The current landscape of software tools for the climate-sensitive infectious disease modelling community.

Climate-sensitive infectious disease modelling is crucial for public health planning and is underpinned by a complex network of software tools. We identified only 37 tools that incorporated both climate inputs and epidemiological information to produce an output of disease risk in one package, were transparently described and validated, were named (for future searching and versioning), and were accessible (ie, the code was published during the past 10 years or was available on a repository, web platform, or other user interface). We noted disproportionate representation of developers based at North American and European institutions. Most tools (n=30 [81%]) focused on vector-borne diseases, and more than half (n=16 [53%]) of these tools focused on malaria. Few tools (n=4 [11%]) focused on food-borne, respiratory, or water-borne diseases. The under-representation of tools for estimating outbreaks of directly transmitted diseases represents a major knowledge gap. Just over half (n=20 [54%]) of the tools assessed were described as operationalised, with many freely available online.

Patterns of sexual and HIV-related stigma among men who have sex with men and women living with HIV in Haiti.

Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented.

Co-learning during the co-creation of a dengue early warning system for the health sector in Barbados.

Over the past decade, the Caribbean region has been challenged by compound climate and health hazards, including tropical storms, extreme heat and droughts and overlapping epidemics of mosquito-borne diseases, including dengue, chikungunya and Zika. Early warning systems (EWS) are a key climate change adaptation strategy for the health sector. An EWS can integrate climate information in forecasting models to predict the risk of disease outbreaks several weeks or months in advance. In this article, we share our experiences of co-learning during the process of co-creating a dengue EWS for the health sector in Barbados, and we discuss barriers to implementation as well as key opportunities. This process has involved bringing together health and climate practitioners with transdisciplinary researchers to jointly identify needs and priorities, assess available data, co-create an early warning tool, gather feedback via national and regional consultations and conduct trainings. Implementation is ongoing and our team continues to be committed to a long-term process of collaboration. Developing strong partnerships, particularly between the climate and health sectors in Barbados, has been a critical part of the research and development. In many countries, the national climate and health sectors have not worked together in a sustained or formal manner. This collaborative process has purposefully pushed us out of our comfort zone, challenging us to venture beyond our institutional and disciplinary silos. Through the co-creation of the EWS, we anticipate that the Barbados health system will be better able to mainstream climate information into decision-making processes using tailored tools, such as epidemic forecast reports, risk maps and climate-health bulletins, ultimately increasing the resilience of the health system.

A realist evaluation of the continuum of HIV services for men who have sex with men.

BACKGROUND: Men who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: (1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, (2) assessing the outcomes of this approach and (3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways. METHODS: Guided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement. RESULTS: The results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance. CONCLUSIONS: The study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.

HIV among men who have sex with men in the Caribbean: reaching the left behind.

OBJECTIVES: To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030. METHODS: A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries. RESULTS: 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic. CONCLUSIONS: To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto 'Leave no one behind'.

HIV among men who have sex with men in the Caribbean: reaching the left behind / La infección por el VIH en hombres que tienen relaciones sexuales con hombres en el Caribe: alcanzar a los que quedaron atrás / HIV em homens que fazem sexo com homens no Caribe: alcançando os que ficaram para trás

ABSTRACT Objectives. To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030. Methods. A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries. Results. 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic. Conclusions. To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto 'Leave no one behind'.

RESUMEN Objetivos. Presentar los factores epidemiológicos, sociales y culturales que impulsan la epidemia de la infección por el VIH en los hombres que tienen relaciones sexuales con hombres (HSH) en el Caribe, así como destacar las respuestas a nivel nacional y regional y las brechas que deben cerrarse para poner fin a la epidemia de sida para el 2030. Métodos. Se realizó una revisión bibliográfica a partir de búsquedas en las siguientes bases de datos: PubMed y Scopus. Se seleccionaron artículos publicados en los últimos diez años que abordan los factores de riesgo socioculturales, la descripción de las iniciativas nacionales y regionales, y los posibles retos y obstáculos al control eficaz de la epidemia en los HSH. Este informe se centra exclusivamente en aquellas publicaciones sobre los HSH en los países del Caribe. Resultados. Se realizó un análisis temático de 11 estudios arbitrados y 9 artículos y marcos programáticos de la bibliografía gris. La prevalencia de la infección por el VIH en los HSH es alta y las tasas varían entre los países del Caribe. Existen varios factores que influyen en la epidemia de la infección por el VIH en los HSH en el Caribe, pero el estigma y la discriminación están en el centro de la vulnerabilidad social y ayudan a impulsar la epidemia. Conclusiones. En la era de los Objetivos de Desarrollo Sostenible y su lema de "no dejar a nadie atrás", no se puede continuar desatendiendo a los HSH si se quiere poner fin a la epidemia de sida para el 2030.

RESUMO Objetivos. Descrever o perfil epidemiológico e fatores socioculturais determinantes da epidemia de HIV em homens que fazem sexo com homens (HSH) na região do Caribe e chamar atenção para as respostas nacionais e regionais e o que ainda falta para suprir as falhas e eliminar a aids até 2030. Métodos. Uma revisão da literatura foi realizada nas bases de dados PubMed e Scopus com a seleção de artigos publicados nos 10 últimos anos. Os desfechos de interesse foram fatores de risco socioculturais, descrição das iniciativas nacionais e regionais e potenciais desafios e obstáculos ao controle efetivo da epidemia de HIV em HSH. O estudo se restringiu exclusivamente a publicações relativas a HSH vivendo nos países do Caribe. Resultados. Onze estudos avaliados por pares e 9 relatos da literatura cinzenta e enquadramentos de programas foram analisados tematicamente. A prevalência do HIV é alta em HSH vivendo no Caribe e os índices variam entre os países. Diversos fatores influenciam a epidemia em HSH, mas o estigma e a discriminação constituem a base da vulnerabilidade social e têm um papel central na epidemia do HIV no Caribe. Conclusões. Para eliminar a epidemia de aids até 2030, os HSH não podem mais ficar sem monitoração na era dos Objetivos de Desenvolvimento Sustentável com sua missão de "não deixar ninguém para trás".

Attitudes of medical students towards men who have sex with men living with HIV: implications for social accountability.

OBJECTIVES: To explore the attitudes that medical students in Haiti harbour toward Men who have Sex with Men living with HIV in order to better understand how stigma and other factors may impair healthcare, and to explore suggestions of opportunities in line with the values of social accountability. METHODS: This study employed a qualitative design by using a grounded theory approach regarding the context of Haiti. We used purposive sampling to select the 22 research participants. In-depth interviews were conducted, audio-recorded, transcribed and analyzed using an inductive content analysis approach. RESULTS: Although stigmatizing attitudes emerged through the findings, medical students expressed willingness to provide Men who have Sex with Men with adequate health services in relation to HIV care. Their expressions were based on the Men who have Sex with Men's comprehensive right to receive equitable care, the moral responsibility of healthcare professionals, their perception of health disparities and the HIV global risk reduction. Participants pointed out that the medical education curriculum did not consider sexual health and specificities of sexual minorities and suggested a more inclusive and socially accountable training based on equity and quality. CONCLUSIONS: The students expressed favourable attitudes regarding health services to Men who have Sex with Men even though some layered stigmatizing attitudes emerged through the discussions. They all lacked skills on how to handle health specificities of sexual minorities. These findings recommend a revision of the medical education curriculum in regard to social accountability principles.

A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men.

While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.