TY - JOUR
T1 - Characterising unmet HIV prevention and treatment needs among young female sex workers and young men who have sex with men in Cameroon
T2 - a cross-sectional analysis
AU - Bowring, Anna L.
AU - Ketende, Sosthenes
AU - Rao, Amrita
AU - Mfochive Njindam, Iliassou
AU - Decker, Michele R.
AU - Lyons, Carrie
AU - Levitt, Daniel
AU - Olawore, Oluwasolape
AU - Turpin, Gnilane
AU - Fako, Guy H.
AU - Fouda, Ghislaine
AU - Tamoufe, Ubald
AU - Billong, Serge C.
AU - Njoya, Oudou
AU - Zoung-Kanyi Bissek, Anne Cecile
AU - Baral, Stefan
N1 - Funding Information:
This study was implemented through the CHAMP project, which was led by CARE and funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development (USAID). Viral load testing was done with the support of the LINKAGES project (University of North Carolina, Chapel Hill). ALB is supported by an Australian National Health and Medical Research Council Early Career Fellowship. SB's effort was funded in part from the Johns Hopkins University Center for AIDS Research, a US National Institutes of Health (NIH) funded programme ( P30AI094189 ), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: National Institute of Allergy and Infectious Diseases, National Cancer Institute, National Institute of Child Health and Human Development, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Institute of Mental Health, National Institute on Aging, Fogarty International Center, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, and Office of AIDS Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of USAID, PEPFAR, NIH, Agency for Healthcare Research and Quality, nor other supporting agencies. The authors would like to thank all study team members, advisors and study participants for their time and contributions to the study. Partners in CHAMP and involved in the implementation of this study included CARE Cameroon, CARE USA, Johns Hopkins School of Public Health, Metabiota, Moto Action, the National AIDS Control Committee (NACC), Horizons Femmes, Humanity First, Alternatives, Alcondoms, Cameroon Medical Women's Association, Cameroon National Association for Family Welfare, La Direction de la Recherche Operationnelle en Santé, L'Institut Nationale de Statistique and L'Observatoire National de la Santé Publique du Cameroun. Our great appreciation also goes to collaborating health facilities: Yaounde Military Hospital, Biyem-Assi District Hospital, Laquintinie Hospital; Douala Military Hospital; Nylon District Hospital; District Medical Centre Soboum, Bertoua Regional Hospital, Bamenda Regional Hospital, and Kribi District Hospital. The authors extend their gratitude to the Cameroon Government, and in particular the Minister of Public Health, the Permanent Secretary of NACC, and their collaborators.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/7
Y1 - 2019/7
N2 - Background: In Cameroon, female sex workers (FSWs) and men who have sex with men (MSM) carry disproportionately high burdens of HIV. Despite specific vulnerabilities and health needs, young key populations remain understudied and underserved in Cameroon owing to legal, ethical, and social challenges. We aimed to assess and compare HIV-related behavioural and structural risks and coverage of HIV prevention and treatment services between young and older key populations to inform implementation strategies. Methods: FSWs and MSM aged 18 years or older were recruited through respondent-driven-sampling for a biobehavioural survey carried out in five Cameroonian cities. Prevalence of HIV, risk, stigma, and health service engagement were compared between young (18–24 years) and older (≥25 years) key populations. Multivariable Poisson regression models, disaggregated by key population, were constructed to estimate prevalence ratios (PR) by age group for HIV service engagement. Findings: Participants were recruited between Nov 30, 2015, and Oct 12, 2016. Among FSWs, 724 (32%) of 2255 were aged 18–24 years, and median age of first transactional or compensated sex was 22 years (IQR 19–28). Among MSM, 840 (63%) of 1323 were aged 18–24 years, and median age of first anal sex was 18 years (IQR 17–21). RDS-adjusted HIV prevalence was 8·5% (95% CI 4·7–15·2) among young FSWs and 12·9% (9·5–18·2) among young MSM. HIV viral suppression (<1000 copies per mL) was evident in 24 (43%) of 56 young and 292 (61%) of 479 older FSWs (p=0·0091) and 40 (34%) of 119 of young and 64 (42%) of 153 older MSM (p=0·17). Young FSWs were less likely than older FSWs to report recent peer education (PR 0·65, 95% CI 0·48–0·88), or membership of an FSW community-based organisation (PR 0·69, 0·55–0·86) and were more likely to report untreated sexually transmitted infection symptoms in the past year (PR 1·29, 1·03–1·61). Young MSM were less likely than older MSM to report an HIV test in the past year (PR 0·88, 0·78–0·98), recent peer education (PR 0·77, 0·62–0·95) and receipt of free condoms (PR 0·77, 0·67–0·89). By key population, condom use and recent experiences of stigma and violence were similar between age groups (p>0·05). Interpretation: Young key populations have similar behavioural and structural risks to older populations but have lower coverage of HIV preventive and treatment services. Achieving an AIDS-free generation in Cameroon and elsewhere in the region necessitates overcoming social and legal challenges and delivering innovative, evidence-based, and human rights-affirming HIV prevention and treatment interventions for young key populations. Funding: PEPFAR, USAID.
AB - Background: In Cameroon, female sex workers (FSWs) and men who have sex with men (MSM) carry disproportionately high burdens of HIV. Despite specific vulnerabilities and health needs, young key populations remain understudied and underserved in Cameroon owing to legal, ethical, and social challenges. We aimed to assess and compare HIV-related behavioural and structural risks and coverage of HIV prevention and treatment services between young and older key populations to inform implementation strategies. Methods: FSWs and MSM aged 18 years or older were recruited through respondent-driven-sampling for a biobehavioural survey carried out in five Cameroonian cities. Prevalence of HIV, risk, stigma, and health service engagement were compared between young (18–24 years) and older (≥25 years) key populations. Multivariable Poisson regression models, disaggregated by key population, were constructed to estimate prevalence ratios (PR) by age group for HIV service engagement. Findings: Participants were recruited between Nov 30, 2015, and Oct 12, 2016. Among FSWs, 724 (32%) of 2255 were aged 18–24 years, and median age of first transactional or compensated sex was 22 years (IQR 19–28). Among MSM, 840 (63%) of 1323 were aged 18–24 years, and median age of first anal sex was 18 years (IQR 17–21). RDS-adjusted HIV prevalence was 8·5% (95% CI 4·7–15·2) among young FSWs and 12·9% (9·5–18·2) among young MSM. HIV viral suppression (<1000 copies per mL) was evident in 24 (43%) of 56 young and 292 (61%) of 479 older FSWs (p=0·0091) and 40 (34%) of 119 of young and 64 (42%) of 153 older MSM (p=0·17). Young FSWs were less likely than older FSWs to report recent peer education (PR 0·65, 95% CI 0·48–0·88), or membership of an FSW community-based organisation (PR 0·69, 0·55–0·86) and were more likely to report untreated sexually transmitted infection symptoms in the past year (PR 1·29, 1·03–1·61). Young MSM were less likely than older MSM to report an HIV test in the past year (PR 0·88, 0·78–0·98), recent peer education (PR 0·77, 0·62–0·95) and receipt of free condoms (PR 0·77, 0·67–0·89). By key population, condom use and recent experiences of stigma and violence were similar between age groups (p>0·05). Interpretation: Young key populations have similar behavioural and structural risks to older populations but have lower coverage of HIV preventive and treatment services. Achieving an AIDS-free generation in Cameroon and elsewhere in the region necessitates overcoming social and legal challenges and delivering innovative, evidence-based, and human rights-affirming HIV prevention and treatment interventions for young key populations. Funding: PEPFAR, USAID.
UR - http://www.scopus.com/inward/record.url?scp=85066761815&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066761815&partnerID=8YFLogxK
U2 - 10.1016/S2352-4642(19)30123-3
DO - 10.1016/S2352-4642(19)30123-3
M3 - Article
C2 - 31105052
AN - SCOPUS:85066761815
SN - 2352-4642
VL - 3
SP - 482
EP - 491
JO - The Lancet Child and Adolescent Health
JF - The Lancet Child and Adolescent Health
IS - 7
ER -