September: hiv-prevention | News and features

Despite efforts to eliminate HIV, levels remain high among key populations, with UNAIDS estimating that globally men who have sex with men (MSM), people who inject drugs (PWID) and female sex workers (FSW) have three to 11 times higher burden of HIV infection and contribute to the majority of new HIV infections. The £5 million award will fund an eight-year study to improve current prevention strategies for these key populations.

While existing HIV prevention interventions work for key populations, “structural factors”, such as unemployment, homelessness, stigma, violence and criminalisation, may severely limit their impact. These factors are pervasive in key populations globally and can increase the vulnerability of key populations to HIV through reducing access to health services, retention to HIV treatment, and increasing HIV risk behaviours.

Although largely overlooked in the past, initiatives to reduce structural factors and their effects are a focus of recent global HIV elimination strategies, but there is limited evidence to show why it is essential to bring these to the forefront of HIV prevention efforts and how this could be achieved.

Peter Vickerman, Professor of Infectious Disease Modelling from the Bristol Medical School’s Population Health Sciences and NIHR Health Protection Research Unit (NIHR HPRU) and project lead said:  “We are incredibly excited and grateful to Wellcome for giving us this opportunity to improve HIV programming among key populations, which by focussing on structural factors could also improve the broader quality of life of these vulnerable populations.

“To date, HIV prevention initiatives have generally not focussed on structural interventions, in part because the effects of structural factors on HIV are complex, poorly understood and challenging to quantify. Our proof-of-concept modelling suggests their role could be considerable.”

The project will include systematic reviews, epidemiological analyses, mathematical modelling and cost-effectiveness analyses, to quantify and cost the contribution of structural factors to driving the HIV epidemic, and the impact of interventions that address them. The project aims to enable evidence-based planning in HIV programming for key populations including structural interventions.

Professor Boily, a senior member of the study team from Imperial College London, added: “Mitigating the effects of structural factors is likely to be key if we are to achieve global targets of eliminating HIV by 2030. Our project will deliver the tools and evidence-base needed to implement HIV elimination initiatives that systematically track, reduce, and mitigate exposure to structural factors among key populations.”

The project team will also work closely with global and in-country stakeholders, community advisory groups, and affected communities in each setting where research is undertaken.

Professor Platt, an epidemiologist and senior member of the project team from the London School of Hygiene and Tropical Medicine, continued: “Key populations often face marginalisation, stigma and socio-economic disadvantage and consequently carry one of the highest burdens of HIV/AIDS globally. It is critical that people most affected by these issues have a voice in research. We will work closely with communities in all aspects of the project, from prioritising research questions to interpretation of findings and write-up to translating findings into practice and policy change.”

The project brings together an international team of epidemiologists, mathematical modellers, health economists, field scientists and community representatives. The core team includes Professor Marie-Claude Boily (Imperial College London), Dr Mathieu Maheu-Giroux (McGill University), Dr Adelina Artenie (University of Bristol), Dr Jack Stone (University of Bristol), Professors Lucy Platt and Fern Terris-Prestholt (London School of Hygiene and Tropical Medicine, LSHTM), Ms Tetiana Saliuk (Alliance for Public Health, Ukraine), Mr Serge Niangoran (Programme PAC-CI, Côte d’Ivoire) and Mr Aditya Singh (Johns Hopkins India). In addition, over 30 collaborators worldwide have joined the project to offer data, methodological or field expertise and to act as partners from international public health agencies. The team will be further expanded to include four postdoctoral researchers from LSHTM, Imperial College and McGill and three PhD students based in India, Ukraine and Cote D’Ivoire.

The project, titled ‘Transforming the response to the HIV epidemics amongst key populations: Addressing structural factors for achieving HIV elimination’, began in July 2023.

 For further information on the project, please contact Professor Peter Vickerman at [email protected]

Further information

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