TY - JOUR
T1 - HIV prevalence, risk behaviour, and treatment and prevention cascade outcomes among cisgender men, transgender women, and transgender men who sell sex in Zimbabwe: a cross-sectional analysis of programmatic data
AU - Kloek, Mariëlle
AU - Chabata, Sungai T.
AU - van Noord, Laura
AU - Machingura, Fortunate
AU - Makandwa, Rumbidzo
AU - Dirawo, Jeffrey
AU - Takaruza, Albert
AU - Matambanadzo, Primrose
AU - de Vlas, Sake J.
AU - Hontelez, Jan A.C.
AU - Cowan, Frances
PY - 2023/6/14
Y1 - 2023/6/14
N2 - Background: There is limited evidence about the HIV vulnerabilities and service engagements among people who sell sex in sub-Saharan Africa identifying as cisgender men, transgender women or transgender men. We present unique data describing the sexual risk behaviour, HIV prevalence, and access to HIV services among cisgender men (MWSS), transgender women (TGWWSS), and transgender men (TGMWSS) who sell sex in Zimbabwe.Methods:From July 2018, CeSHHAR expanded its community and clinical services to include SW in their diversity more broadly. All SW reached by the programme have routine data collected, including routine HIV testing, and were referred using a network of peer educators. Sexual risk behaviour, HIV prevalence, and HIV services uptake over the period July 2018 to June 2020 were analysed through descriptive statistics by gender group.Findings:In total, 423 MWSS, 343 TGWWSS, and 237 TGMWSS were included. Age standardized HIV prevalence estimates were 26·2% [95% CI: 22·0; 30·7] for MWSS, 39·4% [95% CI: 34·1; 44·9] for TGWWSS, and 38·4% [95% CI: 32·1; 45·0] for TGMWSS. Among those living with HIV, respectively 66·0% [95% CI: 55·7; 75·3], 74·8% [95% CI: 65·8; 82·4], and 70·2% [95% CI: 59·3; 79·7] knew their status, andrespectively 15·5% [95% CI: 8·9; 24·2], 15·7% [95% CI: 9·5; 23·6] and 11·9% [95% CI: 5·9; 20·8] were on ART. Self-reported condom use was consistently low across gender groups, ranging from 28% to 55%.Interpretation:These unique data demonstrate that people who sell sex identifying as cisgender men, transgender women or transgender men in sub-Saharan Africa face high HIV prevalence and risk, coinciding with alarmingly low access to HIV prevention, testing and treatment services. There is an urgent need for people-centred HIV interventions for these high-risk groups and for more inclusive HIV policies and research to ensure we truly attain universal access for all.
AB - Background: There is limited evidence about the HIV vulnerabilities and service engagements among people who sell sex in sub-Saharan Africa identifying as cisgender men, transgender women or transgender men. We present unique data describing the sexual risk behaviour, HIV prevalence, and access to HIV services among cisgender men (MWSS), transgender women (TGWWSS), and transgender men (TGMWSS) who sell sex in Zimbabwe.Methods:From July 2018, CeSHHAR expanded its community and clinical services to include SW in their diversity more broadly. All SW reached by the programme have routine data collected, including routine HIV testing, and were referred using a network of peer educators. Sexual risk behaviour, HIV prevalence, and HIV services uptake over the period July 2018 to June 2020 were analysed through descriptive statistics by gender group.Findings:In total, 423 MWSS, 343 TGWWSS, and 237 TGMWSS were included. Age standardized HIV prevalence estimates were 26·2% [95% CI: 22·0; 30·7] for MWSS, 39·4% [95% CI: 34·1; 44·9] for TGWWSS, and 38·4% [95% CI: 32·1; 45·0] for TGMWSS. Among those living with HIV, respectively 66·0% [95% CI: 55·7; 75·3], 74·8% [95% CI: 65·8; 82·4], and 70·2% [95% CI: 59·3; 79·7] knew their status, andrespectively 15·5% [95% CI: 8·9; 24·2], 15·7% [95% CI: 9·5; 23·6] and 11·9% [95% CI: 5·9; 20·8] were on ART. Self-reported condom use was consistently low across gender groups, ranging from 28% to 55%.Interpretation:These unique data demonstrate that people who sell sex identifying as cisgender men, transgender women or transgender men in sub-Saharan Africa face high HIV prevalence and risk, coinciding with alarmingly low access to HIV prevention, testing and treatment services. There is an urgent need for people-centred HIV interventions for these high-risk groups and for more inclusive HIV policies and research to ensure we truly attain universal access for all.
U2 - 10.1016/s2352-3018(23)00088-7
DO - 10.1016/s2352-3018(23)00088-7
M3 - Article
SN - 2405-4704
VL - 10
SP - e453-e460
JO - The Lancet HIV
JF - The Lancet HIV
IS - 7
ER -
