New research from the Ukraine on key populations. Background: The HIV epidemic in Ukraine has been driven by a rapid rise among people who inject drugs, but recent studies have shown an increase through sexual transmission.

The dynamics of the HIV epidemic in Ukraine are shifting. Increasingly sexual transmission is becoming more common, and transmission through injecting drug use reducing. Fearnhill and colleagues’ study of phylogenetics and recent infections among 876 newly diagnosed people living with HIV in Kiev highlights these trends.

The study also demonstrates plenty of uncertainty and suggests that the stigma associated with both injecting drug use and with gay men and other men having sex with men may lead to significant under-reporting of both in traditional epidemiological surveillance.

Although phylogenetics cannot prove misclassification, it is highly suggestive when large clusters of HIV from known gay men and other men who have sex with men include no women, but do include other men, who self-report to be heterosexual. Transmission was most common among gay men and other men who have sex with men, and from those with recent infections. HIV strains from women often cluster with those from people who inject drugs. In a complex and dynamic environment with overlapping risk factors for HIV infection, phylogenetics adds a useful lens through which to examine what is happening. Yet again, the challenge is to translate more granular understanding of the epidemics into clear public health policy and practice. Read more via Science Now