New HIV Infections Among Key Populations and Their Partners in 2010 and 2022, by World Region: A Multisources Estimation.

BACKGROUND: Previously, The Joint United Nations Programme on HIV/AIDS estimated proportions of adult new HIV infections among key populations (KPs) in the last calendar year, globally and in 8 regions. We refined and updated these, for 2010 and 2022, using country-level trend models informed by national data. METHODS: Infections among 15-49 year olds were estimated for sex workers (SWs), male clients of female SW, men who have sex with men (MSM), people who inject drugs (PWID), transgender women (TGW), and non-KP sex partners of these groups. Transmission models used were Goals (71 countries), AIDS Epidemic Model (13 Asian countries), Optima (9 European and Central Asian countries), and Thembisa (South Africa). Statistical Estimation and Projection Package fits were used for 15 countries. For 40 countries, new infections in 1 or more KPs were approximated from first-time diagnoses by the mode of transmission. Infection proportions among nonclient partners came from Goals, Optima, AIDS Epidemic Model, and Thembisa. For remaining countries and groups not represented in models, median proportions by KP were extrapolated from countries modeled within the same region. RESULTS: Across 172 countries, estimated proportions of new adult infections in 2010 and 2022 were both 7.7% for SW, 11% and 20% for MSM, 0.72% and 1.1% for TGW, 6.8% and 8.0% for PWID, 12% and 10% for clients, and 5.3% and 8.2% for nonclient partners. In sub-Saharan Africa, proportions of new HIV infections decreased among SW, clients, and non-KP partners but increased for PWID; elsewhere these groups' 2010-to-2022 differences were opposite. For MSM and TGW, the proportions increased across all regions. CONCLUSIONS: KPs continue to have disproportionately high HIV incidence.

Availability and Quality of Surveillance and Survey Data on HIV Prevalence Among Sex Workers, Men Who Have Sex With Men, People Who Inject Drugs, and Transgender Women in Low- and Middle-Income Countries: Review of Available Data (2001-2017).

BACKGROUND: In 2019, 62% of new HIV infections occurred among key populations (KPs) and their sexual partners. The World Health Organization (WHO) recommends implementation of bio-behavioral surveys every 2-3 years to obtain HIV prevalence data for all KPs. However, the collection of these data is often less frequent and geographically limited. OBJECTIVE: This study intended to assess the availability and quality of HIV prevalence data among sex workers (SWs), men who have sex with men (MSM), people who inject drugs, and transgender women (transwomen) in low- and middle-income countries. METHODS: Data were obtained from survey reports, national reports, journal articles, and other grey literature available to the Global Fund, Joint United Nations Programme on HIV/AIDS, and WHO or from other open sources. Elements reviewed included names of subnational units, HIV prevalence, sampling method, and size. Based on geographical coverage, availability of trends over time, and recency of estimates, data were categorized by country and grouped as follows: nationally adequate, locally adequate but nationally inadequate, no recent data, no trends available, and no data. RESULTS: Among the 123 countries assessed, 91.9% (113/123) presented at least 1 HIV prevalence data point for any KP; 78.0% (96/123) presented data for at least 2 groups; and 51.2% (63/123), for at least 3 groups. Data on all 4 groups were available for only 14.6% (18/123) of the countries. HIV prevalence data for SWs, MSM, people who inject drugs, and transwomen were available in 86.2% (106/123), 80.5% (99/123), 45.5% (56/123), and 23.6% (29/123) of the countries, respectively. Only 10.6% (13/123) of the countries presented nationally adequate data for any KP between 2001 and 2017; 6 for SWs; 2 for MSM; and 5 for people who inject drugs. Moreover, 26.8% (33/123) of the countries were categorized as locally adequate but nationally inadequate, mostly for SWs and MSM. No trend data on SWs and MSM were available for 38.2% (47/123) and 43.9% (54/123) of the countries, respectively, while no data on people who inject drugs and transwomen were available for 76.4% (94/123) and 54.5% (67/123) of the countries, respectively. An increase in the number of data points was observed for MSM and transwomen. Overall increases were noted in the number and proportions of data points, especially for MSM, people who inject drugs, and transwomen, with sample sizes exceeding 100. CONCLUSIONS: Despite general improvements in health data availability and quality, the availability of HIV prevalence data among the most vulnerable populations in low- and middle-income countries remains insufficient. Data collection should be expanded to include behavioral, clinical, and epidemiologic data through context-specific differentiated survey approaches while emphasizing data use for program improvements. Ending the HIV epidemic by 2030 is possible only if the epidemic is controlled among KPs.

Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries.

OBJECTIVE: To assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women. METHODS: Size estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into 'nationally adequate', 'nationally inadequate but locally adequate', 'documented but inadequate methods', 'undocumented or untimely' and 'no data.' FINDINGS: Of 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries. CONCLUSIONS: Size estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches.