title: Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs.
abstract: Studies completed over the past 15 years have consistently demonstrated the importance of community-level determinants in potentiating or mitigating risks for the acquisition and transmission of HIV. Structural determinants are especially important in mediating HIV risk among key populations, including men who have sex with men, people who inject drugs, sex workers of all genders, and transgender women. The objective of this systematic review was to synthesize the evidence characterizing the community-level determinants that potentiate or mitigate HIV-related outcomes for key populations. The results of the review suggest that although health communication programs represent community-level strategies that have demonstrated the effectiveness in increasing the uptake of HIV testing and decreasing the experienced stigma among people living with HIV, there are limited studies focused on key populations in low- and middle-income settings. Moreover, interpretation from the 22 studies that met inclusion and exclusion criteria reinforce the importance of the continued measurement of community-level determinants of HIV risks and of the innovation in tools to effectively address these risks as components of the next generation of the HIV response. Consequently, the next generation of effective HIV prevention science research must improve our understanding of the multiple levels of HIV risk factors, while programming for key populations must address each of these risk levels. Failure to do so will cost lives, harm communities, and undermine the gains of the HIV response.
authors.affiliation: Key Populations Program, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
authors.forename: Claire E
authors.initials: CE
authors.lastname: Holland
authors.forename: Kate
authors.initials: K
authors.lastname: Shannon
authors.forename: Carmen
authors.initials: C
authors.lastname: Logie
authors.forename: Paul
authors.initials: P
authors.lastname: Semugoma
authors.forename: Bhekie
authors.initials: B
authors.lastname: Sithole
authors.forename: Erin
authors.initials: E
authors.lastname: Papworth
authors.forename: Fatou
authors.initials: F
authors.lastname: Drame
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control* / Q000523:psychology; D058015:Health Communication / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D011477:Sex Work; D012931:Social Environment; D019966:Substance-Related Disorders; D063106:Transgender Persons