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Background: East African cross-border sites are visited by mobile and vulnerable populations, such as female sex workers, men who have sex with men, truck drivers, fisherfolk, and young women who may not benefit from treatment and prevention interventions at their home residence. The goal of this analysis was to use data on cross-border populations in East Africa to explore whether mobile and vulnerable populations were receiving fewer prevention services.
Methods: The USAID- and PEPFAR-funded MEASURE Evaluation project, led by the University of North Carolina at Chapel Hill, collected cross-sectional data using the Priorities for Local AIDS Control Efforts (PLACE) sampling method at 14 cross-border locations near or along the land and lake borders of Kenya, Rwanda, Tanzania, and Uganda from August 2016-January 2017. This bio-behavioral survey captured information from 11,428 individuals at 833 venues (e.g., bars, hotels, guest houses) across all sites. Data were weighted using survey sampling weights and analyzed using methods to account for the complex sampling design.
Results: Across all venues, informants reported offering an average of 2 HIV prevention activities in the six months preceding the survey. The average number of prevention services offered at each venue varied by country, with the highest in Uganda [2.46 (95% CI: 2.14, 2.79)] and lowest in Rwanda [0.95 (95% CI: 2.14, 2.79)]. Only 4.2% (95% CI: 3.2, 5.2) of respondents reported it was easy to access sexual lubricants. Over 40% of venues with sex onsite (48.3% of all sites) or FSWs living at the spot (17.9% of all sites) did not have condoms available. Among respondents reporting vaginal and anal sex, reported use of condom at last sexual encounter were 38.1 (95% CI: 36.3, 39.9) and 62.9 (95% CI: 56.5, 69.2), respectively.
Conclusions: Prevention activities appear to be appropriately targeted towards venues with high prevalence behaviors at the spot (e.g., sex work, sex onsite, or alcohol use). However, gaps remain in access to condoms and sexual lubricants and use of condoms, and there are several opportunities to improve access at sites visited by mobile and vulnerable populations at high risk for HIV.


Percentage of 833 spots in cross-border sites visited by mobile and vulnerable populations that offered specific HIV prevention services in the past s
[Percentage of 833 spots in cross-border sites visited by mobile and vulnerable populations that offered specific HIV prevention services in the past s]