Identifying Opportunities for Collaboration Across the Social Sciences to Reach the 10-10-10: A Multilevel Approach

Assessing and Addressing Social Determinants of HIV among Female Sex Workers in the Dominican Republic and Tanzania through Community Empowerment-Based Responses

PURPOSE OF REVIEW

This review describes social determinants of HIV in two geographic and epidemic settings, the Dominican Republic (DR) and Tanzania, among female sex workers (FSW), their influence on HIV outcomes including 90-90-90 goals, and the development and impact of tailored, context driven, community empowerment-based responses in each setting.

RECENT FINDINGS

Our review documents the significance of social determinants of HIV including sex work-related stigma, discrimination, and violence and the impact of community empowerment-based approaches on HIV incidence in Tanzania and other HIV prevention, treatment, and care outcomes, including care engagement and adherence, in the DR and Tanzania. Community empowerment approaches where FSW drive the response to HIV and strategically engage partners to target socio-structural and environmental factors can have a demonstrable impact on HIV prevention, treatment, and care outcomes. Such approaches can also support further gains towards reaching the 90-90-90 across geographies and types of epidemics.

The Role of Community Health Workers Within the Continuum of Services for HIV, Viral Hepatitis, and Other STIs Amongst Men Who Have Sex with Men in Europe

Little is known about Community Health Workers (CHWs) who work in non-clinical settings to provide sexual health support around HIV, viral hepatitis, and other sexually transmitted infections (STIs) to men who have sex with men (MSM) in Europe and neighbouring countries. This article describes for the first time, who CHWs are, and how they contribute to the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM. The first European Community Health Worker Online Survey (ECHOES) developed in the framework of the EU-funded ESTICOM project (www.esticom.eu), was available in 16 languages (October 2017-January 2018). Amongst the 1035 persons aged 18 and older reporting CHW activities in the previous 12 months, 28.2% were women, 30.7% were volunteers, 59.2% were men self-defining as gay/homosexual, bisexual or queer (‘peer CHWs’), and most CHWs worked/volunteered in private not-for-profit organisations (86.4%). CHWs involvement in the continuum of services for HIV, viral hepatitis and other STIs was as follows: primary prevention (88.6%), consultation and counselling (58.0%), testing provision (50.6%), linkage to care (49.8%), and treatment and support activities (51.3%). CHWs were also involved in cross-cutting activities such as developing interventions, advocacy, and engaging in research (46.3%). CHWs as a public health workforce contribute to all steps of the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM in Europe. National governments should recognise and support CHWs better in order to make their activities more visible and sustainable, and increase their impact on the continuum of services.