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Adedimeji A, Sinayobye JD, Asiimwe-Kateera B, Chaudhry J, Buzinge L, Gitembagara A, Murenzi G, Mugenzi P, Patel VV, Castle PE, Mutesa L, Palefsky J, Anastos KM. Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): Implications for HIV and STI transmission. PLoS One 2019; 14:e0211099. [PMID: 30657797 PMCID: PMC6338414 DOI: 10.1371/journal.pone.0211099] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/08/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS resulting from risky sexual behaviors. Social and contextual factors are known to mediate risk behaviors, but there is limited information about the prevalence of risky sexual practices of Rwandan MSM and the concomitant socio-contextual determinants making it difficult to assess implications for preventing HIV/STI transmission in this key population. METHODS Using exploratory qualitative design, we obtained socio-contextual information regarding prevalence of risky sexual behavior and assessed implications for HIV/ STIs transmission and preventive measures taken by MSM to improve sexual health and wellbeing. Thirty MSM were recruited to participate in in-depth interviews using respondent-driven sampling from LGBT associations in Kigali. Data were analyzed using standard qualitative data analysis procedures. RESULTS Respondents' were between 18-40 years old; all completed primary education and are mostly low-socioeconomic status. Risky sexual practices were common, but differed by peculiar individual and contextual factors. Older MSM often reported occasional sexual relations with women to avoid suspicion and social stigma. Younger MSM's risky sexual practices are mostly transactional and mediated by the need for social acceptance and support. Knowledge of STIs was poor, but prevalence, especially of HPV was high. The options for improving sexual wellbeing are limited and mostly clandestine. CONCLUSION Risky sexual behavior of Rwandan MSM has major implications for HIV/STI transmission. An environment of intense social stigma and social isolation makes it difficult to obtain information or services to improve sexual health. Effective interventions that address individual and contextual determinants of risk and access to health services are urgently needed to limit the consequence of MSM as a bridge for HIV transmission to the general population.
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Affiliation(s)
- Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
- * E-mail:
| | - Jean d’Amour Sinayobye
- Division of Research and Medical Education, Rwanda Military Hospital, Kanombe, Kigali, Rwanda
| | | | - Junaid Chaudhry
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Lydia Buzinge
- Division of Research and Medical Education, Rwanda Military Hospital, Kanombe, Kigali, Rwanda
| | | | - Gad Murenzi
- Division of Research and Medical Education, Rwanda Military Hospital, Kanombe, Kigali, Rwanda
| | - Pacifique Mugenzi
- Division of Research and Medical Education, Rwanda Military Hospital, Kanombe, Kigali, Rwanda
| | - Viraj V. Patel
- Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Health System, Bronx, New York, United States of America
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Leon Mutesa
- College of Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Joel Palefsky
- School of Medicine, University of California, San Francisco, California, United States of America
| | - Kathryn M. Anastos
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Division of General Internal Medicine, Albert Einstein College of Medicine/Montefiore Health System, Bronx, New York, United States of America
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