Substantial Increase in Transactional Sex and HIV Risk Among Adolescents During the COVID-19 Pandemic: Results From a Repeated Cross-Sectional Study in Botswana.

The COVID-19 pandemic and resulting public health response has disrupted the lives of adolescents and their families worldwide. We evaluated the impact of the pandemic on attitudes, beliefs, and sexual risk behavior among adolescents in Botswana. Participants were recruited using household-based sampling across residential districts (blocks) in and around Gaborone, Botswana, and completed surveys on laptop computers at a private, central location. We compared baseline survey data from 380 adolescents who completed the survey pre-pandemic (n = 139) to those who completed the survey intra-pandemic (n = 241). Participants had a mean age of 15.2 years; 58.6% were girls and 41.4% were boys. Intra-pandemic, participants reported greater engagement in transactional sex (38.1% compared to 13.6% pre-pandemic, p <. 05), more favorable attitudes toward transactional sex with sugar daddies and sugar mommies (p <. 05), greater intentions to remain sexually active in the future (29.2% vs.13.6%, respectively, p <.05), and lower self-efficacy in handling risky sexual situations (p < .01). Public health interventions that lessen these concerning shifts in attitudes and behaviors will be key to protecting the sexual health of adolescents and to supporting their safe transition to adulthood.

HIV SELF-TESTING UNCOVERS HIGH BURDEN of HIDDEN INFECTIONS in INDIA

Background: The number of undiagnosed persons globally remains a barrier to achieving UNAIDS 95-95-95 goals. While nearly 80% are aware of their status, there is much variability by age and geography. Many of those undiagnosed are not engaging in traditional HIV services and do not visit physical locations;novel strategies are needed to overcome structural barriers. We implemented an online, HIV self-testing (HIVST) service for vulnerable populations in India. Methods: An integrated web-based platform for HIVST www.safezindagi. net/selftesting was implemented across 24 Indian states in July 2021. Virtual outreach workers (vORWs) contacted clients on dating apps and social media platforms, provided counseling, and directed interested clients to HIVST via a platform that allowed for home delivery or pick up at a community site. HIVST could be assisted or unassisted with pre/post-test counseling from vORWS. Linkage to confirmatory testing/ART and PrEP was provided as needed. Descriptive statistics were used to characterize outcomes. Results: Between June 30-October 21, 2021, 2,234 clients registered and 1,356 (61%) clients ordered an HIVST kit. Median age of the 1,356 clients was 27 years;74% were male and 66% self-identified as MSM. Ten percent self-identified as transgender. In the prior 6 months, 67% reported condomless sex, 51% multiple partners, 13% transactional sex, 7% STIs, and 4% injection drug use. 1,190 clients (88%) received their kits within 3 days;44% used a courier service and 56% picked up from a community site. Of 1,070 (90%) results uploaded, 43 (4%) were positive with geographical variability (5 states had >4% positivity). The median age of the positive clients was 30 years and 74% were male. Of importance, 65% reported condomless sex with multiple partners in prior 6 months and none were previously tested for HIV. 19 (44%) were linked to confirmatory testing of whom 16 (84%) were confirmed positive and 14 (88%) initiated ART at public centers (see Figure). Conclusion: These data highlight the role of an HIVST platform to reach first time test-takers in a population with high risk behaviors and identified HIV burden >16 times the general population. With increasing online engagement and uptake of telemedicine globally, as well as continuing disruptions due to COVID-19, HIVST offers a critical approach to reach high-risk individuals, identify PLHIV, and link them to care and treatment.

HIGH LEVEL of HIV VIRAL SUPPRESSION in UGANDAN MEN with URETHRITIS and BACTERIAL STI

Background: Historically, control of HIV infection in young men living with HIV (LWH) has been problematic. We examined the STI/HIV burden in young men with urethral discharge syndrome (UDS) in Kampala, Uganda. Methods: Between Oct 2019-Nov 2020, 250 men with UDS were enrolled at 6 urban sites. All HIV positive men (20%, 50/250) had plasma viral load testing (Abbott m2000 RealTime HIV-1);when VL>1000 copies/mL, resistance and recency testing (Asanté HIV-1 Rapid Recency Assay, Sedia Biosciences) were performed. Penile meatal swabs were retrospectively tested for gonorrhea, chlamydia, trichomoniasis, and Mycoplasma genitalium (Hologic Aptima CT/NG, TV, MG). Descriptive statistical analysis, logistic, and bivariable and multivariable regression were undertaken. Results: Among the men LWH, 92% (46/50) had VL<1000;4 were not suppressed, 1 of whom was previously undiagnosed. Among the viremic individuals, no major resistance mutations were found and none appeared recently infected. Men (median age 24[22;32]) reported sex partners/previous 2 months (median 2[1;2]), 61.6% engaged in transactional sex in the previous 6 months, and 48.4% reported alcohol use. 44.4% reported alcohol use before sex in the previous 6 months. Overall, 0.4% reported 'always' condom use, 21.8% continued condomless sex since onset of UDS symptoms. There was a high burden of active, undiagnosed STIs found in these men (see Table);of the 10% who had syphilis, 80% were previously undiagnosed. Agreement between HIV-and syphilis-POC and lab-based testing was 100% and 95% (19/20), respectively. By multivariable logistic regression, alcohol use (OR, 3.32 (95% CI:1.61, 7.11)), and condomless sexual activity since symptom onset (OR, 2.86 (95% CI:1.20, 6.84)) were significantly associated with HIV;92% had at least one other STI. Conclusion: Among men presenting with UDS, bacterial STIs were very common. 20% had HIV with a surprisingly high level of viral suppression and no evidence of resistance in those with detectable VL. Recency testing results were non-discriminatory;none appeared recently infected. Risk of future HIV acquisition is high in those not LWH. Given the high frequency of bacterial STI, alcohol use and unprotected high-risk sexual behavior in this population, men with UDS who test negative for HIV should be prioritized for PrEP. Future research, evaluating the effect of SARS-CoV-2 on the burden of STI and level of viral suppression in this population, is required.

Quilted cellphilm method: A participatory visual health research method for working with marginalised and stigmatised communities.

The use of participatory visual methods and integration of cellphone technology is expanding in global public health research. Cellphilm method capitalises on these trends by inviting participants to use mobile devices to create short videos about health topics. This paper presents the quilted cellphilm method, which supports the participation of stigmatised populations to engage in research. We present the method with reference to the Celling Sex project, which worked with young women who have transactional sex experience. Four key steps in our unique model are discussed: (a) individual cellphilm-making; (b) participatory analysis; (c) creating a composite video; (d) publicly screening the work. We consider how working individually with participants in the cellphilm-making process built trust. We unpack how offering participants opportunities to engage in either group or one-on-one activities promoted participation in collaborative analysis. We outline how creating a composite video of the cellphilms and organising screenings facilitated knowledge translation and exchange. Overall, the quilted cellphilm method created a supportive community for vulnerable participants to generate products that challenged social stigma. Increased reliance on mobile media, especially during the COVID-19 pandemic, makes the quilted cellphilm method an opportune, exciting and accessible approach for participatory public health research.