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Dive into the research topics where Chris Collins is active.

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Featured researches published by Chris Collins.


The Lancet | 2012

A call to action for comprehensive HIV services for men who have sex with men

Chris Beyrer; Patrick S. Sullivan; Jorge Sanchez; David W. Dowdy; Dennis Altman; Gift Trapence; Chris Collins; Elly Katabira; Michel Kazatchkine; Michel Sidibé; Kenneth H. Mayer

Where surveillance has been done, it has shown that men (MSM) who have sex with men bear a disproportionate burden of HIV. Yet they continue to be excluded, sometimes systematically, from HIV services because of stigma, discrimination, and criminalisation. This situation must change if global control of the HIV epidemic is to be achieved. On both public health and human rights grounds, expansion of HIV prevention, treatment, and care to MSM is an urgent imperative. Effective combination prevention and treatment approaches are feasible, and culturally competent care can be developed, even in rights-challenged environments. Condom and lubricant access for MSM globally is highly cost effective. Antiretroviral-based prevention, and antiretroviral access for MSM globally, would also be cost effective, but would probably require substantial reductions in drug costs in high-income countries to be feasible. To address HIV in MSM will take continued research, political will, structural reform, community engagement, and strategic planning and programming, but it can and must be done.


AIDS | 2013

The increase in global HIV epidemics in MSM

Chris Beyrer; Patrick S. Sullivan; Jorge Sanchez; Stefan Baral; Chris Collins; Andrea L. Wirtz; Dennis Altman; Gift Trapence; Kenneth H. Mayer

Epidemics of HIV in MSM continue to expand in most low, middle, and upper income countries in 2013 and rates of new infection have been consistently high among young MSM. Current prevention and treatment strategies are insufficient for this next wave of HIV spread. We conducted a series of comprehensive reviews of HIV prevalence and incidence, risks for HIV, prevention and care, stigma and discrimination, and policy and advocacy options. The high per act transmission probability of receptive anal intercourse, sex role versatility among MSM, network level effects, and social and structural determinants play central roles in disproportionate disease burdens. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiologic data show marked clustering of HIV in MSM networks, and high proportions of infections due to transmission from recent infections. Prevention strategies that lower biological risks, including those using antiretrovirals, offer promise for epidemic control, but are limited by structural factors including, discrimination, criminalization, and barriers to healthcare. Subepidemics, including among racial and ethnic minority MSM in the United States and UK, are particularly severe and will require culturally tailored efforts. For the promise of new and combined bio-behavioral interventions to be realized, clinically competent healthcare is necessary and community leadership, engagement, and empowerment are likely to be key. Addressing the expanding epidemics of HIV in MSM will require continued research, increased resources, political will, policy change, structural reform, community engagement, and strategic planning and programming, but it can and must be done.


The Lancet | 2012

From personal survival to public health: Community leadership by men who have sex with men in the response to HIV

Gift Trapence; Chris Collins; Sam Avrett; Robert Carr; Hugo Sanchez; George Ayala; Daouda Diouf; Chris Beyrer; Stefan Baral

Community leadership and participation by gay men and men who have sex with men (MSM) have been central to the response to HIV since the beginning of the epidemic. Through a wide array of actions, engagement of MSM has been important in the protection of communities. The connection between personal and community health as drivers of health advocacy continue to be a powerful element. The passion and urgency brought by MSM communities have led to the targeting and expansion of HIV and AIDS research and programming, and have improved the synergy of health and human rights, sustainability, accountability, and health outcomes for all people affected by HIV. MSM are, however, frequently excluded from the evidence-based services that they helped to develop, despite them generally being the most effective actors in challenging environments. Without MSM community involvement, government-run health programmes might have little chance of effectively reaching communities or scaling up interventions to lessen, and ultimately end, the HIV pandemic.


The Lancet | 2016

The global response to HIV in men who have sex with men

Chris Beyrer; Stefan Baral; Chris Collins; Eugene T. Richardson; Patrick S. Sullivan; Jorge Sanchez; Gift Trapence; Elly Katabira; Michel Kazatchkine; Owen Ryan; Andrea L. Wirtz; Kenneth H. Mayer

Gay, bisexual, and other men who have sex with men (MSM) continue to have disproportionately high burdens of HIV infection in countries of low, middle, and high income in 2016. 4 years after publication of a Lancet Series on MSM and HIV, progress on reducing HIV incidence, expanding sustained access to treatment, and realising human rights gains for MSM remains markedly uneven and fraught with challenges. Incidence densities in MSM are unacceptably high in countries as diverse as China, Kenya, Thailand, the UK, and the USA, with substantial disparities observed in specific communities of MSM including young and minority populations. Although some settings have achieved sufficient coverage of treatment, pre-exposure prophylaxis (PrEP), and human rights protections for sexual and gender minorities to change the trajectory of the HIV epidemic in MSM, these are exceptions. The roll-out of PrEP has been notably slow and coverage nowhere near what will be required for full use of this new preventive approach. Despite progress on issues such as marriage equality and decriminalisation of same-sex behaviour in some countries, there has been a marked increase in anti-gay legislation in many countries, including Nigeria, Russia, and The Gambia. The global epidemic of HIV in MSM is ongoing, and global efforts to address it remain insufficient. This must change if we are ever to truly achieve an AIDS-free generation.


The Lancet Global Health | 2013

Country ownership and the turning point for HIV/AIDS

Chris Collins; Chris Beyrer

There is no substitute for either local knowledge or national leadership as the world moves towards the endgame in the HIV/AIDS epidemic. Increased country engagement, or so-called country ownership, in HIV and health programming is central to achieve adequate scale in service delivery, improve the acceptability of interventions, increase domestic investments in health, and advance integration of HIV programming with national health goals and systems. The concept of country ownership was established as a cornerstone of international assistance by the 2005 Paris Declaration on Aid Eff ectiveness, and was reaffi rmed by the 2008 Accra Agenda for Action. Nowadays, major global health donors, including the US Government, identify country ownership as a main goal of their programming. Defi nitions of country ownership vary, but the term generally refers to an expanded role by the aff ected country in planning, implementation, and fi nancing of health programming. Increased country ownership is fundamental to longterm progress in global health, but too rapid a transition runs the very real risk of undercutting access to services and squandering the potential to accelerate progress in HIV/AIDS. Not all partners are ready; countries heavily aff ected by HIV include some middle-income countries with substantial internal resources, and some UN leastdeveloped nations that will probably need sustained donor support and building of technical capacity for years to come. Four areas raise particular concern and deserve close attention. First, rapid transitions could decelerate scale-up of eff ective HIV services, including antiretroviral treatment, prevention of mother-to-child transmission services, and voluntary medical male circumcision. We now know that speed is an important element in success. Recent assessment of UNAIDS data shows that faster decreases in incidence took place in countries that rapidly increased coverage of HIV treatment than in those that were slower. Major shifts in support for treatment and other services could slow the pace of scale up, and, thus, the eff ectiveness of these programmes. The US Institute of Medicine, in its assessment of the President’s Emergency Plan for AIDS Relief (PEPFAR) in February of this year, warned that transition to new models of PEPFAR support, including less direct support for service delivery, has the inherent risk, at least in the short run, that programme and data quality, and access to services, might suff er. Both the US Government Accountability Offi ce and UNAIDS have raised concerns about the readiness of some implementing countries to implement eff ective data and monitoring systems. An assessment by the Center for Strategic and International Studies of PEPFAR in South Africa noted “legitimate fears” that a rushed transition could disrupt the HIV treatment programme in that country. These issues are all the more relevant now that the PEPFAR Stewardship and Oversight Act has been introduced in the US Congress to strengthen the programme. Second, in many settings, country ownership could undermine the nascent response to HIV in many of the most vulnerable populations, including marginalised groups such as men who have sex with men, transgender people, people who inject drugs, and sex workers. In many of the countries with high burdens of HIV/ AIDS, these marginalised groups are criminalised and can be the subject of severe social stigma and police harassment. UNAIDS has reported that more than 90% of funding to address the HIV-related needs of these groups in low-income and middle-income countries comes from external donors, not the implementing government. Outside of sub-Saharan Africa, HIV is mostly an epidemic of key populations, and these groups are at an elevated risk of HIV, including in larger, generalised epidemics. Key populations and their sex partners account for 33% of new HIV infections in Kenya and 51% in Nigeria. PEPFAR and the Global Fund have placed increasing emphasis on key populations, but in many countries, social and political barriers mean that support for HIV services to these marginalised groups might need external fi nancing for the foreseeable future. Third, the transition to increased country ownership will require attention to the participation of various stakeholders in health decision making. As many have reported, country ownership must not come to mean simply government ownership; if it does, the voices of aff ected communities might not be heard and accountability will suff er. A report from a 2012 international consultation on country ownership and civil society’s involvement in HIV and family planning programming noted that in many countries the Published Online October 17, 2013 http://dx.doi.org/10.1016/ S2214-109X(13)70092-5


AIDS | 2017

Consequences of a changing US strategy in the global HIV investment landscape

Jessica B McGillen; Alana Sharp; Brian Honermann; Gregorio Millett; Chris Collins; Timothy B. Hallett

Objective: The global fight against HIV/AIDS in Africa has long been a focus of US foreign policy, but this could change if the federal budget for 2018 proposed by the US Office of Management and Budget is adopted. We aim to inform public and Congressional debate around this issue by evaluating the historical and potential future impact of US investment in the African HIV response. Design/methods: We use a previously published mathematical model of HIV transmission to characterize the possible impact of a series of financial scenarios for the historical and future AIDS response across Sub-Saharan Africa. Results: We find that US funding has saved nearly five million adults in Sub-Saharan Africa from AIDS-related deaths. In the coming 15 years, if current numbers on antiretroviral treatment are maintained without further expansion of programs (the proposed US strategy), nearly 26 million new HIV infections and 4.4 million AIDS deaths may occur. A 10% increase in US funding, together with ambitious domestic spending and focused attention on optimizing resources, can avert up to 22 million HIV infections and save 2.3 million lives in Sub-Saharan Africa compared with the proposed strategy. Conclusion: Our synthesis of available evidence shows that the United States has played, and could continue to play, a vital role in the global HIV response. Reduced investment could allow more than two million avoidable AIDS deaths by 2032, whereas continued leadership by the United States and other countries could bring UNAIDS targets for ending the epidemic into reach.


Science | 2003

The need for a global HIV vaccine enterprise

Richard D. Klausner; Anthony S. Fauci; Lawrence Corey; Gary J. Nabel; Helene D Gayle; Seth Berkley; Barton F. Haynes; David Baltimore; Chris Collins; R. Gordon Douglas; José Esparza; Donald P. Francis; N. K. Ganguly; Julie Louise Gerberding; Margaret I. Johnston; Michel Kazatchkine; Andrew J. McMichael; Malegapuru W. Makgoba; Giuseppe Pantaleo; Peter Piot; Yiming Shao; Edmund Tramont; Harold E. Varmus; Judith N. Wasserheit


Science | 2003

Enhanced: The Need for a Global HIV Vaccine Enterprise

Richard D. Klausner; Anthony S. Fauci; Lawrence Corey; Gary J. Nabel; Helene D Gayle; Seth Berkley; Barton F. Haynes; David Baltimore; Chris Collins; R. Gordon Douglas; José Esparza; Donald P. Francis; Ganguly Nk; Julie Louise Gerberding; Margaret I. Johnston; Michel Kazatchkine; Andrew J. McMichael; Malegapuru W. Makgoba; Giuseppe Pantaleo; Peter Piot; Yiming Shao; Edmund Tramont; Harold E. Varmus; Judith N. Wasserheit


Science | 2003

Medicine. The need for a global HIV vaccine enterprise.

Richard D. Klausner; Fauci As; Lawrence Corey; Gary J. Nabel; Helene D Gayle; Seth Berkley; Barton F. Haynes; David Baltimore; Chris Collins; Douglas Rg; José Esparza; Donald P. Francis; Ganguly Nk; Julie Louise Gerberding; Margaret I. Johnston; Kazatchkine; Andrew J. McMichael; Malegapuru W. Makgoba; Giuseppe Pantaleo; Peter Piot; Yiming Shao; Edmund Tramont; Harold E. Varmus; Judith N. Wasserheit


Science | 2004

Support for the RV144 HIV Vaccine Trial

Robert B. Belshe; Genoveffa Franchini; Marc Girard; Frances Gotch; Pontiano Kaleebu; Marta L. Marthas; Michael B. McChesney; Rose McCullough; Fred Mhalu; Dominique Salmon-Ceron; Rafick Pierre Sekaly; Koen K. A. Van Rompay; Bernard Verrier; Britta Wahren; Mercedes Weissenbacher; Maureen Baehr; Dana Cappiello; Chris Collins; David Gold; Alexandre Menezes; Mike Powell; Robert Reinhard; Luis Santiago; Bill Snow; Jim Thomas; Steve Wakefield; Mitchell Warren; Edd Lee; Huntly Collins; Dennis R. Burton

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Chris Beyrer

Johns Hopkins University

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Jorge Sanchez

Asociación Civil Impacta Salud y Educación

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David Baltimore

California Institute of Technology

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Edmund Tramont

National Institutes of Health

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Harold E. Varmus

National Institutes of Health

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