Lancet Hiv最新文献

International migrants, especially those belonging to key populations, face a considerable HIV burden. However, continuity of HIV care for this group is often challenged along the migration route. We assess the available evidence on the existing interventions that aim to strengthen community and health systems to ensure the continuity of HIV care for international migrants. We did a systematic search of PubMed for publications from 1989 until 2023 focused on different stages of the HIV care continuum regardless of the geographical region. The literature was reviewed with a thematic approach. Globally, legal regulations can restrict access to HIV care and fuel fear of deportation among undocumented migrants. The intersection of HIV-related and migration-related stigma creates further challenges for uninterrupted access to HIV care along the migration route, with negative clinical and public health consequences. Different potential interventions were identified including: provision of HIV care regardless of migration status; utilisation of mobile health, mobile units, and community-led initiatives to bring HIV care to migrants; and utilisation of participatory and co-creation methods to develop tailored and sustainable HIV-related interventions with migrant communities. Improving access to the continuity of care for migrants requires a shift towards intersectional policies rooted in co-creation approaches to address the underlying multiple and mutually reinforcing inequalities.

Background: HIV incidence among people who inject drugs in South Africa has never been estimated. We aimed to estimate HIV incidence and associations with risk and protective factors among people who inject drugs engaged with harm-reduction services.

Methods: For this retrospective cohort study we used programmatic data collected from April 1, 2019, to March 30, 2022, by the Networking HIV and AIDS Community of South Africa, which offers harm-reduction services and HIV testing to people who inject drugs. During this 3-year period, services were delivered through drop-in centres and outreach in four South African provinces: Gauteng, KwaZulu-Natal, Western Cape, and Eastern Cape. Our cohort comprised people who inject drugs who did not self-report being HIV positive, were HIV negative at first testing, and had at least one follow-up test. Data were collected by outreach teams. We estimated HIV incidence, assuming seroconversions occurred at the midpoint between the last negative test and first positive test. We assessed associations between HIV seroconversion risk and several factors with Cox regression models, including sociodemographic characteristics, primary drugs used, uptake of interventions (ie, number of harm-reduction packs and opioid agonist treatment [OAT]), and HIV testing interval.

Findings: Of 31 182 people who inject drugs accessing harm-reduction services, 20 955 (including 3409 self-reporting being HIV positive) were not tested for HIV. Of 10 227 people who tested at least once, 8152 were HIV negative at first test and of these, 2402 had at least two tests and formed the study cohort. Overall, 283 (11·8%) people who inject drugs acquired HIV over 2306·1 person-years. HIV incidence was higher in Gauteng (16·7 per 100 person-years; 95% CI 14·5-19·1) and KwaZulu-Natal (14·9 per 100 person-years; 11·3-19·3), than in the Eastern Cape (5·0 per 100 person-years; 2·3-9·6) and Western Cape (3·2 per 100 person-years; 1·9-4·9). In multivariable Cox models, HIV acquisition risk varied by race, primary drugs used, and interval between HIV tests. Additionally, people who injected drugs and received OAT in the past year had lower HIV risk (adjusted hazard ratio 0·48; 95% CI 0·22-1·03) than people who did not receive OAT, although the 95% CI was wide and crossed the null.

Interpretation: Our study highlights a pressing need for scale-up of HIV prevention strategies, particularly opioid agonist treatment, for people who inject drugs in South Africa. Dedicated investments are needed to develop monitoring systems for HIV incidence, risk behaviours, and uptake of interventions to ensure effective and equitable programmes.

Funding: Wellcome Trust, Canadian Institutes of Health Research, and Global Fund to Fight AIDS, Tuberculosis and Malaria.

Displaced populations living with HIV, including refugees and asylum seekers, face substantial challenges across various regions globally. The intersection of forced migration and HIV presents both shared challenges and region-specific differences. Key issues include little access to health care, pervasive stigma, discrimination, and disruptions in the continuity of HIV care. Refugees often encounter barriers such as legal, cultural, and economic disparities that impact their overall health outcomes. Although HIV prevalence differs across regions, displaced populations consistently face disproportionate challenges including high-risk environments and little health-care access. Addressing these challenges requires a focus on equitable health-care access, with both actionable local interventions and broader global policy changes and an emphasis on long-term sustainability. Reliable and continuous drug supplies, interagency collaboration, and holistic health-care approaches are essential. International collaboration, robust evidence generation, and comprehensive responses are urgently needed to address the complex interplay between forced migration and HIV among vulnerable populations.