Nav: Home

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries

October 07, 2019

A meta-analysis involving 44,993 men who have sex with men in Africa finds that anti-LGBT legislation is associated with lower HIV testing and awareness.

This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months. In addition, only a quarter of men living with HIV were on antiretroviral therapy or virally suppressed.

The analysis, published in The Lancet HIV journal, found that testing for HIV was higher where there was more protective and progressive legislation and fewer or no LGBT-related arrests.

Although rates of testing are substantially higher than before 2011, they are not sufficient to achieve the targets set by the UN (to have 90% of people living with HIV aware of their status, 90% of those aware also on antiretroviral therapy, and 90% of these achieving viral suppression by 2020). The findings support previous country-level studies suggesting an association between anti-LGBT legislation and access to testing and treatment.

Globally, men who have sex with men are about 28 times more likely to be living with HIV than are men in the general population, and this is particularly apparent in sub-Saharan Africa where human rights of these men are often violated. Anti-LGBT discrimination creates barriers to implementing effective HIV research, policy and health programmes along with disruption of services provided by community and non-governmental organisations.

Professor Marie-Claude Boily of Imperial College London, UK says: "Nearly one million people living with HIV still die annually because they cannot or do not get tested and engage in treatment. Our results suggest that despite improvements in recent years in Africa, engagement in HIV testing and treatment among men who have sex with men is still low, and additional efforts are urgently needed. With an estimated 67% of men who have sex with men in Africa surveyed after 2011 having ever tested for HIV, we are still a long way off achieving the UNAIDS 90-90-90 targets." [1]

The review used 75 independent studies conducted between 2004 and 2017 from 28 African countries to estimate HIV testing, status awareness, engagement in care, antiretroviral therapy use, and viral suppression in the men.

Over all studies conducted after 2011, the estimated proportion of participants ever tested for HIV was 67%, which was 1.3 times higher than before 2011, and was highest in southern Africa (80%) and lowest in northern Africa (34 %). In comparison, the proportion of men tested in the last 12 months was 50% in studies after 2011, which was 1.6 times higher than before 2011, and again was highest in southern but lowest in eastern Africa (67% vs 40%).

The proportion of men who have sex with men who are HIV positive and aware of their status was much lower at just 19%, and was particularly low in eastern Africa even after 2011 (9%). Overall, less than 24% of men living with HIV were currently on antiretroviral therapy, and an estimated 25% of men living with HIV were currently virally suppressed. It was not possible to look at changes over time as there was not enough data in the studies on these outcomes.

Levels of HIV testing ever, in the past 12 months, and HIV status awareness were lower in countries with the most severe anti-LGBT legislation, compared with countries with the least severe legislation. Men were more likely to have ever been tested for HIV in countries with more protective and progressive legislation and no LGBT-related arrests from 2014-17.

The authors note some limitations, including that there were no studies in 26 African countries, including 13 countries where same-sex relations are illegal, so the new findings may not apply to the entire African continent and results may be worse in countries with more severe anti-LGBT legislation. Despite a substantial increase in the number of studies on testing for HIV, treatment and viral suppression, data remains scarce for all outcomes except HIV testing, especially from central and northern Africa. This means the study may underestimate or overestimate engagement, especially for antiretroviral therapy use and viral suppression. The authors note that this reflects the challenges of doing research among key populations that face substantial stigma.

The anti-LGBT legislation index used in the study only includes information about legislation, not how it is implemented so may not have captured the full picture. Because most of the studies included were self-reported and used non-confidential interview methods, underreporting and reporting biases are possible.

In a linked Comment article, Dr Jean Joel Bigna of the Centre Pasteur of Cameroon, Yaoundé, Cameroon, says: "Stannah and colleagues have provided important updates on the current situation regarding the HIV care cascade among men who have sex with men in Africa, and highlight areas where urgent action is needed. Governments in Africa should develop comprehensive programmes and holistic interventions to provide care, support, and preventive services for this hard-to-reach stigmatised and discriminated vulnerable population. Community mobilisation, health-care worker education to decrease stigma and discrimination and engagement remain crucial to end the HIV/AIDS pandemic both globally and at its epicentre in Africa. Human rights are universal and sexual orientation is no grounds for exclusion."
-end-
NOTES TO EDITORS

This study was funded by the UK Medical Research Council, UK Department for International Development, and the US National Institutes of Health through the HIV Prevention Trial Network. It was conducted by researchers from the MRC Centre for Global Infectious Disease Epidemiology and HIV Prevention Trials Network Modelling Centre, Imperial College London, London School of Hygiene and Tropical Medicine and Johns Hopkins

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf if you have any questions or feedback, please contact The Lancet press office pressoffice@lancet.com

[1] Quote direct from author and cannot be found in the text of the Article.

Peer-reviewed / Meta-analysis / People

The Lancet

Related Hiv Articles:

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).
Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.
Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.
The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.
The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.
NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
First ever living donor HIV-to-HIV kidney transplant
For the first time, a person living with HIV has donated a kidney to a transplant recipient also living with HIV.
The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.
Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.
More HIV News and HIV Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Making Amends
What makes a true apology? What does it mean to make amends for past mistakes? This hour, TED speakers explore how repairing the wrongs of the past is the first step toward healing for the future. Guests include historian and preservationist Brent Leggs, law professor Martha Minow, librarian Dawn Wacek, and playwright V (formerly Eve Ensler).
Now Playing: Science for the People

#566 Is Your Gut Leaking?
This week we're busting the human gut wide open with Dr. Alessio Fasano from the Center for Celiac Research and Treatment at Massachusetts General Hospital. Join host Anika Hazra for our discussion separating fact from fiction on the controversial topic of leaky gut syndrome. We cover everything from what causes a leaky gut to interpreting the results of a gut microbiome test! Related links: Center for Celiac Research and Treatment website and their YouTube channel
Now Playing: Radiolab

The Flag and the Fury
How do you actually make change in the world? For 126 years, Mississippi has had the Confederate battle flag on their state flag, and they were the last state in the nation where that emblem remained "officially" flying.  A few days ago, that flag came down. A few days before that, it coming down would have seemed impossible. We dive into the story behind this de-flagging: a journey involving a clash of histories, designs, families, and even cheerleading. This show is a collaboration with OSM Audio. Kiese Laymon's memoir Heavy is here. And the Hospitality Flag webpage is here.