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Hamilton A, Shin S, Taggart T, Whembolua GL, Martin I, Budhwani H, Conserve D. HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the Caribbean: a systematic review. Sex Transm Infect 2020; 96:189-196. [PMID: 31506346 PMCID: PMC7062576 DOI: 10.1136/sextrans-2018-053932] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/16/2019] [Accepted: 08/13/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This systematic review summarises evidence on the HIV testing barriers and intervention strategies among Caribbean populations and provides pertinent implications for future research endeavours designed to increase rates of HIV testing in the region. METHODS We used a systematic approach to survey all literature published between January 2008 and November 2018 using four electronic databases (MEDLINE/PubMed, Embase, Web of Science and Global Health). Only peer-reviewed articles published in English that examined HIV testing uptake and interventions in the Caribbean with men, men who have sex with men, female sex workers, transgender women and incarcerated individuals were included. RESULTS Twenty-one studies met the inclusion criteria. Lack of confidentiality, access to testing sites, stigma, discrimination, poverty and low HIV risk perception were identified as key barriers to HIV testing. These barriers often contributed to late HIV testing and were associated with delayed treatment initiation and decreased survival rate. Intervention strategies to address these barriers included offering rapid HIV testing at clinics and HIV testing outreach by trained providers and peers. CONCLUSION HIV testing rates remain unacceptably low across the Caribbean for several reasons, including stigma and discrimination. Future HIV testing interventions should target places where at-risk populations congregate, train laypersons to conduct rapid tests and consider using oral fluid HIV self-testing, which allows individuals to test at home.
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Affiliation(s)
- Akeen Hamilton
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
| | - Stephen Shin
- University of North Carolina at Chapel Hill, Department of Sociology, Chapel Hill, NC, USA
| | - Tamara Taggart
- George Washington University, Department of Prevention and Community Health, Washington, DC, USA
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Guy-Lucien Whembolua
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, CT, USA
| | - Indira Martin
- Government of the Bahamas Ministry of Health, Nassau, Bahamas
| | - Henna Budhwani
- University of Alabama at Birmingham, Department of Health Care Organization and Policy, Birmingham, AL, USA
| | - Donaldson Conserve
- Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina System, Columbia, SC, USA
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Landis RC, Abayomi EA, Bain BC, Greene E, Janossy G, Joseph P, Kerrigan D, McCoy JP, Nunez C, O'Gorman M, Pastoors A, Parekh BS, Quimby KR, Quinn TC, Robertson KR, Thomas R, van Gorp E, Vermund SH, Wilson V. Shifting the HIV Paradigm from Care to Cure: Proceedings from the Caribbean Expert Summit in Barbados, August 2017. AIDS Res Hum Retroviruses 2018; 34:561-569. [PMID: 29732897 PMCID: PMC6053839 DOI: 10.1089/aid.2017.0310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The CCAS EXPERT SUMMIT convened an array of international experts in Barbados on August 27-31, 2017 under the theme "From Care to Cure-Shifting the HIV Paradigm." The Caribbean Cytometry & Analytical Society (CCAS) partnered with the Joint United Nations Programme on HIV/AIDS (UNAIDS) to deliver a program that reviewed the advances in antiretroviral therapy and the public health benefits accruing from treatment as prevention. Particular emphasis was placed on reexamining stigma and discrimination through a critical appraisal of whether public health messaging and advocacy had kept pace with the advances in medicine. Persistent fear of HIV driving discriminatory behavior was widely reported in different regions and sectors, including the healthcare profession itself; continued fear of the disease was starkly misaligned with the successes of new medical treatments and progress toward the UNAIDS 90-90-90 targets. The summit therefore adopted the mantra "Test-Treat-Defeat" to help engage with the public in a spirit of optimism aimed at creating a more conducive environment for persons to be tested and treated and, thereby, help reduce HIV disease and stigma at the individual and community levels.
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Affiliation(s)
- R. Clive Landis
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
- Office of the Deputy Principal, The University of the West Indies - Cave Hill Campus, Bridgetown, Barbados
| | - E. Akinola Abayomi
- Division of Haematopathology, Faculty of Medicine, Tygerberg Academic Hospital, Stellenbosch University, Cape Town, South Africa
| | - Brendan C. Bain
- Department of Medicine, University Hospital of the West Indies, Mona, Jamaica
| | - Edward Greene
- Office of the UN Secretary General, United Nations, New York, New York
| | - George Janossy
- Department of Immunology, University College Medical School, University College, London, United Kingdom
| | - Patrice Joseph
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Deanna Kerrigan
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - J. Philip McCoy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Cesar Nunez
- UNAIDS Latin American and Caribbean Regional Support Team, Panama City, Panama
| | - Maurice O'Gorman
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Bharat S. Parekh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kim R. Quimby
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, The University of the West Indies, Bridgetown, Barbados
| | - Thomas C. Quinn
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kevin R. Robertson
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Eric van Gorp
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, the Netherlands
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