Optimizing HIV Services for Key Populations in Public-Sector Clinics in Myanmar.

Key populations, ie, female sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prisons and other closed settings, experience stigma, discrimination, and structural barriers when accessing HIV prevention and care. Public health facilities in Myanmar became increasingly involved in HIV service delivery, leading to an urgent need for healthcare workers to provide client-centred, key population-friendly services. Between July 2017-June 2018, the Myanmar Ministry of Health and Sports and National AIDS Programme collaborated with ICAP at Columbia University and the US Centers for Disease Control and Prevention to implement a quasi-experimental, multicomponent intervention including healthcare worker sensitization training with pre- and post- knowledge assessments, healthcare worker and client satisfaction surveys, and structural changes. We observed modest improvements among healthcare workers (n = 50) in knowledge assessments. Classification of clients into key population groups increased and fewer clients were classified as low risk. Key population clients reported favourable perceptions of the quality and confidentiality of care through self-administered surveys. Our findings suggest public health facilities can deliver HIV services that are valued by key population clients.

Intimate Partner Violence Experienced by Adults With Diagnosed HIV in the U.S.

INTRODUCTION: Intimate partner violence is associated with adverse health consequences among people with diagnosed HIV, which could have implications for disease progression and transmission. However, nationally representative estimates of intimate partner violence among people with diagnosed HIV are lacking. Investigators used nationally representative data to estimate the prevalence of physical violence by an intimate partner among adults with diagnosed HIV and examine the differences by selected characteristics. METHODS: This analysis included interview and medical record data from the 2015-2017 cycles of the Medical Monitoring Project, analyzed in 2019. Weighted percentages and 95% CIs were used to report the prevalence of intimate partner violence among people with diagnosed HIV (N=11,768). Bivariate and multivariate differences in intimate partner violence by sociodemographic, behavioral, and clinical characteristics were examined using Rao-Scott chi-square tests (p<0.05). RESULTS: Among people with diagnosed HIV, 26.3% reported having ever experienced intimate partner violence, and 4.4% reported having experienced intimate partner violence in the past 12 months. The prevalence of intimate partner violence differed by gender and gender/sexual identity. People who experienced intimate partner violence in the past 12 months were more likely to engage in behaviors associated with elevated HIV transmission risk and have unmet needs for supportive services. People who recently experienced intimate partner violence were less likely to be engaged in routine HIV care but were more likely to seek emergency care services and have poor HIV clinical outcomes. CONCLUSIONS: This study's findings support the need for screening people with diagnosed HIV for intimate partner violence and offering linkage to supportive services. Screening for intimate partner violence among people with diagnosed HIV, coupled with supportive services and counseling, may lead to improved safety and HIV clinical outcomes and decreased need for emergency and inpatient medical services.

HIV-positive persons who inject drugs experience poor health outcomes and unmet needs for care services.

Comparison of social determinants of health and clinical outcomes between HIV-positive persons who inject drugs (PWID) and HIV-positive persons who do not inject drugs is essential to understanding disparities and informing HIV prevention and care efforts; however, nationally representative estimates are lacking. Interview and medical record data were collected for the Medical Monitoring Project during 2015-2018 among U.S. adults with diagnosed HIV. Among HIV-positive PWID (N=340) and HIV-positive persons who do not inject drugs (N=11,475), we reported weighted percentages and prevalence ratios with predicted marginal means to compare differences between groups (P<.05). Associations with clinical outcomes were adjusted for age, race/ethnicity, and gender. HIV-positive PWID were more likely to be homeless (29.1% vs. 8.1%) and incarcerated (18.3% vs. 4.9%). HIV-positive PWID were less likely to be retained in HIV care (aPR: 0.85 [95% CI: 0.77-0.94]), and were more likely to have poor HIV outcomes, have unmet needs for care services (aPR: 1.50 [1.39-1.61]), seek non-routine care, and experience healthcare discrimination (aPR: 1.42 [1.17-1.73]). Strengthening interventions supporting (1) continuity of care given high levels of incarceration and housing instability, (2) early ART initiation and adherence support, and (3) drug treatment and harm reduction programs to limit transmission risk may improve outcomes among HIV-positive PWID.