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1.
Washington, D.C.; OPS; 2021-02-16. (OPS/CDE/HT/21-0002).
em Espanhol | PAHO-IRIS | ID: phr-53277

RESUMO

En América Latina y el Caribe, entre 70% y 80% de las nuevas infecciones por el VIH se presentan en los grupos de población clave o en sus clientes o parejas sexuales. La información estratégica de calidad sobre los servicios ofrecidos a estos grupos de población, es esencial para la toma de decisiones programáticas que pongan a los países en el camino hacia la eliminación del VIH para el 2030. Desde el 2019, varios países de la región han fortalecido el monitoreo de los servicios preventivos de VIH ofrecidos a los grupos de población clave. Las mejoras han incluido el fortalecimiento de los sistemas de información, la capacitación para la recogida y el análisis de los datos, y el fomento de la toma de decisiones basada en evidencia para mejorar la disponibilidad y cobertura de los servicios de VIH e ITS. A través de la construcción de las cascadas de prevención y atención al VIH, ocho países han conseguido medir el impacto de los servicios de VIH no solo a partir de que las personas de población clave con VIH mantengan una carga viral indetectable, sino también de que las personas de población clave VIH-negativas se mantengan libres de infección. Además se ha progresado en medir la contribución que las asociaciones de la sociedad civil llevan a cabo en la respuesta contra el VIH y las ITS. Este aspecto es fundamental para garantizar su sostenibilidad y el financiamiento por fuentes nacionales. En esta publicación se resumen los principales logros alcanzados en América Latina y el Caribe en favor de la mejora de la información estratégica relacionada con los servicios de VIH para los grupos de población clave. En él se ponen de relieve las experiencias de la region, que pueden servir de ejemplo a otras regiones, a medida que nos adentramos en los últimos diez años para alcanzar los objetivos de eliminación del VIH/sida.


Assuntos
HIV , Parceiros Sexuais , Infecções por HIV , População , Serviços de Saúde , Doenças Transmissíveis , Minorias Sexuais e de Gênero , Identidade de Gênero , Reforço de Estruturas , América , Região do Caribe , Profissionais do Sexo , Doenças Sexualmente Transmissíveis
2.
Washington, D.C.; PAHO; 2021-02-11. (PAHO/CDE/HT/21-0002).
em Inglês | PAHO-IRIS | ID: phr-53271

RESUMO

In Latin America and the Caribbean, 70-80% of new HIV infections occur among key populations and their clients or sexual partners. High-quality strategic information on the monitoring of HIV prevention services offered to key populations is essential to drive programmatic decisions that put countries on the path to eliminating HIV by 2030. Since 2019, several countries in the region have strengthened the monitoring of HIV preventive services offered to key populations. Improvements include the strengthening of information systems, capacity building for data collection and analysis, and fostering evidence-based decision making to improve the availability and coverage of HIV and STI services. By building the HIV prevention and care cascades, 8 countries in the region have measured the impact of HIV services. This impact is determined not only from the number of people from the key population living with HIV maintaining an undetectable viral load but also from the number of people from the HIV-negative key population kept HIV-free through the provision of essential services. Moreover, countries have progressed in measuring civil society's contribution in the response against HIV and STIs. This aspect is essential to guarantee their sustainability and financing from national sources. The document shown here is a guide for Latin American and Caribbean countries to improve strategic information related to HIV services for key populations through strengthened monitoring using a combination prevention approach.


Assuntos
HIV , População , Reforço de Estruturas , Serviços de Saúde , Doenças Transmissíveis , América , América Latina , Região do Caribe , Minorias Sexuais e de Gênero , Identidade de Gênero , Profissionais do Sexo , Doenças Sexualmente Transmissíveis
3.
Rev. baiana enferm ; 35: e37327, 2021.
Artigo em Português | LILACS-Express | LILACS, BDENF - Enfermagem | ID: biblio-1149705

RESUMO

Objetivo refletir sobre as situações de vulnerabilidades em saúde vivenciadas por trabalhadoras sexuais durante a pandemia decorrente da infecção pelo SARS-CoV-2. Método trata-se de estudo reflexivo, fundamentado no referencial teórico conceitual da vulnerabilidade em quatro dimensões: ontológica, epidemiológica, simbólica e político-programática. Resultado a saúde das profissionais do sexo, na experiência cotidiana do trabalho sexual, tem sido um desafio para os governos entre todos os grupos associados a estigmas e populações vulneráveis, justamente por serem marginalizados socialmente. Isso se configura como importante para a compreensão desse fenômeno em meio à crise financeira, econômica e de saúde que pessoas de diferentes nações sofrem diante do progresso da SARS-CoV-2. Conclusão as situações de vulnerabilidade em saúde decorrente da infecção pelo SARS-CoV-2 que expõem as profissionais do sexo são consolidadas, principalmente, pela ausência do Estado na proteção sócio legal e na garantia dos direitos humanos, para que essas mulheres adquiram condições de enfrentamento e prevenção.


Objetivo reflexionar sobre las situaciones de vulnerabilidades en salud experimentadas por las trabajadoras sexuales durante la pandemia resultante de la infección por SARS-CoV-2. Método se trata de un estudio reflexivo, basado en el marco teórico conceptual de vulnerabilidad en cuatro dimensiones: ontológica, epidemiológica, simbólica y política-programática. Resultado la salud de las trabajadoras sexuales, en la experiencia diaria del trabajo sexual, ha sido un desafío para los gobiernos entre todos los grupos asociados con estigmas y poblaciones vulnerables, precisamente porque están socialmente marginadas. Esto es importante para entender este fenómeno en medio de la crisis financiera, económica y de salud que sufren personas de diferentes naciones ante el progreso del SARS-CoV-2. Conclusión las situaciones de vulnerabilidad a la salud resultantes de la infección por SARS-CoV-2 a que exponen las trabajadoras sexuales se consolidan, principalmente, por la ausencia del Estado en la protección social-jurídica y en la garantía de los derechos humanos, para que estas mujeres adquieran condiciones de enfrentamiento y prevención.


Objective to reflect on the situations of health vulnerabilities experienced by sex workers during the pandemic resulting from SARS-CoV-2 infection. Method this is a reflective study, based on the conceptual theoretical framework of vulnerability in four dimensions: ontological, epidemiological, symbolic and political-programmatic. Result the health of sex workers, in the daily experience of sexual work, has been a challenge for governments among all groups associated with stigmas and vulnerable populations, precisely because they are socially marginalized. This is important for understanding this phenomenon in the midst of the financial, economic and health crisis that people from different nations suffer before the progress of SARS-CoV-2. Conclusion the situations of health vulnerability resulting from the SARS-CoV-2 infection that expose sex workers are consolidated, mainly, by the absence of the State in the social-legal protection and in the guarantee of human rights, so that these women acquire conditions of coping and prevention.


Assuntos
Humanos , Infecções por Coronavirus , Vulnerabilidade em Saúde , Profissionais do Sexo , Pandemias
4.
Ann Epidemiol ; 55: 34-40, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33340655

RESUMO

PURPOSE: Human immunodeficiency virus (HIV) risks are heterogeneous in nature even in generalized epidemics. However, data are often missing for those at highest risk of HIV, including female sex workers. Statistical models may be used to address data gaps where direct, empiric estimates do not exist. METHODS: We proposed a new size estimation method that combines multiple data sources (the Malawi Biological and Behavioral Surveillance Survey, the Priorities for Local AIDS Control Efforts study, and the Malawi Demographic Household Survey). We used factor analysis to extract information from auxiliary variables and constructed a linear mixed effects model for predicting population size for all districts of Malawi. RESULTS: On average, the predicted proportion of female sex workers among women of reproductive age across all districts was about 0.58%. The estimated proportions seemed reasonable in comparing with a recent study Priorities for Local AIDS Control Efforts II (PLACE II). Compared with using a single data source, we observed increased precision and better geographic coverage. CONCLUSIONS: We illustrate how size estimates from different data sources may be combined for prediction. Applying this approach to other subpopulations in Malawi and to countries where size estimate data are lacking can ultimately inform national modeling processes and estimate the distribution of risks and priorities for HIV prevention and treatment programs.


Assuntos
Profissionais do Sexo , Análise Fatorial , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Malaui/epidemiologia , Profissionais do Sexo/estatística & dados numéricos
5.
PLoS One ; 15(12): e0244357, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347494

RESUMO

BACKGROUND: Cambodia has been well recognized for its success in the fight against the HIV epidemic. However, challenges remain in eliminating HIV infections in key populations, including women working in entertainment establishments, such as massage parlors, karaoke bars, or beer gardens. This study explored the prevalence of HIV and identified factors associated with HIV infection among female entertainment workers (FEWs) in Cambodia. METHODS: This national biological and behavioral survey was conducted in 2016 in Phnom Penh and 17 provinces. We used a two-stage cluster sampling method to recruit FEWs for HIV testing performed on-site and face-to-face interviews using a structured questionnaire. We investigated factors associated with HIV infection using multiple logistic regression. RESULTS: This study included 3149 FEWs with a mean age of 26.2 years (SD 5.7). The adjusted prevalence of HIV was 3.2% (95% CI 1.76-5.75). In the multiple logistic regression model, the odds of HIV infection were significantly higher among FEWs in the age group of 31 to 35 (AOR 2.72, 95% CI 1.36-8.25) and 36 or older (AOR 3.62, 95% CI 1.89-10.55); FEWs who were not married but living with a sexual partner (AOR 3.00, 95% CI 1.16-7.79); FEWs who had at least ten years of formal education (AOR 0.32, 95% CI 0.17-0.83); FEWs who reported having abnormal vaginal discharge (AOR 3.51, 95% CI 1.12-9.01), genital ulcers or sores (AOR 2.06, 95% CI 1.09-3.17), and genital warts (AOR 2.89, 95% CI 1.44-6.33) in the past three months; and FEWs who reported using illicit drugs (AOR 3.28, 95% CI 1.20-4.27) than their respective reference group. The odds of HIV infection were significantly lower among FEWs working in karaoke bars (AOR 0.26, 95% CI 0.14-0.50) and beer gardens (AOR 0.17, 95% CI 0.09-0.54) than among freelance FEWs. CONCLUSIONS: The prevalence of HIV among FEWs in Cambodia remains much higher than that in the general population. These findings indicate that differentiated strategies to address HIV and other sexually transmitted infections should be geared towards FEWs working as freelancers or in veiled entertainment venues such as massage parlors and freelance sex workers. Prevention efforts among venue-based FEWs should be sustained.


Assuntos
Condiloma Acuminado/epidemiologia , Infecções por HIV/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Descarga Vaginal/epidemiologia , Adulto , Camboja/epidemiologia , Feminino , Infecções por HIV/etiologia , Comportamentos de Risco à Saúde , Humanos , Modelos Logísticos , Prevalência , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
6.
BMJ Open ; 10(12): e036491, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33323428

RESUMO

OBJECTIVES: The majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study. SETTING: Female SSW charity premises in a large UK inner city. PARTICIPANTS: Females aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month. INTERVENTION: Female SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service. RESULTS: (1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant's lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating. CONCLUSIONS: Recruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial.


Assuntos
Drogas Ilícitas , Profissionais do Sexo , Transtornos Relacionados ao Uso de Substâncias , Adulto , Dessensibilização e Reprocessamento através dos Movimentos Oculares , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Medicina Estatal , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Reino Unido , Adulto Jovem
8.
Afr J AIDS Res ; 19(4): 296-303, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33337978

RESUMO

HIV-incidence studies are used to identify at-risk populations for HIV-prevention trials and interventions, but loss to follow-up (LTFU) can bias results if participants who remain differ from those who drop out. We investigated the incidence of and factors associated with LTFU among Zambian female sex workers (FSWs) in an HIV-incidence cohort from 2012 to 2017. Enrolled participants returned at month one, month three and quarterly thereafter. FSWs were considered LTFU if they missed six consecutive months, or if their last visit was six months before the study end date. Of 420 FSWs, 139 (33%) were LTFU at a rate of 15.7 per 100 person years. In multivariable analysis, LTFU was greater for FSWs who never used alcohol, began sex work above the age of consent, and had a lower volume of new clients. Our study appeared to retain FSWs in most need of HIV-prevention services offered at follow-up.


Assuntos
Infecções por HIV/epidemiologia , Perda de Seguimento , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Infecções por HIV/prevenção & controle , Humanos , Incidência , Fatores de Risco , Adulto Jovem , Zâmbia/epidemiologia
9.
PLoS One ; 15(12): e0244420, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351852

RESUMO

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new strain of virus in the Coronavirus family that has not been previously identified. Since SARS-CoV-2 is a new virus, everyone is at risk of catching the Coronavirus disease 2019 (Covid-19). No one has immunity to the virus. Despite this, misconceptions about specific groups of people who are immune to Covid-19 emerged with the onset of the pandemic. This paper explores South African communities' misconceptions about who is most vulnerable to Covid-19. A rapid qualitative assessment was conducted remotely in Gauteng, KwaZulu-Natal and the Western Cape provinces of South Africa. Recruitment of study participants took place through established relationships with civil society organizations and contacts made by researchers. In total, 60 key informant interviews and one focus group discussion was conducted. Atlas.ti.8 Windows was used to facilitate qualitative data analysis. The qualitative data was coded, and thematic analysis used to identify themes. The results show a high level of awareness and knowledge of the transmission and prevention of SARS-CoV-2. Qualitative data revealed that there is awareness of elderly people and those with immunocompromised conditions being more vulnerable to catching Covid-19. However, misconceptions of being protected against the virus or having low or no risk were also evident in the data. We found that false information circulated on social media not only instigated confusion, fear and panic, but also contributed to the construction of misconceptions, othering and stigmatizing responses to Covid-19. The study findings bring attention to the importance of developing communication materials adapted to specific communities to help reduce misconceptions, othering and stigmatization around Covid-19.


Assuntos
/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , /patogenicidade , Adaptação Fisiológica , Adulto , Idoso , /virologia , Agentes Comunitários de Saúde/psicologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais do Sexo/psicologia , Minorias Sexuais e de Gênero/psicologia , África do Sul/epidemiologia , Estereotipagem
10.
Pan Afr Med J ; 37: 47, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33209174

RESUMO

SARS-CoV-2 has created a global public health emergency with significant mortality and morbidity for people living with HIV (PLWH). Preliminary data reveals persons with immune-compromised status are at risk of developing adverse clinical outcomes from SARS-CoV-2. We aimed to characterise clinical outcomes of HIV patients co-infected with SARS-CoV-2 infection in Nasarawa State, North Central Nigeria. We followed four (4) hospitalised HIV patients that tested positive to SARS-CoV-2 in Nasarawa State and characterised their laboratory findings and clinical outcomes. The consent of the cases was sought and they agreed that their clinical data be published. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 nucleic acid were performed using nasopharyngeal swabs (novel coronavirus PCR fluorescence diagnostic kit, BioGerm medical biotechnology) at the Nigeria Centre for Disease Control (NCDC) in Abuja, Nigeria. Our study reveals mild clinical outcome among HIV patients with SARS-CoV-2 co-infection. There is need for a syndemic framework to be used to conceptualise SARS-CoV-2 impact among HIV patients and an urgent need to strengthen healthcare programmes within Nigeria.


Assuntos
Antirretrovirais/uso terapêutico , Betacoronavirus , Coinfecção/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Síndrome Respiratória Aguda Grave , Profissionais do Sexo , Antivirais/uso terapêutico , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Nigéria , Norfloxacino/uso terapêutico , Pandemias , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real , gama-Globulinas/uso terapêutico
12.
PLoS One ; 15(10): e0239951, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002081

RESUMO

Sri Lanka has a low-level HIV epidemic. This study aims to provide evidence on HIV, syphilis and hepatitis B (HBV) prevalence, sexual risk behaviours and utilisation of HIV prevention interventions among female sex workers (FSW) in the cities Colombo, Galle, and Kandy. Using respondent-driven sampling (RDS), we recruited a total of 458 FSW in Colombo, 360 in Galle and 362 in Kandy from November 2017 to March 2018. Participants provided biological specimens for testing for infections and completed a behavioural questionnaire. We found no HIV nor HBV infections in Galle and Kandy, and low HIV (0.4%) and HBV surface antigen (0.6%) prevalence in Colombo. FSW in Colombo had higher positivity on Treponema pallidum-particle agglutination test (8.4%) compared to Galle (2.0%) and Kandy (2.5%). About two thirds of FSW heard of HIV in each of the cities. Around 90% of FSW used condom at last sex with a client in both Colombo and Galle, but considerably less in Kandy (57.1%). However, lower proportion of FSW used condoms every time during sex with clients in the past 30 day: 22.9% of FSW in Colombo, 26.6% in Kandy and 68.4% in Galle. Across cities, 17.5%-39.5% of FSW reported being tested for HIV in the past 12 months or knowing HIV positive status. The commonest reasons for never testing for HIV was not knowing where to test (54.2% in Colombo, 41.8% in Galle, 48.1% in Kandy) followed by inconvenient testing location (23.7% in Colombo and 31.1% in Kandy). HIV has not yet been firmly established among FSW in three cities in Sri Lanka, but the vulnerability towards HIV and STIs is substantial. HIV interventions should be intensified by expanding community-based HIV testing approaches, increasingawareness of HIV risks and addressing socio-structural vulnerabilities of FSW to HIV.


Assuntos
Soropositividade para HIV/epidemiologia , Hepatite B/epidemiologia , Profissionais do Sexo/estatística & dados numéricos , Sífilis/epidemiologia , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Sri Lanka , Sorodiagnóstico da Sífilis/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1531-1535, 2020 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-33076613

RESUMO

Objective: To explore the correlation between alcohol drinking and high-risk sexual behaviors in HIV negative clients of female sex workers and provide scientific evidence for prevention of HIV sexual transmission. Methods: A cross-sectional survey was conducted in HIV negative clients in Ji'nan and Haikou from December 2018 to May 2019. The estimated sample size was 337, the information about their demographic characteristics, AIDS knowledge awareness, sexual behaviors and alcohol drinking habit were collected through convenience sampling. The data were analyzed by using SPSS 24.0 software. Results: A total of 381 clients were included in this study. Most of them were less than 40 years old, accounting for 89.2% (340/381); 85.3% of them (325/381) reported an education level of high school and above; the clients who were married, had cohabitation with females or had girl friends accounted for 53.2% (202/380). The overall awareness rate of AIDS knowledge was 83.7% (318/380). Of all participants, 80.8% (308/381) had commercial sex in the past year, 79.8% (304/381) had non-commercial sex partners, 62.7% (239/381) had high-risk sexual behaviors. The results of logistic regression showed that compared with those with alcohol drinking frequency ≤2 times per month in last year, the clients with alcohol drinking frequency more than once a week (aOR=3.22, 95%CI: 1.25-8.27) were more likely to have high risk sexual behaviors after adjustment for age, living area, location type of residence, time of local residence, education level, monthly income level, occupation, marital status, knowledge awareness of AIDS and HIV related services, the number of commercial or non-commercial sexual partners in the past year, cost of commercial sex and HIV test frequency. Conclusions: Alcohol drinking is related to high risk sexual behaviors in HIV negative clients, and will increase the risk of HIV transmission. To control AIDS, the intervention of alcohol drinking should be combined with other preventions to improve the correct use of condoms.


Assuntos
Consumo de Bebidas Alcoólicas , Assunção de Riscos , Comportamento Sexual , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Profissionais do Sexo
14.
J Int AIDS Soc ; 23(10): e25632, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33119183

RESUMO

INTRODUCTION: Key populations at elevated risk to contract or transmit HIV may also be at higher risk of COVID-19 complications and adverse outcomes associated with public health prevention measures. However, the conditions faced by specific populations vary according to social, structural and environmental factors, including stigma and discrimination, criminalization, social and economic safety nets and the local epidemiology of HIV and COVID-19, which determine risk of exposure and vulnerability to adverse health outcomes, as well as the ability to comply with measures such as physical distancing. This commentary identifies common vulnerabilities and cross-cutting themes in terms of the impacts of COVID-19 on key populations before addressing issues and concerns specific to particular populations. DISCUSSION: Cross-cutting themes include direct impacts such as disrupted access to essential medicines, commodities and services such as anti-retroviral treatment, HIV pre-exposure prophylaxis, opioid agonist treatment, viral load monitoring, HIV and sexually transmitted infections testing, condoms and syringes. Indirect impacts include significant collateral damage arising from prevention measures which restrict human rights, increase or impose criminal penalties, and expand police powers to target vulnerable and criminalized populations. Significant heterogeneity in the COVID-19 pandemic, the underlying HIV epidemic and the ability of key populations to protect themselves means that people who inject drugs and sex workers face particular challenges, including indirect impacts as a result of police targeting, loss of income and sometimes both. Geographical variations mean that transgender people and men who have sex with men in regions like Africa and the middle east remain criminalized, as well as stigmatized and discriminated against, increasing their vulnerability to adverse outcomes in relation to COVID-19. CONCLUSIONS: Disruptions to both licit and illicit supply chains, loss of income and livelihoods and changes in behaviour as a result of lockdowns and physical distancing have the potential to exacerbate the impacts of the COVID-19 pandemic on key populations. While these impacts will vary significantly, human-rights approaches to COVID-19 emergency laws and public health prevention measures that are population-specific and sensitive, will be key to reducing adverse health outcomes and ensuring that no one is left behind.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Minorias Sexuais e de Gênero , Populações Vulneráveis , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Feminino , Infecções por HIV/complicações , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Renda , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Profilaxia Pré-Exposição , Prisioneiros , Saúde Pública , Fatores de Risco , Profissionais do Sexo , Doenças Sexualmente Transmissíveis/prevenção & controle , Estigma Social , Carga Viral
15.
BMC Infect Dis ; 20(1): 655, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894072

RESUMO

BACKGROUND: People who use drugs including people who inject drugs (PWUD/ID), sex workers (SWs) and men who have sex with men (MSM) are at increased risk of HIV and viral hepatitis infection. Limited epidemiological data on the infections exists in key populations (KPs) in South Africa. We investigated the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV and selected risk factors among these KPs to inform effective responses. METHODS: We used convenience sampling to recruit a targeted 3500 KPs accessing HIV-related health services across Cape Town (SWs, MSM, PWUD/ID), Durban (SWs, PWUD/ID), Pietermaritzburg (SWs), Mthatha (SWs), Port Elizabeth (SWs), Johannesburg (MSM) and Pretoria (MSM and PWUD/ID) into a cross-sectional survey. An interviewer questionnaire to assess socio-demographic characteristics, drug use and sexual risk practices, was administered. HBV surface antigen (HBsAg); HCV antibody, viral load and genotype, and HIV antibody, was tested. RESULTS: Among the 3439 people included in the study (1528 SWs, 746 MSM, 1165 PWUD/ID) the median age was 29 years, most participants were black African (60%), and 24% reported homelessness. 82% reported substance use in the last month, including alcohol (46%) and heroin (33%). 75% were sexually active in the previous month, with condom use at last sex at 74%. HIV prevalence was 37% (highest among SWs at 47%), HBsAg prevalence 4% (similar across KPs) and HCV prevalence was 16% (highest among PWUD/ID at 46%). CONCLUSIONS: HBV, HCV and HIV pose a health burden for KPs in South Africa. While HIV is key for all included KPs, HCV is of particular importance to PWUD/ID. For KPs, HBV vaccination and behavioural change interventions that support consistent condom and lubricant access and use are needed. Coverage of opioid substitution therapy and needle and syringe services, and access to HCV treatment for PWUD/ID need to be expanded.


Assuntos
Infecções por HIV/epidemiologia , HIV/imunologia , Hepacivirus/genética , Hepacivirus/imunologia , Vírus da Hepatite B/imunologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Adulto , Estudos Transversais , Feminino , Genótipo , Anticorpos Anti-HIV/sangue , Infecções por HIV/tratamento farmacológico , Infecções por HIV/etiologia , Infecções por HIV/prevenção & controle , Hepatite B/etiologia , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/etiologia , Anticorpos Anti-Hepatite C/sangue , Homossexualidade Masculina , Humanos , Masculino , Prevalência , Estudos Prospectivos , Fatores de Risco , Profissionais do Sexo , Minorias Sexuais e de Gênero , África do Sul/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Carga Viral , Adulto Jovem
16.
WHO South East Asia J Public Health ; 9(2): 100-103, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978340

RESUMO

The Government of Thailand was prompt to launch social and economic measures to mitigate the effects on the general population following lockdown measures to counter coronavirus disease 2019 (COVID-19). However, sex workers were one of the vulnerable groups who were unable to access state support. A rapid survey of sex workers in Thailand showed that almost all had become unemployed and lost their income as a consequence of the lockdown, restrictions on international flights into the country and the closure of entertainment venues. Most were unable to cover the costs of food and shelter for themselves and their dependents. COVID-19 had also disrupted testing and treatment for sexually transmitted infections and HIV services for sex workers. As in other countries, community-based organizations were essential to providing an immediate, short-term COVID-19 response for sex workers. Also as in other countries, the pandemic has demonstrated that many people's health and well-being depends on very fragile foundations. This presents a clear opportunity to build back better by committing to a longer-term vision for the overall societal inclusion of sex workers. Thailand should advocate for decriminalization of sex work and ensure sex workers are entitled to equal labour rights and inclusion in the government social protection programme. Progress in innovative government initiatives aimed at ending HIV stigma and discrimination show how structural change can come about through harnessing community-based organizations. In turn, HIV services for sex workers need to expand and incorporate targeted interventions to reduce sex workers' occupational susceptibility to COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Profissionais do Sexo , Serviços de Saúde Comunitária/organização & administração , Feminino , Financiamento Governamental/organização & administração , Infecções por HIV/prevenção & controle , Humanos , Masculino , Profissionais do Sexo/legislação & jurisprudência , Profissionais do Sexo/estatística & dados numéricos , Inquéritos e Questionários , Tailândia/epidemiologia
17.
WHO South East Asia J Public Health ; 9(2): 104-106, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978341

RESUMO

Sex workers have been one of the marginalized groups that have been particularly affected by India's stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic. The sudden loss of livelihood and lack of access to health care and social protection intensified the vulnerabilities of sex workers, especially those living with HIV. In response, Ashodaya Samithi, an organization of more than 6000 sex workers, launched an innovative programme of assistance in four districts in Karnataka. Since access to antiretroviral therapy (ART) was immediately disrupted, Ashodaya adapted its HIV outreach programme to form an alternative, community-led system of distributing ART at discreet, private sites. WhatsApp messaging was used to distribute information on accessing government social benefits made available in response to the COVID-19 pandemic. Other assistance included advisory messages posted in WhatsApp groups to raise awareness, dispel myths and mitigate violence, and regular, discreet phone check-ins to follow up on the well-being of members. The lessons learnt from these activities represent an important opportunity to consider more sustainable approaches to the health of marginalized populations that can enable community organizations to be better prepared to respond to other public health crises as they emerge.


Assuntos
Participação da Comunidade , Infecções por Coronavirus/epidemiologia , Infecções por HIV/tratamento farmacológico , Pandemias , Pneumonia Viral/epidemiologia , Profissionais do Sexo , Antirretrovirais/uso terapêutico , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia
18.
Am J Trop Med Hyg ; 103(5): 1780-1782, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32940202

RESUMO

COVID-19 is a global health emergency facing many countries around the world. Sex workers in Africa are among one of the vulnerable populations disproportionately affected by the COVID-19 pandemic on the continent. Sex workers are excluded from African government safety net, and this may force some sex workers back to sex work amid the COVID-19 pandemic. Because of the nature of sex work, physical distancing and other precautionary measures are impossible to observe, further compromising COVID-19 response. Sex workers in Africa have been known to face high levels of stigma and discrimination, including limited access to healthcare services. Disruption in HIV care and prevention services due to the pandemic among this key population may have negative impacts on the hard-won achievements in HIV response in Africa. In addition, stigma and discrimination toward sex workers could also make contact tracing challenging and limit access to COVID-19 testing among this vulnerable group. With the adoption of the 2030 Agenda for the UN Development Program, UN member states all pledged to ensure "no one will be left behind" and to "endeavor to reach the furthest behind first." This could not be more important than now as sex workers as a part of the population are left behind in COVID-19 response in Africa. It is important that the African government should ensure collective and inclusive response in the fight against COVID-19. Sex workers should not be forgotten in Africa's COVID-19 response because no one is safe, until all are safe.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Pneumonia Viral/epidemiologia , Profissionais do Sexo , África , Betacoronavirus , Humanos , Pandemias , Estigma Social , Populações Vulneráveis
20.
PLoS Med ; 17(9): e1003297, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931504

RESUMO

BACKGROUND: The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. METHOD AND FINDINGS: The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11-64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%-48.0%), anxiety 21.0% (95% CI: 4.8%-58.4%), PTSD 19.7% (95% CI 3.2%-64.6%), psychological distress 40.8% (95% CI 20.7%-64.4%), recent suicide ideation 22.8% (95% CI 13.2%-36.5%), and recent suicide attempt 6.3% (95% CI 3.4%-11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. CONCLUSIONS: In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs.


Assuntos
Profissionais do Sexo/psicologia , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Ansiedade , Transtornos de Ansiedade , Criança , Estudos Transversais , Países em Desenvolvimento , Feminino , Infecções por HIV/epidemiologia , Humanos , Saúde Mental , Pessoa de Meia-Idade , Pobreza , Prevalência , Fatores de Risco , Sexo Seguro , Comportamento Sexual , Doenças Sexualmente Transmissíveis/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Ideação Suicida , Tentativa de Suicídio , Violência
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