Abstract
Background:
Key populations (KPs), including female sex workers (FSWs), gay men and other men who have sex with men (MSM), people who inject drugs (PWID), and transgender women (TGW) experience disproportionate risks of HIV acquisition. The UNAIDS Global AIDS 2022 Update reported that one-quarter of all new HIV infections occurred among their non-KP sexual partners. However, this fraction relied on heuristics regarding the ratio of new infections that KPs transmitted to their non-KP partners to the new infections acquired among KPs (herein referred to as “infection ratios”). We recalculated these ratios using dynamic transmission models.
Setting:
One hundred seventy-eight settings (106 countries).
Methods:
Infection ratios for FSW, MSM, PWID, TGW, and clients of FSW were estimated from 12 models for 2020.
Results:
Median model estimates of infection ratios were 0.7 (interquartile range: 0.5–1.0; n = 172 estimates) and 1.2 (0.8–1.8; n = 127) for acquisitions from FSW clients and transmissions from FSW to all their non-KP partners, respectively, which were comparable with the previous UNAIDS assumptions (0.2–1.5 across regions). Model estimates for female partners of MSM were 0.5 (0.2–0.8; n = 20) and 0.3 (0.2–0.4; n = 10) for partners of PWID across settings in Eastern and Southern Africa, lower than the corresponding UNAIDS assumptions (0.9 and 0.8, respectively). The few available model estimates for TGW were higher [5.1 (1.2–7.0; n = 8)] than the UNAIDS assumptions (0.1–0.3). Model estimates for non-FSW partners of FSW clients in Western and Central Africa were high (1.7; 1.0–2.3; n = 29).
Conclusions:
Ratios of new infections among non-KP partners relative to KP were high, confirming the importance of better addressing prevention and treatment needs among KP as central to reducing overall HIV incidence.
Key populations (KPs), including female sex workers (FSWs), gay men and other men who have sex with men (MSM), people who inject drugs (PWID), and transgender women (TGW) experience disproportionate risks of HIV acquisition. The UNAIDS Global AIDS 2022 Update reported that one-quarter of all new HIV infections occurred among their non-KP sexual partners. However, this fraction relied on heuristics regarding the ratio of new infections that KPs transmitted to their non-KP partners to the new infections acquired among KPs (herein referred to as “infection ratios”). We recalculated these ratios using dynamic transmission models.
Setting:
One hundred seventy-eight settings (106 countries).
Methods:
Infection ratios for FSW, MSM, PWID, TGW, and clients of FSW were estimated from 12 models for 2020.
Results:
Median model estimates of infection ratios were 0.7 (interquartile range: 0.5–1.0; n = 172 estimates) and 1.2 (0.8–1.8; n = 127) for acquisitions from FSW clients and transmissions from FSW to all their non-KP partners, respectively, which were comparable with the previous UNAIDS assumptions (0.2–1.5 across regions). Model estimates for female partners of MSM were 0.5 (0.2–0.8; n = 20) and 0.3 (0.2–0.4; n = 10) for partners of PWID across settings in Eastern and Southern Africa, lower than the corresponding UNAIDS assumptions (0.9 and 0.8, respectively). The few available model estimates for TGW were higher [5.1 (1.2–7.0; n = 8)] than the UNAIDS assumptions (0.1–0.3). Model estimates for non-FSW partners of FSW clients in Western and Central Africa were high (1.7; 1.0–2.3; n = 29).
Conclusions:
Ratios of new infections among non-KP partners relative to KP were high, confirming the importance of better addressing prevention and treatment needs among KP as central to reducing overall HIV incidence.
| Original language | English |
|---|---|
| Pages (from-to) | e59-e69 |
| Number of pages | 11 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 95 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jan 2024 |
Bibliographical note
Funding Information:Supported partly by the HPTN Modelling Centre, which is funded by the U.S. National Institutes of Health (NIH UM1 AI068617) through HPTN and by the UNAIDS. R.S., R.L.A., O.S., J.W.I.-E., and M.C.B. acknowledge funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/X020258/1), funded by the UK Medical Research Council (MRC). This UK funded award is carried out in the frame of the Global Health EDCTP3 Joint Undertaking. J.S., P.V., M.C.B., and M.M.G. acknowledge funding from the Wellcome Trust (WT 226619/Z/22/Z). S.M. and S.B. were funded in part by the National Institutes of Allergy and Infectious Diseases (R01AI170249) at the National Institute of Health for the modeling conducted in this study. S.M. and M.M.G. research programs are supported Tier 2 Canada Research Chairs. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising.
Publisher Copyright:
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
