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      Overview of the epidemiological conditions of HIV among key populations in Africa

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          Abstract

          Introduction

          Despite extraordinary progress in HIV treatment coverage and expanding access to HIV prevention services and that multiple African countries are on track in their efforts to reach 90‐90‐90 goals, the epidemic continues to persist, with prevalence and incidence rates too high in some parts of the continent to achieve epidemic control. While data sources are improving, and research studies on key populations in specific contexts have improved, work on understanding the HIV burdens and barriers to services for these populations remains sparse, uneven and absent altogether in multiple settings. More data have become available in the last several years, and data published in 2010 or more recently are reviewed here for each key population. This scoping review assesses the current epidemiology of HIV among key populations in Africa and the social and political environments that contribute to the epidemic, both of which suggest that without significant policy reform, these epidemics will likely continue.

          Results and discussion

          Across Africa, the HIV epidemic is most severe among key populations including women and men who sell or trade sex, men who have sex with men, people who inject drugs, transgender women who have sex with men and prisoners and detainees. These groups account for the majority of new infections in West and Central Africa, and an estimated 25% of new infections in East and Southern Africa, despite representing relatively small proportions of those populations. The HIV literature in Africa emphasizes that despite significant health needs, key populations experience barriers to accessing services within the healthcare and legal justice systems. Current shortcomings of surveillance systems in enumerating key populations impact the way funding mechanisms and resources are allocated and distributed. Adapting more equitable and epidemiologically sound frameworks will be necessary for current and future HIV programming investments.

          Conclusions

          Through this review, the available literature on HIV epidemiology among key populations in Africa brings to light a number of surveillance, programmatic and research gaps. For many communities, interventions targeting the health and security conditions continue to be minimal. Compelling evidence suggests that sweeping policy and programmatic changes are needed to effectively tackle the persistent HIV epidemic in Africa.

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          Most cited references82

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          Scoping studies: towards a methodological framework

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            Worldwide burden of HIV in transgender women: a systematic review and meta-analysis

            The Lancet Infectious Diseases, 13(3), 214-222
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              Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.

              Female sex workers are a population who are at heightened risk of HIV infection secondary to biological, behavioural, and structural risk factors. However, three decades into the HIV pandemic, understanding of the burden of HIV among these women remains limited. We aimed to assess the burden of HIV in this population compared with that of other women of reproductive age. We searched PubMed, Embase, Global Health, SCOPUS, PsycINFO, Sociological Abstracts, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and POPLine for studies of female sex workers in low-income and middle-income countries published between Jan 1, 2007, and June 25, 2011. Studies of any design that measured the prevalence or incidence of HIV among female sex workers, even if sex workers were not the main focus of the study, were included. Meta-analyses were done with the Mantel-Haenszel method with a random-effects model characterising an odds ratio for the prevalence of HIV among female sex workers compared with that for all women of reproductive age. Of 434 selected articles and surveillance reports, 102 were included in the analyses, representing 99,878 female sex workers in 50 countries. The overall HIV prevalence was 11·8% (95% CI 11·6-12·0) with a pooled odds ratio for HIV infection of 13·5 (95% CI 10·0-18·1) with wide intraregional ranges in the pooled HIV prevalence and odds ratios for HIV infection. In 26 countries with medium and high background HIV prevalence, 30·7% (95% CI 30·2-31·3; 8627 of 28,075) of sex workers were HIV-positive and the odds ratio for infection was 11·6 (95% CI 9·1-14·8). Although data characterising HIV risk among female sex workers is scarce, the burden of disease is disproportionately high. These data suggest an urgent need to scale up access to quality HIV prevention programmes. Considerations of the legal and policy environments in which sex workers operate and actions to address the important role of stigma, discrimination, and violence targeting female sex workers is needed. The World Bank, UN Population Fund. Copyright © 2012 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                hjin22@jhu.edu
                arestar1@jhu.edu
                cbeyrer@jhu.edu
                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                10.1002/(ISSN)1758-2652
                JIA2
                Journal of the International AIDS Society
                John Wiley and Sons Inc. (Hoboken )
                1758-2652
                30 June 2021
                July 2021
                : 24
                : Suppl 3 , Key Populations: the Future of the African HIV/AIDS Pandemic? Guest Editors: David Barr, Geoff P Garnett, Kenneth H Mayer, Michelle Morrison ( doiID: 10.1002/jia2.v24.s3 )
                : e25716
                Affiliations
                [ 1 ] Department of Epidemiology Johns Hopkins Bloomberg School of Public Health
                Author notes
                [*] [* ] Corresponding author: Harry Jin, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, Maryland 21205, USA. Tel: 410 502 9048. ( hjin22@ 123456jhu.edu )

                Author information
                https://orcid.org/0000-0002-6347-2617
                https://orcid.org/0000-0003-0665-9124
                Article
                JIA225716
                10.1002/jia2.25716
                8242974
                34190412
                9eb9d169-c6e2-4f22-bd10-b2f1fe78beec
                © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 March 2021
                : 22 October 2020
                : 08 April 2021
                Page count
                Figures: 0, Tables: 1, Pages: 8, Words: 19771
                Product
                Funding
                Funded by: National Institute of Allergy and Infectious Diseases , open-funder-registry 10.13039/100000060;
                Award ID: 5T32AI102623‐08
                Categories
                Review
                Supplement: Review
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:30.06.2021

                Infectious disease & Microbiology
                hiv,incidence,surveillance,key populations,africa,sexual and gender minorities,sex workers,people who inject drugs

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