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Fiorentino M, Yanwou N, Gravier-Dumonceau Mazelier R, Eubanks A, Roux P, Laurent C, Spire B. Sexual behaviours and risk with women in MSM in sub-Saharan Africa. AIDS 2024; 38:273-287. [PMID: 38300157 PMCID: PMC10842665 DOI: 10.1097/qad.0000000000003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/09/2023] [Indexed: 02/02/2024]
Abstract
In sub-Saharan Africa (SSA), MSM - a high HIV prevalence group - experience strong social stigma and pressure to have female partners. Accordingly, they could constitute a bridging group for HIV transmission to cisgender women. We developed a multilevel summary of MSM sexual behaviors and risk with women in various SSA regions. Following PRISMA guidelines, we conducted a mixed-method systematic review of data of sex with women in MSM in SSA. We performed meta-analyses on quantitative data (i.e. percent of recent sex and condomless sex with women) for each SSA region (when proportions reported in ≥4 studies). Pooled proportions were calculated using random-effects models. Qualitative data were analyzed using the three-step thematic synthesis methodology. The pooled proportion of MSM who had sex with women was 58% (33-83%) in East Africa (in the previous 3 months), and 27% (13-48%) in Southern Africa and 50% (95% CI 39-62%) in West Africa (in the previous 6 months); 23% (16-32%) of MSM in West Africa had condomless sex with a woman (during the most recent encounter). Approximately one quarter of MSM had recent multiple female partners. MSM reported having sex with women because of heteronormative pressure, erotic/romantic attraction, or financial needs leading to transactional sex. MSM may act as a bridging population to women in SSA, as they commonly practice sex with women and risky sexual behaviors with them. HIV programmes and community-based support for MSM should be adapted to this population to reduce this risk.
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Affiliation(s)
- Marion Fiorentino
- Aix Marseille Univ, IRD, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM
| | - Nathan Yanwou
- Aix Marseille Univ, IRD, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille
| | | | - August Eubanks
- Aix Marseille Univ, IRD, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM
| | - Perrine Roux
- Aix Marseille Univ, IRD, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM
| | | | - Bruno Spire
- Aix Marseille Univ, IRD, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM
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HIV Prevalence among Injury Patients Compared to Other High-Risk Groups in Tanzania. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sixty-eight percent of persons infected with HIV live in Africa, but as few as 67% of those know their infection status. The emergency department (ED) might be a critical access point to HIV testing. This study sought to measure and compare HIV prevalence in an ED injury population with other clinical and nonclinical populations across Tanzania. Adults (≥18 years) presenting to Kilimanjaro Christian Medical Center ED with acute injury of any severity were enrolled in a trauma registry. A systematic review and meta-analysis was conducted to compare HIV prevalence in the trauma registry with other population groups. Further, 759 injury patients were enrolled in the registry; 78.6% were men and 68.2% consented to HIV counseling and testing. The HIV prevalence was 5.02% (tested), 6.25% (self-report), and 5.31% (both). The systematic review identified 79 eligible studies reporting HIV prevalence (tested) in 33 clinical and 12 nonclinical population groups. Notable groups included ED injury patients (3.53%, 95% CI), multiple injury patients (10.67%, 95% CI), and people who inject drugs (17.43%, 95% CI). These findings suggest that ED injury patients might be at higher HIV risk compared to the general population, and the ED is a potential avenue to increasing HIV testing among young adults, particularly men.
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Boothe MAS, Semá Baltazar C, Sathane I, Raymond HF, Fazito E, Temmerman M, Luchters S. Young key populations left behind: The necessity for a targeted response in Mozambique. PLoS One 2021; 16:e0261943. [PMID: 34972172 PMCID: PMC8719759 DOI: 10.1371/journal.pone.0261943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The first exposure to high-risk sexual and drug use behaviors often occurs during the period of youth (15-24 years old). These behaviors increase the risk of HIV infection, especially among young key populations (KP)-men how have sex with men (MSM), female sex workers (FSW), and people who inject drugs (PWID). We describe the characteristics of young KP participants in the first Biobehavioral Surveillance (BBS) surveys conducted in Mozambique and examine their risk behaviors compared to adult KP. METHODS Respondent-driven sampling (RDS) methodology was used to recruit KP in three major urban areas in Mozambique. RDS-weighted pooled estimates were calculated to estimate the proportion of young KP residing in each survey city. Unweighted pooled estimates of risk behaviors were calculated for each key population group and chi-square analysis assessed differences in proportions between youth (aged less than 24 years old) and older adult KP for each population group. RESULTS The majority of MSM and FSW participants were young 80.7% (95% CI: 71.5-89.9%) and 71.9% (95% CI: 71.9-79.5%), respectively, although not among PWID (18.2%, 95% CI: 13.2-23.2%). Young KP were single or never married, had a secondary education level or higher, and low employment rates. They reported lower perception of HIV risk (MSM: 72.3% vs 56.7%, p<0.001, FSW: 45.3% vs 24.4%, p<0.001), lower HIV testing uptake (MSM: 67.5% vs 72.3%, p<0.001; FSW: 63.2% vs 80.6%; p<0.001, PWID: 53.3% vs 31.2%; p = 0.001), greater underage sexual debut (MSM: 9.6% vs 4.8%, p<0.001; FSW: 35.2% vs 22.9%, p<0.001), and greater underage initiation of injection drug use (PWID: 31.9% vs 7.0%, p<0.001). Young KP also had lower HIV prevalence compared to older KP: MSM: 3.3% vs 27.0%, p<0.001; FSW: 17.2% vs 53.7%, p<0.001; and PWID: 6.0% vs 55.0%, p<0.001. There was no significant difference in condom use across the populations. CONCLUSION There is an immediate need for a targeted HIV response for young KP in Mozambique so that they are not left behind. Youth must be engaged in the design and implementation of interventions to ensure that low risk behaviors are sustained as they get older to prevent HIV infection.
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Affiliation(s)
- Makini A. S. Boothe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Cynthia Semá Baltazar
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- National Institute of Health, Maputo, Mozambique
| | - Isabel Sathane
- National STI-HIV/AIDS Control Program, National Directorate of Public Health, Mozambique
| | - Henry F. Raymond
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
| | - Erika Fazito
- ICAP, Columbia University, Pretoria, South Africa
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Obstetrics and Gynecology, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Population Health, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Mauka W, Mbotwa C, Moen K, Lichtwarck HO, Haaland I, Kazaura M, Leyna GH, Leshabari MT, Mmbaga EJ. Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach. JMIR Form Res 2021; 5:e23204. [PMID: 34617904 PMCID: PMC8532018 DOI: 10.2196/23204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/03/2021] [Accepted: 08/01/2021] [Indexed: 01/30/2023] Open
Abstract
Background There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570
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Affiliation(s)
- Wilhellmuss Mauka
- Department of Behavioural Science, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Christopher Mbotwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, United Republic of Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Inga Haaland
- Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Method Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Germana H Leyna
- Tanzania Food and Nutrition Centre, Dar es Salaam, United Republic of Tanzania
| | - Melkizedeck T Leshabari
- Department of Behavioural Science, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania.,Department of Community Medicine and Global Health, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
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Chen J, Fan H, Chen H, Yao F. Correlates of group sex participation among men who have sex with men in Chongqing, Southwestern China. BMC Public Health 2021; 21:561. [PMID: 33752635 PMCID: PMC7983368 DOI: 10.1186/s12889-021-10607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Findings from specific countries indicated group sex was common among men who have sex with men (MSM), and men who reported group sex participation were at increased risk of human immunodeficiency virus (HIV)/sexually transmitted infections (STIs). The purpose of the current analysis was to describe the prevalence and correlates of group sex participation among a community-based sample of MSM in Chongqing, southwestern China. METHODS Convenience sampling method was used to recruit participants and data were collected through an anonymous questionnaire. Logistic regression analysis was employed to identify correlates of group sex participation. RESULTS Overall, 1151 eligible participants were enrolled in the study. 14.7% of MSM reported participating in group sex in their lifetime, and 5.8% reported group sex participation in the prior 6 months. Factors positively associated with group sex participation in both the prior 6 months and the lifetime included: monthly income ≥3000 Yuan (adjusted odds ratios [aOR] = 3.67, 95% confidence interval [CI] 1.25-10.75; aOR = 2.30, 95% CI 1.21-4.35), initiating anal sex before 18 years old (aOR = 1.86, 95% CI 1.03-3.34; aOR = 2.00, 95% CI 1.31-3.05), using gay apps to seek sex partners (aOR = 7.41, 95% CI 2.57-21.33; aOR = 9.75, 95% CI 4.92-19.33), recreational drug use (aOR = 10.10, 95% CI 5.52-18.49; aOR = 4.75, 95% CI 3.20-7.05) and having condomless internal ejaculation (CIE) (aOR = 3.66, 95% CI 2.01-6.68; aOR = 1.61, 95% CI 1.11-2.35). Factors only associated with group sex participation in the lifetime were older age (age between 26 and 35 years old: aOR = 2.06, 95% CI 1.30-3.26; age > 35 years old: aOR = 1.95, 95% CI 1.10-3.46) and history of STIs (aOR = 2.51, 95% CI 1.37-4.62). CONCLUSIONS The results of this study suggested that group sex participation was a potentially risky context for acquisition and transmission of HIV/STIs. Close attention should be given to MSM who participated in group sex, and appropriate risk reduction interventions should be developed specific to this subgroup of MSM.
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Affiliation(s)
- Jin Chen
- Department of Medical Records and Statistics, the People's Hospital of Tongliang District, Chongqing, China
| | - Hui Fan
- Department of Preventive Medicine, North Sichuan Medical College, Nanchong, China
| | - Huailiang Chen
- Department of Infectious Diseases Prevention and Healthcare, the People's Hospital of Sichuan Tianfu New Area, Chengdu, China.
| | - Feifei Yao
- Department of STD/HIV Control and Prevention, Sichuan Tianfu New Area Center for Disease Control and Prevention, Chengdu, China
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Chen J, Huang YL, Chen HL, Xia J. Nitrite inhalants use, sexual behaviors and HIV/syphilis infection among men who have sex with men in Chongqing, China. Infect Dis Poverty 2020; 9:127. [PMID: 32887643 PMCID: PMC7650275 DOI: 10.1186/s40249-020-00748-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emerging evidence indicates nitrite inhalants have become increasingly prevalent among men who have sex with men (MSM). The present study aimed to describe the prevalence and correlates of nitrite inhalants use and its association with risky sexual behaviors and human immunodeficiency virus (HIV)/syphilis infection among MSM in Chongqing, a city in China where MSM were burdened with the highest pooled HIV prevalence in the country. METHODS This cross-sectional study was conducted in Chongqing between March 2019 and February 2020. Information of demographics, drug use, sexual behaviors and HIV testing was collected through an anonymous survey. Blood samples were drawn from each participant for the diagnoses of HIV and syphilis. Logistic regression analysis was performed to evaluate factors correlated with nitrite inhalants use and its relationship with risky sexual behaviors and HIV/syphilis infection. RESULTS Of the 1151 eligible participants, 18.9% (218) reported use of at least one type of recreational drugs in the past 6 months, and nitrite inhalants were the most commonly used substance (17.7, 95% confidence interval [CI]: 15.6-20.2%). The proportions of participants reported engaging in group sex and practicing condomless internal ejaculation during anal sex in the past six months were 5.8% (95% CI: 4.4-7.2%) and 41.7% (95% CI: 38.7-44.7%), respectively. The general prevalence of HIV and syphilis infection among the enrolled MSM were 16.8% (95% CI: 14.7-19.0%) and 12.6% (95% CI: 10.7-14.4%), respectively. Factors positively associated with nitrite inhalants use included: age ≤ 25 (adjusted odds ratio [aOR] = 2.08, 95% CI: 1.10-3.94), monthly individual income ≥ CNY 3000 (Chinese Yuan) (aOR = 1.95, 95% CI: 1.18-3.22), preferring receptive anal intercourse (aOR = 2.27, 95% CI: 1.34-3.84) and versatile anal intercourse (aOR = 2.60, 95% CI: 1.64-4.13), age at first anal intercourse < 18 (aOR = 1.79, 95% CI: 1.21-2.67), engaging in group sex in the past six months (aOR = 9.34, 95% CI: 4.95-17.63), having multiple male sex partners in the past 6 months (aOR = 2.32, 95% CI: 1.50-3.58), practicing CIE during anal sex in the past six months (aOR = 1.71, 95% CI: 1.19-2.46), HIV infection (aOR = 1.72, 95% CI: 1.11-2.66) and syphilis infection (aOR = 1.98, 95% CI: 1.23-3.17). CONCLUSIONS This study found that nitrite inhalants were the most commonly used recreational substance among MSM and nitrite inhalants use were associated with higher probability of HIV and syphilis infection. Therefore, increased attention and counselling should be given to nitrite inhalants-using MSM.
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Affiliation(s)
- Jin Chen
- Department of Medical Records Management, the People's Hospital of Tongliang District, Chongqing, China
| | - Yu-Ling Huang
- Department of STD/HIV Control and Prevention, Sichuan provincial Center for Disease Control and Prevention, Chengdu, China
| | - Huai-Liang Chen
- Department of Infectious Diseases Prevention and Healthcare, the People's Hospital of Chengdu Tianfu New Area, Chengdu, China.
| | - Ji Xia
- Department of Medical Records Management, the People's Hospital of Tongliang District, Chongqing, China
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