Experiences of Stigma and Support Reported by Participants in a Network Intervention to Reduce HIV Transmission in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois.

A growing body of evidence suggests that network-based interventions to reduce HIV transmission and/or improve HIV-related health outcomes have an important place in public health efforts to move towards 90-90-90 goals. However, the social processes involved in network-based recruitment may pose a risk to participants of increasing HIV-related stigma if network recruitment causes HIV status to be assumed, inferred, or disclosed. On the other hand, the social processes involved in network-based recruitment to HIV testing may also encourage HIV-related social support. Yet despite the relevance of these processes to both network-based interventions and to other more common interventions (e.g., partner services), there is a dearth of literature that directly examines them among participants of such interventions. Furthermore, both HIV-related stigma and social support may influence participants' willingness and ability to recruit their network members to the study. This paper examines (1) the extent to which stigma and support were experienced by participants in the Transmission Reduction Intervention Project (TRIP), a risk network-tracing intervention aimed at locating recently HIV-infected and/or undiagnosed HIV-infected people and linking them to care in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois; and (2) whether stigma and support predicted participant engagement in the intervention. Overall, experiences of stigma were infrequent and experiences of support frequent, with significant variation between study sites. Experiences and perceptions of HIV-related stigma did not change significantly between baseline and six-month follow-up for the full TRIP sample, and significantly decreased during the course of the study at the Chicago site. Experiences of HIV-related support significantly increased among recently-HIV-infected participants at all sites, and among all participants at the Odessa site. Both stigma and support were found to predict participants' recruitment of network members to the study at the Athens site, and to predict participants' interviewer-rated enthusiasm for naming and recruiting their network members at both the Athens and Odessa sites. These findings suggest that network-based interventions like TRIP which aim to reduce HIV transmission likely do not increase stigma-related risks to participants, and may even encourage increased social support among network members. However, the present study is limited by its associational design and by some variation in implementation by study site. Future research should directly assess contextual differences to improve understanding of the implications of site-level variation in stigma and support for the implementation of network-based interventions, given the finding that these constructs predict participants' recruitment of network members and engagement in the intervention, and thereby could limit network-based interventions' abilities to reach those most in need of HIV testing and care.

A new approach to prevent HIV transmission: Project Protect intervention for recently infected individuals.

Past research suggests that as many as 50% of onward human immunodeficiency virus (HIV) transmissions occur during acute and recent HIV infection. It is clearly important to develop interventions which focus on this highly infectious stage of HIV infection to prevent further transmission in the risk networks of acutely and recently infected individuals. Project Protect tries to find recently and acutely infected individuals and prevents HIV transmission in their risk networks. Participants are recruited by community health outreach workers at community-based HIV testing sites and drug users' community venues, by coupon referrals and through referrals from AIDS clinics. When a network with acute/recent infection is identified, network members are interviewed about their risky behaviors, network information is collected, and blood is drawn for HIV testing. Participants are also educated and given prevention materials (condoms, syringes, educational materials); HIV-infected participants are referred to AIDS clinics and are assisted with access to care. Community alerts about elevated risk of HIV transmission are distributed within the risk networks of recently infected. Overall, 342 people were recruited to the project and screened for acute/recent HIV infection. Only six index cases of recent infection (2.3% of all people screened) were found through primary screening at voluntary counseling and testing (VCT) sites, but six cases of recent infection were found through contact tracing of these recently infected participants (7% of network members who came to the interview). Combining screening at VCT sites and contact tracing the number of recently infected people we located as compared to VCT screening alone. No adverse events were encountered. These first results provide evidence for the theory behind the intervention, i.e., in the risk networks of recently infected people there are other people with recent HIV infection and they can be successfully located without increasing stigma for project participants.

Sex, drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine.

SETTING: One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010-2011. OBJECTIVE: Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion. DESIGN: Retrospective cohort study involving record reviews. RESULTS: Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert. CONCLUSIONS: In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.

Contexte : Cent quarante organisations non gouvernementales impliquées dans la mise en œuvre de programmes de prévention du virus de l'immunodéficience humaine (VIH) pour des clients comprenant des utilisateurs de drogues injectables, des détenus, des travailleuses du sexe, des homosexuels masculins et des enfants des rues en Ukraine de 2010 à 2011.Objectif : Evaluer les facteurs associés au dépistage du VIH, à un second dépistage dans l'année qui suit et à une séroconversion parmi les clients enrôlés.Schéma : Etude rétrospective de cohorte par revue de dossiers.Résultats : Sur 192 487 clients, 42 109 (22%) ont eu un test VIH initial (22% étaient positifs). Parmi les clients négatifs au départ, 10 858 (27%) ont eu un deuxième test dans l'année, dont 317 (3%) se sont révélés VIH positifs. Les taux de dépistage initial et subséquent étaient plus faibles parmi les prisonniers (0,3%) et d'autres groupes comme les enfants des rues et les partenaires de groupes à risque (6%), ainsi que ceux qui n'avaient pas bénéficié de conseil ni de services comme la distribution de préservatifs et d'aiguilles. Les sujets qui n'avaient pas bénéficié de conseil étaient plus enclins à la séroconversion.Conclusions: Dans cette vaste cohorte de groupes à risque élevé d'Europe de l'Est, le taux de dépistage était faible et le taux de séroconversion élevé. Cette situation est préoccupante en termes de santé publique et met en doute la qualité d'ensemble du conseil et la manière dont il est adapté aux besoins spécifiques de divers groupes à risque. Il est urgent de réaliser des études qualitatives afin de comprendre les raisons du non dépistage et d'élaborer des interventions spécifiques des clients.

Marco de referencia: Las 140 organizaciones no gubernamentales que aplican programas de prevención de la infección por el virus de la inmunodeficiencia humana (VIH) a usuarios como los consumidores de drogas inyectables, los reclusos, las trabajadoras del sexo, los hombres que tienen relaciones sexuales con hombres y los niños de la calle en Ucrania entre el 2010 y el 2011.Objetivo: Evaluar los factores que se asocian con la práctica de la prueba diagnóstica del VIH, la repetición de la prueba un año después de la primera y la seroconversión en los usuarios inscritos.Método: Fue este un estudio retrospectivo de cohortes con análisis de las historias clínicas.Resultados: De los 192 487 usuarios del programa, 42 109 recibieron una primera prueba del VIH (22%); 22% fueron positivos. De las personas con un resultado negativo inicial, 10 858 repitieron la prueba un año después (27%) y 317 de ellas obtuvieron un resultado positivo (3%). Las tasas de práctica de la prueba del VIH y de repetición de la misma fueron inferiores en los reclusos (0,3%), en el grupo de otros (los niños de la calle y las parejas de personas de los grupos de riesgo, 6%) y en las personas que no recibieron asesoramiento ni servicios como la distribución de agujas o preservativos. La seroconversión fue más frecuente en las personas que no recibieron orientación.Conclusión: En este amplio estudio de cohortes de grupos de riesgo en Europa oriental, la tasa de pruebas diagnósticas del VIH fue baja y los índices de seroconversión fueron altos. Esta situación representa un problema de salud pública y pone en tela de juicio la calidad general de los programas de asesoramiento y la forma como estos se adaptan a las necesidades específicas de los diversos grupos de riesgo. Se precisan con urgencia estudios cualitativos que analicen las razones de la falta de la prueba diagnóstica, con el fin de elaborar intervenciones que sean específicas para determinados usuarios.