CROI 2020 Abstract eBook

Abstract eBook

Poster Abstracts

Background: HIV prevention programming among female sex workers (FSW) is of national priority in the implementation of Nigeria HIV Research Agenda. FSWs are high risk group with the second highest HIV prevalence among the key populations in Nigeria. Generating evidence needed for implementable prevention strategies is vital to future national prevention and control efforts. The 2014 Integrated Biological Behavioral Surveillance Survey (IBBSS) provided the most recent national progress and performance data among the key populations. This study assessed HIV prevalence among FSWs and risk factors to HIV infection. Methods: Secondary data analysis of 2014 IBBSS was undertaken among 8050 FSWs in brothels (BFSW) and non-brothels (NBFSW). Two-stage cluster and time location sampling techniques were used in selecting the FSWs in 13 states and Federal Capital Territory in the six geo-political zones. The survey involved HIV testing, and collected information on demographic, and sexual and reproductive health indicators. A random-effects logistic regression model was fitted with HIV infection as the outcome, and was used to ascertain state level variation. Results: The mean age of FSWwas 27.1±6.2years; mean age at first sex was 17.0±2.8years and average number of clients/day was 4.4. About 36.1%were married. About 38.8% had sex partners that were 10years older. Condom use at last sex was 91.8% among the FSWs; 40.3% experienced condom breakage in the last month prior to the survey and consistent condom use was 29.1%. About 55.0% completed at least secondary education, 46.2% had been away from home for more than one month and 72.6% received information/education on HIV/STIs in the last 12 months. HIV prevalence among FSWwas 14.4% (BFSW was 19.4% and NBFSWwas 8.6%). Factors associated with HIV infection were brothel-based FSW OR=2.6 95%CI 1.4-4.2; being away from home for at least one month OR=1.8 95%CI 1.1-2.9; consistent condom use OR=0.7 95%CI 0.5-0.8 and receiving information/education on HIV/STIs OR=0.7 95%CI 0.4-0.8. The estimated variance between states was 0.4 with a standard error of 0.1. Conclusion: Although consistent condom use was low, it was protective against HIV in addition to information materials given to FSWs. There was state-level variation. Thus, there is a need for state-level intervention with more emphasis on BFSWs. Also, targeted health education programs are needed to increase consistent condom use. 854 HIV RISK, BEHAVIOUR, AND SERVICE UPTAKE IN ADOLESCENT GIRLS SELLING SEX IN ZIMBABWE Mariken M. De Wit 1 , Brian Rice 1 , Elizabeth Fearon 1 , Tendayi Mharadze 2 , Sitholubuhle Magutshwa 2 , Joanna Busza 1 , Sithembile Musemburi 2 , Amon Mpofu 3 , Owen Mugurungi 4 , Dagmar Hanisch 5 , James R. Hargreaves 1 , Frances Cowan 2 1 London School of Hygiene & Tropical Medicine, London, UK, 2 Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe, 3 National AIDS Council Zimbabwe, Harare, Zimbabwe, 4 Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe, 5 United Nations Populations Fund, Harare, Zimbabwe Background: Adolescent girls who sell sex (AGSS) in sub-Saharan Africa are disproportionally affected by HIV, yet little is known about how these vulnerabilities intersect and its implications for programming. Using a representative sample of AGSS in Zimbabwe, we estimate population size, determine risk factors for, and the prevalence of, HIV infection, and explore engagement with HIV services. Methods: In 2017 rapid ethnographic mapping of the spatial and social organization of AGSS (aged 16-19 years) was conducted, followed by a bio- behavioural survey using respondent driven sampling (RDS) in Harare and Bulawayo, and a census method in Gokwe, and Beitbridge. Unique objects were distributed to all women at sites identified as sex work locations during mapping in Harare and Bulawayo. All recruited women were tested for HIV and completed an interviewer administered questionnaire. Data were analysed using RDS-II weighting in Harare and Bulawayo and pooled across sites to run a logistic regression examining sociodemographic and sex work characteristics associated with being HIV-positive. Results: In total, 615 AGSS were recruited. HIV prevalence varied between 7.2% and 38.0% by site. HIV prevalence rose sharply with age from 2.1% among AGSS aged 16 to 26.9% among those aged 19 years. AGSS who were in school and had more years of education were less likely to be infected. Overall, more than half of HIV positive AGSS were aware of their HIV status (range 45.5-61.5% by site). Of those, 68.2% to 100%were on antiretroviral treatment (ART). Among HIV negative women, rates of HIV testing in the preceding 6 months was

62.0-71.4%. Reported alcohol and drug use was common, as was past history of physical and sexual violence. The size of the population of adolescent girls selling sex was estimated to be 1342 (95% CI 498-2186) in Harare and 1462 (95% CI 845-2079) in Bulawayo using the unique object multiplier method. For Gokwe (n=41) and Beitbridge (n=79) all AGSS were contacted. Conclusion: AGSS aged 16-19 years in Zimbabwe have a high HIV prevalence that increases rapidly by age, often report high alcohol and drug use, have commonly experienced both sexual and physical violence and, as a consequence, are extremely vulnerable. Among HIV positive AGSS just over 50% knew their HIV status, and the proportion taking ART varied by site. Testing rates in HIV negatives were high. Programmes specifically aimed at the needs of AGSS are urgently needed, offering regular HIV testing to improve knowledge of HIV status. 855 TRANSACTIONAL SEX WITH OLDER PARTNERS HEIGHTENS HIV RISKS AMONG AGYW IN TANZANIA Katherine Rucinski 1 , Gaspar Mbita 2 , Kelly Curran 3 , Albert Komba 2 , Caterina Casalini 2 , Esther Majani 2 , Mary Drake 2 , Anthony Galishi 2 , Yeronimo Mlawa 2 , Upendo Kategile 4 , William Kafura 4 , Sheree Schwartz 1 , Stefan Baral 1 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2 Jhpiego, Dar es Salaam, Tanzania, United Republic of, 3 Jhpiego, Baltimore, MD, USA, 4 USAID Tanzania, Dar es Salaam, Tanzania, United Republic of Background: Across sub-Saharan Africa, transactional sex and sexual relationships with older partners both affect HIV risk in adolescent girls and young women (AGYW). The extent to which these behaviors operate either independently or together to impact HIV acquisition is not well known. Methods: Data were collected through the Sauti Project, a PEPFAR/USAID funded project which provides combination HIV prevention services to AGYW and key and vulnerable populations across Tanzania. Out-of-school AGYW aged 15-24 years who were accessing HIV-prevention services through Sauti completed a questionnaire to assess demographics and other psychosocial measures between 2016-2018. AGYWwere tested for HIV and those who tested positive were linked to HIV care and treatment as per Tanzania national guidelines. We estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for the associations of transactional sex (any sex in exchange for money, services or gifts) and intergenerational sex (reporting a sexual partner ≥10 years older) with prevalent HIV infection. We assessed potential synergism between both exposures by comparing their observed and expected joint associations using additive and multiplicative criteria. Results: Among 12,708 sexually active AGYW, median age was 21 years (IQR 19, 23). Transactional sex and intergenerational sex were common (43% and 33%, respectively); 5% reported engaging in both behaviors. Two percent were living with HIV. The association of transactional sex with HIV prevalence was 1.27 (95% CI 0.97, 1.67) and the association of intergenerational sex with HIV prevalence was 0.97 (95% CI 0.50, 1.89) when setting AGYWwho reported neither behavior as a reference category. AGYWwho reported both transactional sex and intergenerational sex had nearly twice the HIV prevalence of AGYWwho reported neither behavior (aPR 1.74; 95% CI 1.03, 2.94). Evidence of interaction was present, suggesting transactional sex and intergenerational sex operate synergistically to heighten HIV risks in AGYW. Conclusion: Transactional sex was not strongly associated with HIV prevalence in the absence of intergenerational sex, and intergenerational sex was not associated with HIV prevalence in the absence of transactional sex. Targeting AGYWwho are likely to engage in commodified sex with older partners, such as AGYWwho are economically and socially vulnerable, may maximize effectiveness of behavioral and biomedical HIV prevention efforts.

Poster Abstracts

856 FACTORS ASSOCIATED WITH HIV SEROCONVERSION IN YOUNG WOMEN IN SOUTH AFRICA Lara Lewis 1 , Ayesha B. Kharsany 1 , Cherie Cawood 2 , Hilton Humphries 1 , Brendan Maughan-Brown 3 , David Khanyile 2

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