The use of structural equation modelling and behavioural theory to target priority interventions to increase condom use among the intimate partners of sex workers in French Guiana

French Guiana is the French overseas territory that is most affected by HIV. Sex work seems to be an important driver of the epidemic. Although female sex workers are informed by local NGOs, they still have risky behaviours, including not using condoms with their intimate partner despite knowing HIV is highly prevalent. 

The objective of this study was to find intervention targets on this specific behaviour. For this, a structural equation model (SEM) was built using assumptions from behavioural theories. Behaviour theories attempt to connect research and practice. Within the health belief model framework, perceived threats, perceived benefits, and self-perceived efficacy were tested. Vulnerability was added because of the particular context of French Guiana. 

The results highlight that female sex workers’ perceived self-efficacy was central in condom use with the intimate partner (with a significant correlation coefficient of 0.52 in the SEM). The perceived self-efficacy was strongly influenced by sociodemographic factors, particularly by nationality. Female sex workers from Brazil seemed to be more comfortable about asking their intimate partner to use condoms (OR: 7.81; CI: 1.87–32.63) than sex workers of other nationalities. 

These results emphasize that prevention interventions for female sex workers should emphasize their empowerment.

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By:  Marie-Claire Parriault^a*, Astrid Van Melle^a, Célia Basurko^a, Leila Adriouch^b, Stéphanie Rogier^a, Pierre Couppié^c & Mathieu Nacher^ab

^a INSERM CIC 1424, Cayenne General Hospital, Cayenne, French Guiana

^b COREVIH Guyane, Cayenne General Hospital, Cayenne, French Guiana

^c Department of Dermatology, Cayenne General Hospital, Cayenne, French Guiana

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Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: A cross-sectional analysis

OBJECTIVES:

Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.

METHODS:

In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.

RESULTS:

FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.

CONCLUSIONS:

Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.

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By:  Parcesepe AM¹, L'Engle KL², Martin SL³, Green S³, Suchindran C⁴, Mwarogo P⁵.

¹Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA.

²FHI 360, Durham, North Carolina, USA Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA.

³Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁴Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁵FHI 360, Nairobi, Kenya.

Sex Transm Infect. 2016 May 23. pii: sextrans-2016-052549. doi: 10.1136/sextrans-2016-052549. [Epub ahead of print]

  

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Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs – a rapidly increasing, vulnerable population in southwest China. 

The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14–66) recruited over five years (2010–2014) from 35 National Sentinel Surveillance sites in Guangxi. 

Analyses included Fisher’s exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. 

Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. 

Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. 

Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.

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By: Yu YJ1, Li X1, Tam CC2, Zhou Y3, Chen Y3, Shen Z3.

• 1a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA.
• 2b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA.
• 3c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China.
• AIDS Care. 2016 May 30:1-6

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Risk Factors Associated with HIV among Men Who Have Sex With Men (MSM) in Ecuador

The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. 

A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. 

An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. 

Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

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By:  Hernandez I1, Reina-Ortiz M2, Johnson A3, Rosas C4, Sharma V3, Teran S4, Naik E3, Salihu HM5, Teran E6, Izurieta R3.

• 1Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
• 2University of South Florida, Tampa, FL, USA Fundación Raíces, Esmeraldas, Ecuador.
• 3University of South Florida, Tampa, FL, USA.
• 4Universidad San Francisco de Quito, Quito, Ecuador.
• 5Baylor College of Medicine, Houston, TX, USA.
• 6Universidad San Francisco de Quito, Quito, Ecuador eteran@usfq.edu.ec.
• Am J Mens Health. 2016 May 8. pii: 1557988316646757 

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Syphilis among middle-aged female sex workers in China: A three-site cross-sectional study

OBJECTIVES:

This study addresses the lack of empirical studies about the epidemic of syphilis among middle-aged female sex workers (FSWs). The objectives of this study were to investigate prevalence of syphilis, and its potential risk factors among middle-aged FSWs in China.

DESIGN:

A cross-sectional study with respondent-driven sampling (RDS).

SETTING:

A multisite study conducted at three Chinese cites (Nanning, Hefei, and Qingdao) with different levels of sexually transmitted diseases in 2014.

PARTICIPANTS:

1245 middle-aged female sex workers who were over 35 years old (about 400 per study site).

MAIN OUTCOME MEASURES:

Unprotected commercial sex, and syphilis and HIV infection were biologically tested and measured.

RESULTS:

The RDS-adjusted prevalence of active syphilis was 17.3% in Hefei, 9.9% in Qingdao, and 5.4% in Nanning. The RDS-adjusted prevalence of prevalent syphilis was between 6.8% and 33.6% in the three cities. The proportion of unprotected sex in the past 48 h verified by the prostate-specific antigen test (PSA) was between 27.8% and 42.4%. Multiple log-binomial regression analyses indicate that middle-aged FSWs who had 5 or more clients in the past week prior to interviews and engaged in unprotected sex were more likely to be active syphilitic cases. Middle-aged FSWs who had rural residency were less likely to be active syphilitic cases.

CONCLUSIONS:

In contrast with previous studies that reported low prevalence of syphilis and high prevalence of protected sex among FSWs in China, both the prevalence of syphilis and unprotected sex were high among middle-aged FSWs. Evidence-based intervention programmes should be developed and evaluated among this vulnerable population in China and other countries with similar settings.

Below: Location of the three study sites (Qingdao, Hefei, and Nanning)

Full article at:   http://goo.gl/dcEcJy

By:  Liu H¹, Dumenci L², Morisky DE³, Xu Y⁴, Li X⁵, Jiang B⁶.

¹Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland, USA.

²Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA.

³Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA.

⁴Department of AIDS/STD Prevention, Nanning Center for Disease Control and Prevention, Nanning, Guangxi, China.

⁵Department of AIDS/STD Prevention, Hefei Center for Disease Control and Prevention, Hefei, Anhui, China.

⁶Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandon, China.

BMJ Open. 2016 May 10;6(5):e010420. doi: 10.1136/bmjopen-2015-010420.

  

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Consistent Condom Use by Female Sex Workers in Kolkata, India: Testing Theories of Economic Insecurity, Behavior Change, Life Course Vulnerability and Empowerment

Consistent condom use (CCU) is the primary HIV/STI prevention option available to sex workers globally but may be undermined by economic insecurity, life-course vulnerabilities, behavioral factors, disempowerment, or lack of effective interventions. 

This study examines predictors of CCU in a random household survey of brothel-based female sex workers (n = 200) in two neighborhoods served by Durbar (the Sonagachi Project) in Kolkata, India. 

Multivariate logistic regression analyses indicated that CCU was significantly associated with perceived HIV risk, community mobilization participation, working more days in sex work, and higher proportion of occasional clients to regular clients. 

Exploratory analyses stratifying by economic insecurity indicators (i.e., debt, savings, income, housing security) indicate that perceived HIV risk and community mobilization were only associated with CCU for economically secure FSW. Interventions with FSW must prioritize economic security and access to social protections as economic insecurity may undermine the efficacy of more direct condom use intervention strategies.

Full PDF article at:   http://goo.gl/VBWDCT

By:  Anne E. Fehrenbacher1 • Debasish Chowdhury2 • Toorjo Ghose3 • Dallas Swendeman4,5

1 Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, 650 Charles E Young Drive South, Los Angeles, CA 90095, USA

2 Public Health Foundation of India (PHFI), Sector-44, Plot No-47, Gurgaon 122003, India

3 School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Caster D17, Philadelphia 19104, USA

4 Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024, USA

5 Department of Epidemiology, Fielding School of Public Health, 10920 Wilshire Blvd., Suite 350, Los Angeles 90024, USA

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HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys

Background

There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka.

Methods

Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire.

Results

• The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. 
• In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. 
• Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). 
• Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. 
• Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), 
• HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). 
• HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively).

Conclusion

We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.

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By:  Senad Handanagic, Ivana Bozicevic, Marta Civljak, Zoran Dominkovic, Sandra Sevic, Jelena Barbaric, Tatjana Nemeth Blazic, Oktavija Dakovic Rode, Josip Begovac

WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia

Correspondence

Corresponding author. Tel.: +385 1 4590 147; fax: +385 1 4684 212. 

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Intimate partner violence and condom negotiation efficacy among gay and bisexual men in Atlanta

Background:

The experience of intimate partner violence (IPV) has been shown to decrease condom negotiation efficacy among women; however, studies of this association among gay and bisexual men (GBM) are lacking.

Methods:

A venue-recruited sample of 745 GBM was recruited in Atlanta, GA, USA in 2012-13. Participants self-completed a survey including questions on recent (previous 12 month) experience and perpetration of IPV using the IPV-GBM Scale. Multivariate regression analysis examined the association between reporting low condom negotiation efficacy with the respondent's most recent sex partner (19.2% of respondents) and recent experience of IPV with the same or another partner.

Results:

Nearly half the sample (49.1%) reported recent receipt of IPV, although prevalence varied considerably across the forms of IPV. GBM who reported recent IPV experience were significantly less likely to report having felt able to negotiate condom use.

Conclusions:

These findings suggest that IPV may be a significant risk factor for HIV acquisition and transmission among GBM.

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By:  Rob Stephenson A B D, Ryan Freeland B and Catherine Finneran C 

A Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48104, USA. B The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI 48104, USA. C Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA 30322, USA. D Corresponding author. Email: rbsteph@umich.edu 

Sex Health. 2016 Apr 28. doi: 10.1071/SH15212. 

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Sexual Risk Behaviors and Substance Use among Men Sexually Victimized by Women

OBJECTIVES:

To investigate whether forced sex of men by women was associated with sexual risk behaviors, and whether this association was mediated by substance use.

METHODS:

Data from US men aged 18 years or older at interview in the National Survey of Family Growth 2006-2010 (n = 8108) who reported sexual behavior history. Outcome variables were condom use at most recent sex and number of lifetime sexual partners. Sexual activity covariates included age at first consensual sex and treatment of sexually transmitted infections. Alcohol and drug use were the mediating factors.

RESULTS:

Six percent of men reported forced sex by a woman at a mean age of 18 years. On average, victimized men had 3 more lifetime sexual partners than nonvictimized men (P < .01). Furthermore, victimized men who reported drug use had, on average, 4 more female sexual partners (P < .01) than nonvictimized men. Marijuana (P < .05) and crack cocaine use (P < .05) partially mediated the association between forced sex and number of female partners. Neither condom use nor number of male partners differed between victimized and nonvictimized men.

CONCLUSIONS:

A nontrivial fraction of men experience forced sex by women; some of them have elevated sexual risk behaviors. 

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By:  Cook MC1, Morisky DE1, Williams JK1, Ford CL1, Gee GC1.

• 1Mekeila C. Cook is with the University of California, Los Angeles (UCLA) Integrated Substance Abuse Programs, Los Angeles, CA. Donald E. Morisky, Chandra L. Ford, and Gilbert C. Gee are with the UCLA Fielding School of Public Health, Department of Community Health Sciences. John K. Williams is with the UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior. 
• Am J Public Health. 2016 Apr 14:e1-e7.

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Perceptions and Attitudes regarding Sexually Transmitted Infection (STIs) and Family Planning among Adolescents in Northern Madagascar

The prevalence of sexually transmitted infections (STIs) and early pregnancy are high among adolescents in Madagascar. 

We applied a qualitative descriptive approach to evaluate perceptions, attitudes, and misconceptions regarding STIs and contraception among female and male adolescents ages 15-19 years (n = 43) in Northern Madagascar in 2014 using focus group discussions with open-ended questions. Data were coded and analyzed for major themes. Participants were in the 6th to 12th grade in school; 53% were female. 

Despite high levels of awareness, significant stigma against and misconceptions about STIs, condom use, and sexual practices existed. Many participants did not know how to use condoms and felt uncomfortable suggesting condoms with regular partners, despite acknowledging infidelity as a frequent problem. 

Male participants were more willing to use condoms as contraception for unwanted pregnancy than for prevention of STIs. Most participants held misconceptions about side effects of contraceptives, including infertility, cancer, and preventing bad blood from leaving the woman's body. Systematic and community-wide health education and formal reproductive health curricula in schools may improve attitudes and stigma regarding STIs and family planning. 

These strategies need to be developed and employed via collaboration among faith-based, community and non-governmental organizations, schools, and governmental health and social service agencies.

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By:  Klinger A1, Asgary R2.

• 1 Department of Internal Medicine , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA.
• 2 Departments of Population Health and Medicine , New York University School of Medicine , New York , New York , USA. 
• Women Health. 2016 Apr 19.

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HIV Prevalence and Risks Associated with HIV Infection among Transgender Individuals in Cambodia

INTRODUCTION:

Recognizing transgender individuals have a high risk of HIV acquisition, and to inform policies and programming, we conducted an HIV prevalence and risk behaviors survey among transgender individuals in Cambodia.

METHODS:

Cross-sectional survey using a respondent driven sampling method with self-administered audio-computer assisted interviews. HIV testing was performed prior to the questionnaire with results available immediately after. Eligible participants were ≥18 years, identified as male at birth and self-identified/expressed as a different gender, and reported having sex with at least one male partner in past year. From six major urban centers of Cambodia, 891 transgender individuals were recruited.

RESULTS:

The majority of the 891 participants self-identified as third gender or female (94.5%), were young (median age 23, IQR [20-27]), had secondary education or higher (80.5%), not married (89.7%), and employed (90.2%). The majority had first sex before 18 years (66.8%), with a male (79.9%), 37.9% having been paid or paying for this first sex. The rate of HIV positivity among participants was found to be 4.15%. Consistent condom use with male and female partners was low with all partner types, but particularly low with male partners when paying for sex (20.3%). The majority of participants reported having experienced discrimination in their lifetime (54.8%) and 30.3% had been assaulted. Multivariate analysis revealed that older age (adjusted OR = 14.73 [4.20, 51.67] for age 35-44 and adjusted OR = 7.63 [2.55, 22.81] for age 30-34), only having a primary school education or no schooling at all (adjusted OR = 2.62 [1.18, 5.80], being a resident of Siem Reap (adjusted OR = 7.44 [2.37,23.29], receiving payment at first sex (adjusted OR = 2.26 [1.00, 5.11], having sex during/after using drugs (adjusted OR = 2.90 [1.09,7.73]), inconsistent condom use during last anal sex (adjusted OR = 3.84 [1.58, 9.33]), and reporting low self-esteem (adjusted OR = 3.25 [1.35,7.85]) were independently associated with HIV infection.

Below:  A. Condom use with partners during past 6 months by sex transaction type, with female partners. B. Condom use with partners during past 6 months by sex transaction type, with male partners.

CONCLUSIONS:

This study confirms transgender individuals as one of the highest-risk groups for HIV infection in Cambodia. It suggests the need for programmatic strategies that mitigate identified associated risks and facilitate access to HIV care for this population.

Full article at:   http://goo.gl/MDR3Ih

By:  Weissman A1, Ngak S1, Srean C1, Sansothy N2, Mills S3, Ferradini L1.

• 1FHI 360, Phnom Penh, Cambodia.
• 2National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, (NCHADS) and University of Health Science, Phnom Penh, Cambodia.
• 3FHI 360, Bangkok, Thailand. 

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Comparing the impact of increasing condom use or HIV pre-exposure prophylaxis (PrEP) use among female sex workers

Highlights

• To achieve the same impact on FSW HIV prevalence as increasing condom use by 1%, the coverage of PrEP has to increase by >2%.
• The relative impact of PrEP compared to condoms increases for scenarios where pimps contribute to HIV transmission.
• Condom promotion interventions should remain the mainstay HIV prevention strategy for FSWs.
• PrEP should only be implemented to fill prevention gaps where condoms cannot be used.

In many settings, interventions targeting female sex workers (FSWs) could significantly reduce the overall transmission of HIV. To understand the role HIV pre-exposure prophylaxis (PrEP) could play in controlling HIV transmission amongst FSWs, it is important to understand how its impact compares with scaling-up condom use-one of the proven HIV prevention strategies for FSWs. 

It is important to remember that condoms also have other benefits such as reducing the incidence of sexually transmitted infections and preventing pregnancy. A dynamic deterministic model of HIV transmission amongst FSWs, their clients and other male partners (termed 'pimps') was used to compare the protection provided by PrEP for HIV-negative FSWs with FSWs increasing their condom use with clients and/or pimps. For different HIV prevalence scenarios, levels of pimp interaction, and baseline condom use, we estimated the coverage of PrEP that gives the same reduction in endemic FSW HIV prevalence or HIV infections averted as different increases in condom use. 

To achieve the same impact on FSW HIV prevalence as increasing condom use by 1%, the coverage of PrEP has to increase by >2%. The relative impact of PrEP increases for scenarios where pimps contribute to HIV transmission, but not greatly, and decreases with higher baseline condom use. In terms of HIV infections averted over 10 years, the relative impact of PrEP compared to condoms was reduced, with a >3% increase in PrEP coverage achieving the same impact as a 1% increase in condom use. 

Condom promotion interventions should remain the mainstay HIV prevention strategy for FSWs, with PrEP only being implemented once condom interventions have been maximised or to fill prevention gaps where condoms cannot be used.

Below:  The relative impact of PrEP compared to condoms for decreasing the endemic FSW HIV prevalence (a) or averting HIV infections (b) after 10 years for different baseline FSW HIV prevalences, with no condom or PrEP use at baseline.

Below:  Sensitivity analysis on how the relative impact of PrEP changes for specific changes in model parameters

Full article at:   http://goo.gl/hsnL86

By:  Mukandavire Z1, Mitchell KM2, Vickerman P3.

• 1Social and Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK. Electronic address: Zindoga.Mukandavire@lshtm.ac.uk.
• 2Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Electronic address: Kate.Mitchell@imperial.ac.uk.
• 3School of Social and Community Medicine, University of Bristol, Bristol, UK. Electronic address: Peter.Vickerman@bristol.ac.uk. 
• Epidemics. 2016 Mar;14:62-70. doi: 10.1016/j.epidem.2015.10.002. Epub 2015 Nov 12.

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