Explore the vast range of titles available.

Suboptimal uptake of HIV testing remains a primary bottleneck to HIV prevention and treatment for men who have sex with men (MSM) and transgender women (TGW) in Thailand. The World Health Organization has recommended HIV self-testing (HIVST) as an additional strategic HIV service. However, HIVST has not been fully endorsed and implemented in many countries in Southeast Asia. The aim of this study was to assess the uptake of oral fluid-based HIVST in MSM and TGW populations in Thailand. During 2017 and 2018, we conducted a cross-sectional study using convenience sampling to enroll 2,524 participants from three major urban areas. Participants were recruited during outreach and online activities and were offered unassisted or assisted HIVST, or referral to HIV testing services. A descriptive analysis was performed for summarizing data. A total of 2,502 participants (1,422 MSM and 1,082 TGW) were included in the analysis with about one-third (36.1%) of them being first-time testers. Among all participants enrolled in the study, a total of 2,486 participants (99.3%) selected HIVST versus referral to HIV testing services. Of those who selected HIVST, 2,095 (84.3%) opted for assisted HIVST while the rest opted for unassisted HIVST: 1,148 of 1,411 MSM (81.4%) and 947 of 1,075 TGW (88.1%) selected assisted HIVST. While no serious adverse events were reported during the study, we found that among 179 participants who needed a confirmatory test and were referred to HIV testing services, 108 (60.3.4%) accessed these later services. This study demonstrated a high uptake of oral fluid-based HIVST among MSM and TGW populations in Thailand and that HIVST could be scaled up through the national epidemic control program. However, a better understanding of HIV testing-seeking behavior and innovative follow-up solutions are needed to improve and monitor linkages to services for people who undertake HIVST.

Men who have sex with men (MSM) and Transgender Women (TGW) in Thailand contribute to more than half of all new HIV infections annually. This cross-sectional study describes epidemiologic profiles of these key populations (KP) in Key Population-led Test and Treat study. Baseline data were collected using self-administered questionnaires and HIV/STI testing from MSM and TGW aged ≥18 years enrolled in a cohort study in six community sites in Thailand between October 2015 and February 2016. Factors associated with HIV prevalence were determined by logistic regression. TGW in the cohorts had lower education and income levels than MSM. TGW also engaged in sex work more, though similar proportions between MSM and TGW reported to have multiple sexual partners and STI diagnosis at baseline. HIV prevalence was 15.0% for MSM and 8.8% for TGW in the cohorts. HIV prevalence among TGW was more associated with sociodemographic characteristics, whereas factors related to behavioral risks were determined to be associated with HIV prevalence among MSM. TGW and MSM in the cohorts also had high prevalence of STI. Key Population-driven HIV services are able to capture harder-to-reach key populations who are at heightened risk for HIV.

Introduction The South and Southeast Asia region has the second‐highest number of people living with HIV globally. Despite progress in reducing HIV incidence and AIDS‐related deaths, the region still has a long way to go in achieving the Joint United Nations Programme on HIV and AIDS (UNAIDS) 95‐95‐95 HIV testing, treatment and viral suppression targets. HIV self‐testing (HIVST) is recommended by the World Health Organization as an additional approach to HIV testing. This paper provides a commentary on the implementation status, benefits, barriers and recommendations for HIVST implementation in South and Southeast Asia. Additionally, it presents perspectives from HIV testing service experts from 11 countries in the region to put forth recommendations to accelerate the implementation of HIVST in South and Southeast Asia. Discussion There is uneven progress in national HIVST policy development and implementation across the region. HIVST, as an additional testing approach, can help to enhance testing coverage, frequency and demand for follow‐up HIV services among key populations. Key factors influencing the implementation and scale‐up of HIVST include the degree of awareness of HIVST among general and key populations, the development and implementation of supportive national HIVST policies and the availability of public funding for HIVST. To address barriers and leverage enablers to HIVST implementation, generating evidence on cost‐effectiveness and budget impact, developing multisectoral partnerships for market shaping, promoting differentiated and decentralized delivery models, and optimizing linkage to further testing and care are recommended. Conclusions It is crucial to accelerate the implementation and scale‐up of HIVST to differentiate and decentralize the delivery of HIV testing services in South and Southeast Asian countries. Sharing experiences among country experts is vital to foster the adoption of best practices and facilitate the trial‐and‐error process of HIVST implementation. Such collaborative approaches can help South and Southeast Asian countries attain the UNAIDS 95‐95‐95 targets, especially the first 95 on HIV diagnosis, and play a significant role in ending the global AIDS epidemic.

Pre-exposure prophylaxis (PrEP) use could be accelerated by offering alternatives that overcome key barriers associated with oral PrEP. This study aimed to understand willingness and preferences for long-acting injectable cabotegravir (CAB-LA) among gay men and other men who have sex with men (MSM), and transgender women (TGW) in Asia. An online cross-sectional survey was conducted from May to November 2022 among HIV-negative or unknown status MSM and TGW aged ≥18 years across 15 and 11 Asian countries/territories, respectively. Survey items included awareness and use of PrEP and CAB-LA, willingness to use current and emerging PrEP options, and attitudes towards CAB-LA. Descriptive statistics and logistic regression were used to analyse associations with willingness to use CAB-LA. Among 11,870 MSM and 980 TGW, 21.4% (n = 2448) and 32.5% (n = 295) were aware of CAB-LA, respectively, and 17.2% (n = 2036) and 16.8% (n = 165) were willing to use it. CAB-LA was the most preferred PrEP option for 3.6% (n = 400) of MSM and 6.5% (n = 61) of TGW. Awareness and willingness varied across countries/territories and populations. Key benefits of CAB-LA included HIV protection (57.8% MSM, 46.8% TGW), no need for daily pills (42.6% MSM, 31.1% TGW) and longer-term protection (38.0% MSM, 23.6% TGW). Main concerns included cost (39.6% MSM, 22.1% TGW), side-effects (37.5% MSM, 22.2% TGW), insufficient knowledge (33.3% MSM, 20.6% TGW) and pain (21.4% MSM, 24.9% TGW). Successful introduction of CAB-LA, or other new long-acting injectable PrEP options, in Asia will require strategies to raise awareness and demand-generation that responds to the perceived benefits and concerns of communities.

Introduction Despite the high HIV incidence among gay, bisexual and other men who have sex with men (GBMSM) and the demonstrated effectiveness of HIV pre‐exposure prophylaxis (PrEP), PrEP is not accessible at scale across Asia. To help inform future scaling efforts, our study aimed to examine PrEP use and willingness to use among GBMSM to identify opportunities and target groups for upscaling PrEP. Methods The PrEP APPEAL survey was a cross‐sectional survey, promoted through online advertising and community organizations, from May to November 2022. Eligible participants were adult GBMSM who self‐identified as HIV negative residing in Asia. We constructed two cascades: PrEP use (comprising awareness, lifetime use and current use of PrEP) and PrEP willingness among participants who were aware of PrEP but had never used it (comprising HIV exposure risk, willingness in PrEP and willingness to pay for PrEP). Multivariable logistic regression models identified factors associated with lifetime PrEP use and PrEP willingness. Results Of 15,339 participants, 1440 were excluded due to missing data, leaving 13,899 for analysis. Most lived in large or capital cities (68.3%) and in lower‐middle‐income countries (45.1%). The median age was 30 (25−36) years old. For the PrEP use cascade, 82.2% (n = 11,427/13,899) of participants were aware of PrEP, 35.0% (n = 4000/11,427) had used it before and 70.1% (n = 2803/4000) of them were currently on PrEP. For the PrEP willingness cascade, 54.8% of (n = 4068/7427) PrEP‐naïve participants engaged in one or more behaviours with a higher risk of HIV acquisition, 73.7% (n = 2996/4068) of them expressed willingness to use PrEP and 83.0% (n = 2487/2996) of them were willing to pay for PrEP. Multivariable logistic regression models identified system‐level (PrEP availability, accessibility and affordability) predictors of PrEP use. Individual‐level behaviours associated with higher HIV acquisition risks were associated with PrEP use and willingness. Conclusions While PrEP uptake was suboptimal, there was high awareness and willingness in PrEP among GBMSM. This is encouraging for future scale‐up efforts. Future PrEP programmes should address system‐level barriers to support PrEP uptake.

Introduction Scaling up pre‐exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) and transgender women (TGW) in the Asia‐Pacific region has been slow. We identified the drivers of PrEP use and forecasted PrEP uptake given different PrEP programmes for MSM and TGW living in 15 countries and territories in Asia and Australia. Methods Separate online discrete choice experiment surveys for MSM and TGW were distributed in 15 Asian countries and territories and Australia between May and November 2022. We used random parameters logit models to estimate the relative importance of service attributes and predicted PrEP uptake for different programme configurations. Results Among 21,943 participants included in the MSM survey and 1522 in the TGW survey, the mean age was 31.7 (±9.5) years and 28.1 (±7.0) years, respectively. Cost emerged as the primary driver of PrEP use for MSM and TGW across countries, followed by the type of PrEP. When switching from the least preferred PrEP programme (i.e. very high service fee, PrEP implant, rare kidney problems as side effects of PrEP and a 2‐monthly clinic visit) to an optimal programme (i.e. free access to PrEP via peer‐led community clinics which offered sexually transmitted infection [STI] testing, and a 6–12 monthly visit), the predicted PrEP uptake could improve by over 50% for MSM in Australia, China, Hong Kong SAR China, Japan, the Philippines, Taiwan (China) and Thailand, and 37% for TGW. Compared to those at lower risk of HIV, free access was more preferred by MSM at a higher risk of HIV, while telehealth was more preferred by TGW at a substantial risk of HIV. Conclusions Tailoring services to local contexts, including ensuring affordability, preferred type of PrEP and providing differentiated services, could accelerate the uptake of PrEP among MSM and TGW in Asia and Australia. Novel innovations, such as STI and HIV self‐testing, should be explored as alternatives to conventional testing, given that most MSM and TGW prefer less frequent clinic visits and long‐acting PrEP options.

The poor, especially women, are vulnerable to sexual exploitation. So why this strong relation in the opposite direction? Part of the reason must be that household wealth relates to urban residence, and HIV is higher in urban areas. Also, HIV prevalence is partly a function of survival, and wealthier people with HIV probably survive somewhat longer. On the other hand, people with HIV eventually tend to lose wealth because of loss of employment and increased expenses related to disease, thus blunting a positive relation between wealth and HIV. Perhaps wealth simply enables people and especially men to have more sexual partners. However, in Tanzania neither number of partners nor sex with a prostitute in the past 12 months were related to HIV prevalence in men. Thus none of these explanations appear adequate to explain the observed wealth-HIV relation.

The benefits of new methods of prevention of HIV could be jeopardised if they are not accompanied by efforts to change risky behaviour

Quarraisha Abdool Karim and Salim Abdool Karim, University of KwaZulu-Natal, South Africa; Mohamed S Abdullah, Aga Khan University, Kenya; Yigeremu Abebe, Alert Hospital, Addis Adaba; Michael Adler, University College of London; Saifuddin Ahmed, Johns Hopkins University; Milton Amayun, World Vision International; Judy Auerbach, American Foundation for AIDS Research; Antoine Augustin, MARCH, Haiti; Bertran Auvert, University of Paris; Olusegun Babaniyi, WHO, Ethiopia; Robert C Bailey, University of Illinois at Chicago and UNIM Project, Kenya; Bishop Joshua Banda, Assembly of God Church, Zambia; Edward Baralemwa, Pan African Christian AIDS Network, Botswana; Alvaro Bermejo, International HIV/AIDS Alliance; Jane Bertrand and Robert Blum, Johns Hopkins University; Godfrey Biemba, Churches Health Association of Zambia; Daraus Bukenya, African Medical and Research Foundation (AMREF); Gideon Byamugisha, World Vision, Uganda; Jack Caldwell, Australian National University; Sharon Camp, Alan Guttmacher Institute; Martha M Campbell, University of California, Berkeley; Michel Carael, Free University of Brussels; Ken Casey, World Vision International; James Chin, University of California, Berkeley; Vuyelwa Chitimbire, Zimbabwe Association Church Related Hospitals; Brian Chituwo, Minister of Health, Zambia; Peter Clancy, Population Services International; Amy Coen, Population Action International; Myron Cohen, University of North Carolina; Nicholas Danforth, Brandeis University; Charles DeBose, AFRICARE; Nafissatou Diop, Population Council, Senegal; Christopher J Elias, PATH; Wafaa El-Sadr, Columbia University and Harlem Hospital; Paul Farmer, Harvard University; Tori Fernandez Whitney, Church World Service; J Peter Figueroa, Ministry of Health, Jamaica; Janet Fleischman, Center for Strategic and International Studies (CSIS), and the Global Coalition on Women and AIDS; Virginia D Floyd and Erick V A Gbodossou, Promotion des Medecin Traditionnelle (PROMETRA); Knut Fylkesnes, University of Bergen; Sue Goldstein, Soul City, South Africa; C Y Gopinath, PATH, Kenya; Ronald Gray, Johns Hopkins University; Heiner Grosskurth, Medical Research Council and Uganda Virus Research Institute; Geeta Rao Gupta, International Center for Research on Women; Catherine Hankins, UNAIDS; Richard Hayes, London School Hygiene Tropical Medicine; King K Holmes, University of Washington; John Howson, International HIV-AIDS Alliance and Health Communication Partnership; Douglas H Huber, Council of Anglican Provinces of Africa; Jokin de Irala, Universidad de Navarra, Spain; Jesse Kagimba, Office of the Presidency, Uganda; Jean Kagubare, National University of Rwanda; Noerine Kaleeba, TASO, Uganda and UNAIDS; Sam Kalibala, International AIDS Vaccine Initiative; Anatoli Kamali, Medical Research Council Programme, Uganda; Shivananda Khan, Naz Foundation International; Jim Y Kim, WHO; Leon Kintaudi, Church of Christ, Congo; Steve Kraus, UNFPA; Marie Laga, Institute of Tropical Medicine, Antwerp; Peter Lamptey, Family Health.

HIV testing technologies have been available for two decades, but concerns about stigma and discrimination have historically tempered the application of case finding—a cornerstone of public-health practice—to combat the HIV/AIDS pandemic. The recent expansion of access to HIV treatment has resulted in a shift of emphasis from pairing testing with rigorous risk-reduction prevention counselling, to applying testing to find infected individuals, address their care and treatment needs, and prevent them from infecting others. However, the efficacy of case finding for infectious disease prevention is contingent on two basic principles: the ability to identify infected individuals before further transmission occurs, and the availability of effective strategies to prevent such transmission from taking place. Although there is evidence that specific approaches to HIV counselling and testing can support behaviour change, both high infectivity during early HIV infection and specific sexual network structures could combine to substantially limit our ability to identify cases before ongoing transmission occurs. Facilitating the broader adoption of prevention behaviours therefore remains essential to prevent the continued spread of HIV.