[Knowledge, attitudes and practices related to STD and HIV/AIDS: men having sex with men in Senegal]

Sexual behaviours and risk with women in MSM in sub-Saharan Africa

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.

They call us goor-jigeen: a qualitative exploration of the experiences of Senegalese Muslim men who have sex with men living with HIV

Men who have sex with men living with HIV in majority Muslim communities face discrimination based on multiple forms of stigma at socio-cultural and legislative levels. This study aimed to explore qualitatively the experiences of men who have sex with men living with HIV in Dakar, Senegal. In-depth individual interviews were conducted with 30 Senegalese men aged 18 to 55 years, who self-reported as same-sex practising, Muslim, and receiving HIV treatment at health centres in Dakar. Interview data were analysed using an ethnographic phenomenological approach to explore their life experiences. Primary themes included: the self-discovery process; the social, religious and health ramifications of being same-sex practising; and stigma. Within the theme of stigma issues described included shame, blame (of self and others), and violence resulting from being a man who has sex with other men and/or being HIV seropositive. Those with undetectable viral load reported how HIV related stigma and burden diminished as their health improved. Disclosure of being men who have sex with men and/or HIV status, whether voluntary or not, affected experiences of violence and/or isolation. Addressing stigma at healthcare institutions and improving access to HIV treatment can help mitigate the burden of stigma affecting such men. Interventions to address their physical and psychosocial wellbeing require the engagement of multiple stakeholders, including religious and political leaders.

Characteristics of Ethical Leadership: Themes Identification Through Convergent Parallel Mixed Method Design From the Pakistan Context

The current approaches in identifying the characteristics of ethical leadership proceed mainly from a Western perspective based on virtue-driven moral philosophy (i.e., relativism) and frequently ignoring the Asian perspective of morality based on idealism. This study aimed to conduct parallel analysis in convergent design by using qualitative and quantitative methods to extract person-driven ethical leadership themes by considering the Asian context. Using the hypothetico-deductive method, 13 themes were extracted altogether, out of which 4 are new context-driven themes (i.e., altruism, encouragement, collective good, and spiritual transcendence as the emerging themes of ethical leadership in the Asian context).

HIV epidemic among key populations in west Africa

PURPOSE OF REVIEW

Globally, HIV infection remains a significant issue for key populations such as men who have sex with men (MSM) and female sex workers. A review of recent articles was conducted for west African countries to assess the burden of disease among female sex workers and MSM, access to services and identify barriers to implementation of services for key populations.

RECENT FINDINGS

In west Africa, key populations engage in high-risk practices for the acquisition of HIV and other sexually transmitted infections. Available HIV prevalence data fluctuate across and within countries for both MSM and female sex workers and may be five to ten times as high as that of the general population. HIV prevalence varied from 15.9% in The Gambia to 68% in Benin among female sex workers, whereas it ranged from 9.8% in The Gambia to 34.9% in Nigeria for MSM. Yet, important data gaps exist, including key populations size estimations in several countries as well as HIV prevalence, incidence and other biomarkers of HIV risk. Because of sociocultural, legal, political and economic challenges, exacerbated by a poor health system infrastructure, the HIV response is not strategically directed toward programs for key populations in countries with concentrated epidemics. Noteworthy is the low coverage of prevention care and treatment interventions offered to key populations.

SUMMARY

Sufficient planning and political will with legal and structural frameworks that reconcile public health and human rights are needed to prioritize HIV prevention, care and treatment programming for key populations programs in west Africa.

HIV/AIDS in mid-sized cities in Senegal: From individual to place-based vulnerability

In Senegal, recent data indicates that the HIV epidemic is increasingly driven by concurrent sexual partners among men and women in stable relationships. In order to respond to this changing epidemiological profile in Senegal, multi-lateral and national AIDS actors require information about these emerging trends in unstudied populations. To that end, this study has several objectives, first, to assess local dynamics of sexual behaviors among individuals at popular socializing venues in areas at increased risk of HIV transmission; and then to examine how particular venues may influence risks of HIV transmission. In 2013 we collected data at 314 venues in 10 cities in Senegal using PLACE methodology. These venues were listed with collaboration of 374 community informants. They are places where commercial sex workers, MSM, and individuals who are not part of any identified risk group socialize and meet new sexual partners. We conducted 2600 interviews at the 96 most popular venues. A significant portion of the sample reports buying or selling sex and the majority engaged in behavior considered high-risk for transmitting sexual infections. Almost a quarter of patrons interviewed in venues were young people aged 15-24 years. Types of venues described were very diverse. Half of them were venues (n = 156) where sex workers could be solicited and almost a third were venues where MSM could meet male partners (n = 90). The study showed existing pockets of vulnerability to HIV in Thies, Bignona or Saly that are not evident from aggregate HIV data. These early findings suggest links between risky behaviors and type of venue on the one hand and type of city on the other hand. Finally, these findings offer complementary insight to existing studies of HIV vulnerability in Senegal and support a case for venue-based interventions.

Gay men and other men who have sex with men in West Africa: evidence from the field

This paper presents a synthesis of lessons learned from field experiences in HIV prevention, treatment and care services for men who have sex with men in the four contiguous West African countries of the Gambia, Guinea-Bissau, Guinea-Conakry and Senegal. Service provision for men who have sex with men in these countries is contextualised by the epidemiology of HIV, as well as the socio-political environment. These countries share notable commonalities in terms of social structures and culture, though past approaches to the needs of men who have sex with men have varied greatly. This synthesis includes three distinct components. The first focuses on what is known about HIV epidemiology among men who have sex with men in these countries and provides an overview of the data gaps affecting the quality of service provision. The second aspect describes the HIV prevention and treatment services currently available and how organisations and strategies have evolved in their approach to working with men who have sex with men. Finally, an examination of the political and cultural climate highlights socio-cultural factors that enable or impede HIV prevention and treatment efforts for men who have sex with men. The review concludes with a series of recommendations for impactful research, advocacy and service provision to improve the health and human rights context for men who have sex with men in West Africa.