CC BY
0X5K 614.4: 616.98 MPHTH 15.13.29
HIV AND MEN WHO HAVE SEX WITH MEN: BARRIERS TO ACCESSING
IMPROVED HEALTHCARE
Ibraimova A. A.1, Baymuratova M. A.1, Zhakanova G. A.2, *Saussanova D. Zh.1
Kazakhstan's medical university «KSPH», Almaty, Kazakhstan;
2SOE "Almaty Regional Center for Prevention and Fight against AIDS", Almaty,
Kazakhstan.
ABSTRACT
Achieving sustainable health and well-being for all is one of the major challenges of the modern world, which is especially relevant considering global challenges such as infectious disease epidemics. Over the past decades, there have been significant improvements in health care, but despite the successes, the problems associated with the spread of HIV/AIDS remain a serious threat to public health. This is especially true for vulnerable groups of the population, such as men who have sex with men (MSM), who remain at the center of the HIV epidemic in most countries of the world. HIV infection, remaining incurable, continues to have a devastating impact on the health of millions of people, especially in regions with high infection rates and inadequate access to health care.
Key words: AIDS, HIV, sexual health, vulnerable groups, prevention.
Introduction: In recent decades, our world has achieved truly unprecedented improvements in health and well-being, which allows us to strive for sustainable health and stable development for all. The most important element of this strategy are the Sustainable Development Goals, which set the goal of ending the epidemics of AIDS, tuberculosis and malaria, and respectively improving maternal and child health. In the context of a growing number of migrants, the coverage and scale of harm reduction programs hinder the full fight against the high risk of HIV transmission, including drug users and LGBTQ communities, the need for comprehensive solutions is especially urgent. The increase in HIV incidence in countries such as Russia highlights the importance of implementing harm reduction strategies, such as the provision of clean needles and drug therapy. These approaches can not only reduce the number of new cases among vulnerable groups, but also create conditions for improving public health. However, significant gaps in the coverage and scale of harm reduction programmes hinder the full fight against
epidemics, making it necessary to integrate them into primary health care and support the rights of men who have sex with men.
Objective of the study: To assess current harm reduction strategies and identify barriers faced by men who have sex with men in accessing HIV prevention and treatment. The study aims to develop recommendations for improving the health of vulnerable populations through the implementation of more effective programs to combat HIV and other diseases.
Materials and methods. To study the research topic, a systematic search of scientific literature was conducted in a number of authoritative databases, including PubMed, Scopus, Medline and Google Scholar. The main focus was on publications related to men who have sex with men, as well as harm reduction strategies and HIV prevention and treatment measures in this group. The search used keywords and phrases related to HIV epidemiology, access to health services and barriers to achieving sustainable health among vulnerable patients.
Results. Buoyed by unprecedented improvements in human health and development in recent decades, the world has embarked on a challenge that would have been considered unachievable just a generation ago: achieving sustainable health and development for all. Improving the health and well-being of people everywhere is at the heart of the Sustainable Development Goals, with targets calling for ending the AIDS, tuberculosis and malaria epidemics; achieving dramatic improvements in maternal and child health; and tackling the growing burden of noncommunicable diseases [1] Addressing the health needs of the world's vast and growing migrant population is a public health and human rights imperative [2] More than half of all new HIV infections occur among vulnerable populations—people who use drugs, gay men and transgender women, and sex workers and their clients, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS) [3]. The prevalence of infection caused by the human immunodeficiency virus (HIV) is increasing in the Russian Federation, researchers shared in 2014. At the same time, they reported that since the first case of HIV infection was identified in 1987, more than 750 thousand HIV-infected Russians have been identified and 140 thousand of them have been reported to have died. HIV belongs to the lentivirus subfamily of the retrovirus family. Of the two existing types of the virus: HIV-1 and HIV-2, HIV-1 is the most common type of the pathogen, the spread of which is of a pandemic nature, and HIV-2 is found mainly in countries where the population speaks Portuguese [4].
The concept of harm reduction in the context of HIV prevention includes the provision of clean needles and syringes, which is an important component of a comprehensive approach. When combined with access to drug maintenance therapy, this strategy is considered the most effective in reducing new cases of HIV among people who inject drugs. Harm reduction programmes directly contribute to improving public health as they help integrate HIV services, treatment of
independence and primary health care. However, significant gaps in the scale and coverage of harm reduction programmes in many settings limit countries' ability to respond to HIV epidemics
[5]. Harm reduction therefore needs to be considered a key global strategy for health promotion
[6].
Many countries still do not have estimates of the gay population, and half of the countries that do have estimates use methodologies that cast doubt on their reliability [7].
It should be emphasized that a climate of fear and hostility has inevitably increased gay men's susceptibility to HIV and, accordingly, limited their access to essential prevention and treatment services. In India and Moscow, only a small minority of gay men living with HIV have achieved viral suppression, with ignorance of their HIV status being the most significant bottleneck in services [8-9]. As recently as 2016, 12% of all new HIV infections globally and 22% of infections outside sub-Saharan Africa were among gay men and other men who have sex with men [10]. Among HIV-related risk behaviors, unprotected and receptive anal sex are twice as likely to be acquired, and more than 17 times more likely to be acquired through receptive-vaginal sex than through unprotected anal sex [11]. However, the disproportionate burden of HIV among gay men cannot be separated from their deep (and in many cases worsening) social disadvantage [12]. In 2018, gay men were 22 times more likely to be infected with AIDS than all other adult men. A similar pattern was observed among sex workers: their risk of infection was 21 times higher than that of other people aged 15-49 years. Among transgender women, it was 12 times higher than the average [13-14]. It should be noted that in addition to cross-border migration, many people move for work or other reasons to other states or provinces within their own country; in China alone, this affects more than 280 million rural migrants.
Another aspect concerns the various stakeholders united to create a global movement to combat noncommunicable diseases. Experiences in the HIV response (including successes in advocacy, community engagement, models of care, and innovations to ensure access to essential diagnostics and medicines) have the potential to hold important lessons for the community [15]. Ensuring that NCDs receive the attention they deserve will require much greater political commitment and a willingness to confront entrenched financial interests such as the tobacco and food industries [16-17]. Structural approaches (providing smoke-free environments, banning or restricting tobacco and alcohol advertising, using taxes to discourage tobacco or alcohol use, reducing salt and sugar in packaged foods and beverages, and replacing trans fats with healthier alternatives) are critical to efforts to reduce NCDs [18]. For some NCDs, prevention technologies must be scaled up, aggressively promoted, and made widely available. This certainly includes nicotine replacement and other smoking cessation aids, as well as hepatitis and human papillomavirus vaccines. Cognitive-behavioural interventions, related to behaviour change
theories and approaches and linked to HIV risk reduction, have a role in reducing risk behaviours that may increase risk [19]. Screening models for multiple conditions have already been shown to be effective in addressing not only HIV but also hypertension, diabetes and childhood illnesses
[20]. The rationale for integrating HIV and sexual and reproductive health and rights (SRHR) services is compelling, as individuals seeking or needing SRHR and HIV services are likely to face interrelated risks (e.g. sexually transmitted infections and HIV) and have interrelated needs
[21].
HIV remains one of the most serious threats to public health, since an infected person can transmit the virus at any stage of the disease, including the incubation period. It has been proven that HIV infection preserves the virus for life, and cases of spontaneous recovery have not been registered (Plavlinsky S.L., et al. 2018; Pokrovsky V.V. et al. 2017) [22,23]. The prolonged absence of clinical manifestations in infected people leads to the unnoticed spread of HIV and, ultimately, mass AIDS incidence (Pokrovsky V.V. et al. 2017; National AIDS Response Progress Report, 2017) [23, 24]. A negative HIV test result does not always indicate the absence of infection due to the so-called "seronegative window", which can last up to three months; At this time, the virus can be detected by analyzing HIV antigens or genetic material (Marie-Renee B-Lajoie et al., 2016) [25]. Although antiretroviral therapy (ART) does not completely eliminate the virus, it stops its reproduction, restores immunity and prevents the development of secondary diseases (Andrew N Phillips et al., 2018) [26]. However, HIV treatment is not enough to eradicate the epidemic; it is also important to strengthen primary prevention and develop vaccines (Bekker LG et al., 2018) [1]. In Russian practice, risk groups, including men who have sex with men, require special attention to reduce the incidence and spread of the virus [27-28]. HIV remains one of the major global public health problems: to date, this virus has claimed 36.3 million [27.2-47.8 million] human lives [29].
The Government of the Republic of Kazakhstan supports the efforts of the international community in the fight against HIV/AIDS. Recognizing that the problem of HIV infection is one of the most significant, Kazakhstan consistently implements steps to curb the spread of HIV. Issues of combating HIV infection are included in the Concept of Healthcare Development of the Republic of Kazakhstan until 2026 [30]. As of the end of 2021, 14,664 people have died in Kazakhstan since the first case of HIV infection was detected in the country. Mortality from AIDS in Kazakhstan has begun to decline since 2018, from 1.5 per 100 thousand population to 0.9 per 100,000 population in 2022 [31]. The largest number of people living with HIV infection is recorded in the Karaganda, Pavlodar, East Kazakhstan, Almaty regions and in the city of Almaty. At the beginning of 2021, 29,980 people were undergoing treatment in regional and city AIDS centers in Kazakhstan. According to national monitoring data, the HIV epidemic is at a
concentrated stage, i.e. it is spread mainly among key population groups: people who inject drugs, sex workers, men who have sex with men. Although, according to WHO estimates, Kazakhstan belongs to the group of countries with low HIV prevalence, the rate of infection in the country is growing [30]. In accordance with the global strategy, Kazakhstan is implementing the UNAIDS 95/95/95 strategy. In 2021, 81% of people with HIV from the estimated number knew their status, 79% of people with HIV received antiretroviral therapy, 86% of those who received therapy had an undetectable viral load [32].
Conclusions:
• Achieving sustainable health for all is a key priority of our time, which requires a comprehensive approach to improving population health, especially among vulnerable groups such as men who have sex with men.
• In the context of the growing burden of HIV infection, especially in the context of MSM, it is necessary to focus on specific prevention measures and treatment that take into account the unique risks and needs of this group.
• Harm reduction programs, including the distribution of clean needles and syringes, as well as access to drug-assisted therapy, should be integrated as key elements of the fight against HIV among MSM, as they contribute to a significant reduction and prevention of new cases of infection.
• The presence of gaps in the implementation of harm reduction programs in different regions threatens the effectiveness of global efforts to combat the HIV epidemic, especially among MSM. Expanding access to such programs is vital to achieving global health goals.
• Harm reduction programs not only contribute to the fight against HIV, but also ensure the integration of various health services for MSM, which is necessary to create a more effective health system.
• It is essential to consider the diversity of factors that affect the health of men who have sex with men, including social, economic and legal aspects, which requires coordinated efforts from different sectors to address the complex problems associated with their health.
АИТВ ЖЭНЕ ЕРКЕКТЕРМЕН ЖЫНЫСТЬЩ ЦАТЫНАСЦА TYCETIH ЕРКЕКТЕР: ДЕНСАУЛЬЩТЫ ЖАЦСАРТУГА ЦОЛ ЖЕТК1ЗУДЩ КЕДЕРГ1ЛЕР1 Ибраимова А.А.1, Баймуратова М.А.1, Жаканова Г.А.2, *Саусанова Д.Ж.1
^«КДСЖМ» ^азакстанды; медицина университету Алматы к;., ^азакстан;
2 "ЖИТС-ньщ алдын алу жэне оган карсы курес женшдеп Алматы облыстык; орталыгы" ШЖК КМК, Алматы ;., ^азакстан.
ТYЙIНДЕМЕ
^аз1рп элемнщ негiзгi мшдеттершщ бiрi, барлыгына бiрдей денсаулык пен эл-аукатты камтамасыз ету — бул, эаресе, жукпалы аурулардыц эпидемиясы сиякты галамдык сын-катерлер тургысынан мацызды. Соцгы онжылдыкта денсаулык сактау саласында айтарлыктай жетiстiктерге кол жеткiзiлдi, бiрак жегсспктерге карамастан, АИТВ/ЖИТС-тщ таралуымен байланысты мэселелер когам денсаулыгына елеулi кауiп тeндiруде. Бул эсiресе еркектермен жыныстык катынаска тYсетiн еркектер сиякты осал топтарга катысты, олар элемнщ кептеген елдершде АИТВ эпидемиясыныц ортасында калып отыр. АИТВ-инфекциясы емделмеген кYЙiнде калуда, миллиондаган адамныц денсаулыгына зиянды эсерш тигiзiп, эсiресе жогары жуктыру децгеш мен медициналык кемекке колжетiмдiлiк жетюпейтш ещрлерде таралуда.
ТYйiндi свздер: АИТВ, ЖИТС, жыныстыц денсаулыц, осал топтар, АИТВ/ЖИТС алдын алу.
ВИЧ И МУЖЧИНЫ, ПРАКТИКУЮЩИЕ СЕКС С МУЖЧИНАМИ: БАРЬЕРЫ ДОСТУПА К УЛУЧШЕНИЮ ЗДОРОВЬЯ
Ибраимова А.А.1, Баймуратова М.А.1, Жаканова Г.А.2, *Саусанова Д.Ж.1
1Казахстанский медицинский университет «ВШОЗ», г. Алматы, Казахстан;
2КГП на ПХВ «Алматинский областной центр по профилактике и борьбе со СПИД», г.
Алматы, Казахстан.
АННОТАЦИЯ
Достижение устойчивого здоровья и благополучия для всех является одной из основных задач современного мира, что особенно актуально в свете глобальных вызовов, таких как эпидемии инфекционных заболеваний. За последние десятилетия произошли значительные улучшения в области здравоохранения, но несмотря на успехи, проблемы, связанные с распространением ВИЧ/СПИД, остаются серьезной угрозой для общественного здоровья. В особенности это касается уязвимых групп населения, таких как мужчины, роактикующие секс с мужчинами (МСМ), которые продолжают оставаться в центре эпидемии ВИЧ в большинстве стран мира. ВИЧ-инфекция, оставаясь неизлечимой, продолжает оказывать разрушительное воздействие на здоровье миллионов людей, особенно в регионах с высокими темпами инфицирования и недостаточной доступностью медицинской помощи.
Ключевые слова: СПИД, ВИЧ, сексуальное здоровье, уязвимые группы, профилактика.
References:
1. Bekker, LG, Alleyne, G., Baral, S., Cepeda, J., Daskalakis, D., Dowdy, D., Dybul, M., Eholie, S., Esom, K., Garnett, G., Grimsrud, A., Hakim, J., Havlir, D., Isbell, MT., Johnson, L., Kamarulzaman, A., Kasaie, P., Kazatchkine, M., Kilonzo, N., Klag, M., Klein, M., Lewin, SR., Luo, C., Makofane, K., Martin, NK., Mayer, K., Millett, G., Ntusi, N., Pace, L., Pike, C., Piot, P., Pozniak, A., Quinn, TC., Rockstroh, J., Ratevosian, J., Ryan, O., Sippel, S., Spire, B., Soucat, A., Starrs, A., Strathdee, SA., Thomson, N., Vella, S., Schechter, M., Vickerman, P., Weir, B., Beyrer, C. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission // Lancet. 2018. No. 392(10144). P. 312-358. doi: 10.1016/S0140-6736(18)31070-5. Epub 2018 Jul 20. PMID: 30032975; PMCID: PMC6323648.
2. International Organization for Migration, World Health Organization, UN High Commissioner for Human Rights. International Migration, Health, and Human Rights. Geneva, 2013.
3. Joint United Nations Programme on HIV/AIDS (UNAIDS).
4. Rospotrebnadzor. HIV Prevention. Methodological Recommendations. MR 3.1.0087-14. Official Edition. Moscow: Rospotrebnadzor, 2014.
5. Larney, S., Peacock, A., Leung, J. Global, regional, and country coverage of HIV and hepatitis C prevention and treatment interventions among people who inject drugs: a systematic review // Lancet Glob Health. 2017. Vol. 5. P. e1208-e1220. doi: 10.1016/S2214-109X(17)30373-X.
6. Weir, B., Beyrer, C. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society-Lancet Commission // Lancet. 2018. No. 392(10144). P. 312-358. doi: 10.1016/S0140-6736(18)31070-5. Epub 2018 Jul 20. PMID: 30032975; PMCID: PMC6323648.
7. Beyrer, C., Baral, S.D., Collins, K. Global response to HIV among men who have sex with men // Lancet. 2016. Vol. 388. P. 198-206. doi: 10.1016/S0140-6736(16)30781-4.
8. Mehta, S.H., Lucas, G.M., Solomon, S. Continuity of HIV care among men who have sex with men and people who inject drugs in India: Barriers to successful engagement // Clin InfectDis. 2015. Vol. 61. P. 1732-1741. doi: 10.1093/cid/civ669.
9. Wirtz, A.L., Zelaya, C.E., Latkin, C. HIV care continuum among men who have sex with men in Moscow, Russia: Cross-sectional study of awareness of infection and engagement in care // Sex Transm Infect. 2016. Vol. 92. P. 161-167. doi: 10.1136/sextrans-2015-052076.
10. Carroll, A., Mendos, L. State-sponsored homophobia - a global overview of sexual orientation laws: criminalization, protection, and recognition. International Lesbian, Gay, Bisexual, Transgender and Intersex Association; Geneva, 2017.
11. Patel, P., Borkowf, C.B., Brooks, J.T. Estimating the risk of HIV transmission during sexual intercourse: A systematic review // AIDS. 2014. Vol. 28. P. 1509-1519. doi: 10.1097/QAD.00000000000000298.
12. UNAIDS. Press-release on HIV/AIDS infection risks. URL: https://news.un.org/en/story/2019/11/1366601.
13. UN News. Global Look at Human Destinies. [Electronic resource]. URL: https://news.un.org/en/story/2019/11/1366601.
14. HIV Prevention. [Electronic resource]. URL: https://www.unaids.org/en/resources/presscentre/featurestories/2020/december/20201207_ new-hiv-infections-increasing.
15. Atun, R., Jaffar, S., Nishtar, S. Improving health system responses to non-communicable diseases // Lancet. 2013. Vol. 381. P. 690-697. doi: 10.1016/S0140-6736(13)60063-X.
16. Moodie, R., Stuckler, D., Monteiro, C., Lancet NCD Action Group. Profits and pandemics: Preventing harmful effects of tobacco, alcohol, and ultra-processed food and drink industries // Lancet. 2013. Vol. 381. P. 670-679. doi: 10.1016/S0140-6736(12)62089-3.
17. Alleyne, G., Binagwaho, A., Haines, A., Lancet NCD Action Group. Inclusion of non-communicable diseases in the post-2015 development agenda // Lancet. 2013. Vol. 381. P. 566-574. doi: 10.1016/S0140-6736(12)61806-6.
18. UN. Prevention and Control of Non-Communicable Diseases: Report of the Secretary-General. UNGA, New York, 2011. A/66/83.
19. Corey, L., Gray, G.E. Preventing HIV infection - the only way to achieve an AIDSfree generation // Proc Natl Acad Sci USA. 2017. Vol. 114. P. 3798-3800. doi: 10.1073/pnas.1703236114.
20. Chamie, G., Clark, T.D., Kabami, J. Hybrid mobile approach to HIV testing in rural East Africa: Observational study // Lancet HIV. 2016. Vol. 3. P. e111-e119. doi: 10.1016/S2352-3018(15)00251-9.
21. World Health Organization. Comprehensive Guidelines on Sexual and Reproductive Health and Rights for Women Living with HIV. World Health Organization; Geneva,
2017.
22. Plavinsky, S.L., Ladnaya, N.N., Barinova, A.N., Zaitseva, E.E. Epidemiological surveillance of HIV infection. Prevalence of HIV infection and risk behavior among vulnerable populations in 7 regions of the Russian Federation, results of a biobehavioral study, 2017. Moscow,
2018. 140 p.
23. Pokrovsky, V.V. et al. HIV Prevention. Methodical Recommendations. Moscow: Federal Service for Consumer Rights Protection and Human Wellbeing, 2017. P. 17-18.
24. National Report on Achieved Progress in Implementing Global HIV Response Measures. Reporting Period: 2017. 19 p.
25. Marie-Renee, B.-Lajoie et al. Incidence and Prevalence of Opportunistic and Other Infections and the Impact of Antiretroviral Therapy Among HIV-infected Children in Low- and Middle-income Countries: A Systematic Review and Meta-analysis // Clinical Infectious Diseases, CID 2016. Vol. 62. P. 1586-1594.
26. Phillips, A.N. et al. Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study // The Lancet HIV. 2018. Vol. 5. No. 3. P. e146-e154.
27. Kazatchkine, M. Foreword in "Road to Success: Towards Sustainable Harm Reduction Financing, Regional report." 2015. P. 3.
28. Available at: https://idpc.net/blog/2019/06/road-to-2030-concrete-actions-to-scale-up-human-rights-based-approaches-to-harm-reduction.
29. World Health Organization. Fact Sheet: HIV/AIDS. Available at: https://www.who.int/news-room/fact-sheets/detail/hiv-aids.
30. Vambua, F., Mukhanova, G., Petrenko, I., Kamalbekova, G., An, Z. Assessment of Mental Health and TB Care Integration into Primary Health Care (PHC) in Kazakhstan: Lessons Learned and Perspectives for HIV/AIDS Integration into PHC. UNICEF, 2022. P. 78. URL: http://www.unicef. org/kazakhstan.
31. 2021 HIV Response Monitoring and Evaluation Report.
32. Country Report for 2021. URL: www.kncdiz.kz.
Конфликт интересов. Автор заявляет об отсутствии потенциального конфликта интересов, требующего раскрытия в данной статье.
Вклад авторов. Автор внес вклад в разработку концепции, выполнение и обработку результатов, и написание статьи. Заявляем, что данный материал ранее не публиковался и не находится на рассмотрении в других издательствах.
Финансирование. Отсутствует.
Сведения об авторах
Корреспондирующий автор. Саусанова Дамира Жаслановна, докторант по специальности «Общественное здравоохранение», Казахстанский медицинский университет «ВШОЗ», 1 курс, E-mail: damira. sausanova1996@mail. ru , +77055989749, ORCID: https://orcid. org/0000-0003-4991 -2898
Ибраимова Айгуль Абдигалиевна, магистрант по специальности «Общественное здравоохранение», Казахстанский медицинский университет «ВШОЗ», врач эпидемиолог отдела профилактической работы, КГП на ПХВ «Алматинский областной центр по профилактике и борьбе со СПИД», E-mail: [email protected] , +77762641024, ORCID: https://orcid.org/0009-0000-261 7-8323
Баймуратова Майраш Аушатовна, к.м.н., ассоциированный профессор кафедры «Общественное здоровье и социальные науки», Казахстанский медицинский университет «ВШОЗ», E-mail: [email protected], +7705 830 1 0 0 7, ORCID: https://orcid.org/0000-0003-0219-7874
Жаканова Гульмира Аманкасовна, заместитель директора по контролю качества медицинских услуг, КГП на ПХВ «Алматинский областной центр по профилактике и борьбе со СПИД», E-mail: [email protected], +77478985206, ORCID: https://orcid.org/0009-0008-1533-5838
Статья поступила: 03.12.2024 Статья принята: 24.12.2024
