 Abstract e-Book

Abstract eBook

Poster and Themed Discussion Abstracts

patients with a detectable viral load, while reducing viral load testing by more than 40%. False negatives (25/72) would later receive a 12 month viral load test according to current guidelines. Conclusion: CPS may be useful for targeted viral load testing. Results need to be validated in the context of treatment for all, in the absence of CD4 thresholds for ART eligibility. 918 STIGMA ASSOCIATED WITH HIV/STI INCIDENCE AMONG NIGERIAN MEN WHO HAVE SEX WITH MEN Cristina Rodriguez-Hart 1 , Rebecca G. Nowak 2 , Rashelle Musci 1 , Danielle German 1 , Ifeanyi Orazulike 3 , Uchenna Ononaku 4 , Hongjie Liu 5 , Trevor Crowell 6 , Stefan Baral 1 , Man Charurat 2 1 The Johns Hopkins Univ, Baltimore, MD, USA, 2 Univ of Maryland, Baltimore, MD, USA, 3 Intl Cntr on Advocacy and Rights to Hlth, Abuja, Nigeria, 4 Inst of Human Virology Nigeria, Abuja, Nigeria, 5 Univ of Maryland, Coll Park, Coll Park, MD, USA, 6 US Military HIV Rsr Prog, Bethesda, MD, USA Background: Sexual stigma, due to same-sex practices among men who have sex with men (MSM), may contribute to onward transmission of HIV and other sexually transmitted infections (STIs) in Nigeria, impeding achievement of the UNAIDS 90-90-90 treatment goals. Pathways through which this occurs are not well understood. This study assessed whether sexual stigma was associated with HIV and STI incidence and if poor mental health and sexual risk behavior contributed to the pathways between stigma and risk for HIV and STIs. Methods: FromMarch 2013 to February 2016, the TRUST/RV368 study recruited 1,480 MSM in Abuja and Lagos, Nigeria, into a prospective cohort that provides HIV and STI diagnosis and treatment every three months. HIV was diagnosed according to national guidelines using parallel rapid tests. Chlamydia and gonorrhea were diagnosed by PCR on rectal swab and urine specimens. Participants were classified into low (n=633), medium (n=663), and high (n=184) stigma subgroups, based on a latent class analysis of nine stigma indicators. Associations between stigma and HIV and STI incidence were assessed using χ2 tests. The components of the path analysis were hypothesized to have the following order: disclosure, stigma, suicidal ideation, condomless sex, HIV and/or STI incidence and were clustered by city. Model fit was assessed: χ2 goodness-of-fit test p-value>.05, Root Mean Square Error of Approximation (RMSEA)<.05, Comparative Fit Index (CFI)>.90, and Tucker-Lexis Index (TLI) >.90. Results: As stigma increased in severity, incident STIs increased in a dose response relationship (STIs: 8.1%, 12.2%, 16.3% p-value=.003) (Figure 1). Incident HIV infection was less common and increased non-significantly with increasing severity of stigma (HIV: 2.8%, 3.2%, 3.8% p-value=.798). The path analysis found that all direct relationships in the model were significant and that suicidal ideation and condomless sex were significant mediating factors of the association between stigma and HIV and/or STI incidence. The model had good fit across all fit statistics (χ2 p-value=.077, RMSEA=.021, CFI=.979, and TLI=.965). Conclusion: Increasing severity of stigma was associated with risk of HIV and STIs. The integration of stigma mitigation strategies, such as screening and treating for mental health, into combination HIV programming may facilitate the success of important biomedical tools including pre-exposure prophylaxis and treatment as prevention to reduce onward transmission. 919 POPULATION TRENDS IN HIV STIGMA IN LUSAKA, ZAMBIA, 2004–2011 Margaret P. Kasaro 1 , Marie Stoner 2 , Sujit Rathod 3 , Tessa Roberts 3 , Jennifer Winston 2 , Richard Banda 4 , Thankian Kusanthan 5 , Jeffrey S. Stringer 2 , Benjamin H. Chi 2 1 Univ of North Carolina, Lusaka, Zambia, 2 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 3 London Sch of Hygiene & Trop Med, London, UK, 4 Central Statistical Office, Lusaka, Zambia, 5 Univ of Zambia, Lusaka, Zambia Background: Perceptions about HIV, including HIV-related stigma, can be an important barrier to treatment coverage, particularly as antiretroviral therapy (ART) programs expand globally. Methods: We studied the trends in HIV stigma in Lusaka, Zambia during a period of rapid ART expansion (2004-2011). Using data from a 12-round, repeat cross-sectional survey – sampled across the entire Lusaka urban district – we compared responses to six questions over time: HIV can be transmitted through meals, HIV can be transmitted by sharing toilets, unwillingness to care for relatives infected with HIV, HIV is a punishment from God for promiscuity, those infected with AIDS can be recognized, desire to keep HIV infection of a family member a secret. We analyzed the linear trend over time for each question. For those with greater than 2% change per year (yr), we mapped the linear changes by each clinic catchment area Results: We observed the following annual change in participant responses: HIV can be transmitted through meals (-0.86%/yr), HIV can be transmitted by sharing toilets (-0.65%/ yr), unwillingness to care for relatives infected with HIV (-0.69%/yr), HIV is a punishment from God for promiscuity (-4.28%/yr), those with AIDS can be recognized (-2.17%/ yr), desire to keep HIV infection of a family member a secret (+3.21%/yr). P for trend was <0.001 for all. When we mapped changes in the latter three questions (i.e., those with >2.0%/yr) by clinic catchment area, rates of change differed geographically (figure). Conclusion: We observed encouraging trends in HIV stigma in the city of Lusaka during a period of rapid ART scale-up. Five of six indicators declined over this 8-year period, though at varying rates. Over time, an increasing proportion of respondents also preferred to keep HIV infection of a family member a secret. Efforts to reduce HIV stigma remain an important component of expanding HIV programs.

Poster and Themed Discussion Abstracts

CROI 2017 398