HIV bridging within and beyond informal gold mining sites in Mali: The urgent need for care and prevention among mobile and key populations

Background: In Mali, 32% of people living with HIV (PLHIV) lack access to treatment. Informal gold mining sites (IGMS) are remote locations attracting mobile migrant men and women. We compared HIV transmission risk, mobility, behaviours, and vulnerabilities among men, female sex workers (SW), and non-SW women living with HIV at IGMS.Methods: We used one-month and six-month post-HIV diagnosis data to compare men, FSW, and non-SW women regarding their HIV transmission risk to partners (condomless sex and unsuppressed viral load), mobility, and socioeconomic vulnerabilities.Results: Among 149 PLHIV, 34% were men, 26% FSW, and 40% non-SW women. Most men originated from Mali (88%), FSW from Nigeria (64%) and Mali (21%), and non-SW women from Mali (67%) and Côte d’Ivoire (23%). FSW were the youngest (median 25 years vs. 41 years for men and 30 years for non-SW women, p < 0.001), and more likely to come from precarious households (90% vs. 35% and 33%, respectively, p < 0.001). Non-SW women experienced the highest onsite socioeconomic precarity (55% vs. 33% for men and 16% for FSW). FSW reported 90 sexual partners (median) in the previous month, versus one in the other groups (p < 0.001). Men and non-SW women more frequently reported condomless sex during their most recent encounter (84% and 88% vs. 18% in FSW, p < 0.001). Six months after diagnosis, men had a higher HIV transmission risk than FSW (36% vs. 12%, p = 0.096, n = 72).Conclusion: In a context of low condom use, limited testing, and suboptimal viral suppression, the distinct sexual and mobility patterns of men and women living with HIV at Malian IGMS make them potential HIV bridging populations between IGMS and their home regions, as well as between transactional and marital partners. These findings highlight the urgent need to strengthen and tailor HIV services, not only for FSW but also for other mobile high-risk populations in IGMS.