ArticleJournal of the International AIDS Society2021
Estimating the contribution of key populations towards HIV transmission in South Africa.
Article in Journal of the International AIDS Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
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Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Prospects of HIV elimination among men who have sex with men: A systematic review of modeling studies.PLoS computational biology · 2026Pooled it
- Marriage and Steady Relationships with Women in Men Who Have Sex with Men in Sub-Saharan Africa: A Mixed-Method Systematic Review and Meta-analyses.AIDS and behavior · 2025Pooled it
- "Safe Places Like These are Rare": Feasibility of the Speaking Out and Allying Relationships (SOAR) Intervention for HIV-Positive Sexual Minority Men in Eastern Cape, South Africa.AIDS and behavior · 2026Trial
- Longitudinal Trajectories of Engagement With HIV Treatment Support Strategies Among Female Sex Workers Living With HIV in South Africa.Journal of acquired immune deficiency syndromes (1999) · 2025Trial
- "I have the vaccine in my body": perceptions of female sex workers after enrolling in a phase IIb HIV vaccine and pre-exposure prophylaxis trial in urban Tanzania.BMC public health · 2025Trial
- Gender-responsive infectious disease models: Guidelines and systematic scoping review.Dialogues in health · 2026Review
- Evaluating the impact of achieving cascade equality in Eswatini: a modeling study on the prevention impacts of antiretroviral therapy.AIDS (London, England) · 2026Article
- "It would have been easier for me to give up if I were alone": how a pilot individualized case management intervention influenced female sex workers' oral HIV pre-exposure prophylaxis use in eThekwini, South Africa.BMC public health · 2026Article
- Identifying priority populations for HIV interventions using acquisition and transmission indicators: a combined analysis of 15 mathematical models from ten African countries.The lancet. HIV · 2026Article
- Barriers to and Facilitators of Heterosexual Men's Engagement with the PrEP Care Continuum in Sub-Saharan Africa: A Scoping Review.AIDS and behavior · 2026Article
- The impact of cuts in the US President's Emergency Plan for AIDS Relief funding for HIV pre-exposure prophylaxis in sub-Saharan Africa: a modelling study.The lancet. HIV · 2025Article
- Transactional Sex and its Drivers among Men Who Have Sex with Men in Plateau State North Central Nigeria.Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine · 2025Article
- Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey.Journal of the International AIDS Society · 2025Article
- Cost-effective pricing of long-acting injectable HIV pre-exposure prophylaxis for adolescent girls and young women in South Africa: a model-based analysis.The Lancet. Global health · 2025Article
- Longitudinal patterns and predictors of opioid and stimulant use initiation and cessation among female sex workers living with HIV in South Africa.Drug and alcohol dependence · 2025Article
- Impact of COVID-19 on the HIV Treatment Outcomes Among Men Who Have Sex with Men in South Africa After the Implementation of a Differentiated Service Delivery Model: An Interrupted Time Series Analysis.International journal of environmental research and public health · 2025Article
- Prevalence and risk factors of high-risk sexual behavior among elderly men with HIV infection in Chongqing, China.Scientific reports · 2025Article
- Harnessing Big Heterogeneous Data to Evaluate the Potential Impact of HIV Responses Among Key Populations in Sub-Saharan Africa: Protocol for the Boloka Data Repository Initiative.JMIR research protocols · 2025Article
- Population Size Estimation of Men Who Have Sex With Men in Low- and Middle-Income Countries: Google Trends Analysis.JMIR public health and surveillance · 2025Article
- Geospatial and phylogenetic clustering of acute and recent HIV infections in Lilongwe, Malawi.PLOS global public health · 2025Article
Corrections and comments
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Authors and funding
26 authors.
Funding
Abstract
introductionIn generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA).
methodsWe developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020.
resultsSex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient.
conclusionsClients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.
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