Quantifying the evolving contribution of HIV interventions and key populations to the HIV epidemic in Yaoundé, Cameroon

Romain Silhol, Peter Vickerman, Marie-Claude Boily, et al.

Research output: Contribution to journalArticle (Academic Journal)peer-review


Background: Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of KP and lower-risk groups to HIV transmission.

Setting: Yaoundé, Cameroon.

Methods: We parametrised and fitted a deterministic of HIV transmission model to
Yaoundé-specific demographic, behavioural, HIV and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to unprotected sex within and between each risk group.

Results: Condom use and ART together may have averted 43% (95% uncertainty interval: 31-54) of incident infections over 1980-2018 and 72% (66-79) over 2009-2018. Most onward transmissions over 2009-2018 stemmed from unprotected sex between lower-risk individuals (47% (32-61)), clients (37% (23-51)), and MSM (35% (20-54)) with all their partners. The contribution of commercial sex decreased from 25% (8-49) over 1989-1998 to 8% (3-22) over 2009-2018, due to higher intervention coverage among FSW.

Conclusion: Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services which successfully reduced transmissions in the context of commercial sex.
Original languageEnglish
JournalJournal of Acquired Immune Deficiency Syndromes
Early online date20 Nov 2020
Publication statusE-pub ahead of print - 20 Nov 2020


  • mathematical model
  • HIV incidence
  • population attributable fraction
  • condom use
  • key populations

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