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Kloek M, Chabata ST, van Noord L, Machingura F, Makandwa R, Dirawo J, Takaruza A, Matambanadzo P, de Vlas SJ, Hontelez JAC, Cowan FM. HIV prevalence, risk behaviour, and treatment and prevention cascade outcomes among cisgender men, transgender women, and transgender men who sell sex in Zimbabwe: a cross-sectional analysis of programme data. Lancet HIV 2023; 10:e453-e460. [PMID: 37329898 DOI: 10.1016/s2352-3018(23)00088-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/31/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There is a paucity of evidence on HIV vulnerabilities and service engagements among people who sell sex in sub-Saharan Africa and identify as cisgender men, transgender women, or transgender men. We aimed to describe sexual risk behaviours, HIV prevalence, and access to HIV services among cisgender men, transgender women, and transgender men who sell sex in Zimbabwe. METHODS We did a cross-sectional analysis of routine programme data that were collected between July 1, 2018, and June 30, 2020, from cisgender men who sell sex, transgender women who sell sex, and transgender men who sell sex, as part of accessing sexual and reproductive health and HIV services provided through the Sisters with a Voice programme, at 31 sites across Zimbabwe. All people who sell sex reached by the programme had routine data collected, including routine HIV testing, and were referred using a network of peer educators. Sexual risk behaviours, HIV prevalence, and HIV services uptake during the period from July, 2018, to June, 2020, were analysed through descriptive statistics by gender group. FINDINGS A total of 1003 people who sell sex were included in our analysis: 423 (42·2%) cisgender men, 343 (34·2%) transgender women, and 237 (23·6%) transgender men. Age-standardised HIV prevalence estimates were 26·2% (95% CI 22·0-30·7) among cisgender men, 39·4% (34·1-44·9) among transgender women, and 38·4% (32·1-45·0) among transgender men. Among people living with HIV, 66·0% (95% CI 55·7-75·3) of cisgender men, 74·8% (65·8-82·4) of transgender women, and 70·2% (59·3-79·7) of transgender men knew their HIV status, and 15·5% (8·9-24·2), 15·7% (9·5-23·6), and 11·9% (5·9-20·8) were on antiretroviral therapy, respectively. Self-reported condom use was consistently low across gender groups, ranging from 26% (95% CI 22-32) for anal sex among transgender women to 32% (27-37) for vaginal sex among cisgender men. INTERPRETATION These unique data show that people who sell sex and identify as cisgender men, transgender women, or transgender men in sub-Saharan Africa have high HIV prevalences and risk of infection, with alarmingly low access to HIV prevention, testing, and treatment services. There is an urgent need for people-centred HIV interventions for these high-risk groups and for more inclusive HIV policies and research to ensure we truly attain universal access for all. FUNDING Aidsfonds Netherlands.
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Affiliation(s)
- Mariëlle Kloek
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sungai T Chabata
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Laura van Noord
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fortunate Machingura
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Rumbidzo Makandwa
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Jeffrey Dirawo
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Albert Takaruza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | | | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jan A C Hontelez
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany.
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Rael CT, Sandfort TGM, Gichangi P, Lafort Y, Mantell JE. Condom Use Among Male Sex Workers With Their Male Clients in Mombasa, Kenya: Results of a Sub-analysis of a Pilot, Multilevel, Structural, HIV Risk-Reduction Intervention. J Assoc Nurses AIDS Care 2023; 34:248-258. [PMID: 37129476 PMCID: PMC10754228 DOI: 10.1097/jnc.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
ABSTRACT Despite the advent of preexposure prophylaxis, consistent condom use continues to be recommended because preexposure prophylaxis does not prevent sexually transmitted infections. This is important for high-risk populations (e.g., male sex workers; MSW) in low-resource, high-HIV/sexually transmitted infection prevalence settings, such as the Mombasa region in Kenya. This study aimed to examine the relationship between MSW's condom use, and their knowledge, beliefs, and attitudes about condoms. MSW (N = 158) completed surveys on their sexual behaviors/practices/attitudes. We used multiple regressions to identify associations between condom use, HIV knowledge/attitudes, and self-efficacy. Three quarters of participants reported always using condoms in the past week, and 64.3% reported always using condoms in the past month with male clients. Mean scores for knowledge and attitudes/self-efficacy toward condoms/safer sex were positively associated with condom use. Interventions to build self-efficacy, such as condom negotiation, and/or bringing up condom use with clients may be useful for Kenyan MSW.
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Affiliation(s)
- Christine Tagliaferri Rael
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Theo G M Sandfort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gichangi
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Yves Lafort
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Joanne E Mantell
- Christine Tagliaferri Rael, PhD, University of Colorado College of Nursing, Aurora, Colorado, USA, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Peter Gichangi, BSc, MBCHB, MMED(O/G), PhD, MPH, DVC, ARE, Department of Environmental and Health Sciences, School of Applied and Health Sciences, Technical University of Mombasa, Mombasa, Kenya
- Yves Lafort, MD, MS, PhD, Ghent University, Ghent, Belgium
- Joanne E. Mantell, MS, MSPH, PhD, HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute, New York, New York, USA, and Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Curtis MG, Boe JL. The Lived Experiences of Male Sex Workers: A Global Qualitative Meta-Synthesis. SEXES 2023. [DOI: 10.3390/sexes4020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
The sex industry literature predominantly focuses on the lived experiences of cisgender female sex workers, their customers, and work dynamics. Recently, there has been a shift in the discourse regarding sex work as the sex industry has been openly represented within art, fashion, and film. As such, there has been a growing number of qualitative studies dedicated to investigating cisgender men’s experiences of the sex industry. This article seeks to identify and synthesize these emergent findings to identify possible gaps in the literature, aid in defining new research opportunities, and guide public health policy development. Using qualitative meta-synthesis, 66 original studies were identified and analyzed. Nine meta-themes emerged. Findings demonstrated that male sex workers (MSWs) encounter many of the same experiences that have been previously documented by female sex workers, such as work-related discrimination and the influence of economics on their interest and involvement in the industry. However, MSWs also experience areas of privilege and discrimination unique to their lived experiences. This was particularly salient for men who sold sex in countries where sexual minorities are criminalized or decriminalized but not legalized. These findings highlight the need for responsive sex worker resources tailored to address the unique issues faced by MSWs.
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Affiliation(s)
- Michael G. Curtis
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60208, USA
| | - Joshua L. Boe
- Department of Couple and Family Therapy, Nova Southeastern University, Davie, FL 33314, USA
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Larmarange J, Broqua C. Les hommes bisexuels sont moins exposés au virus de l’immunodéficience humaine que les homosexuels exclusifs en Afrique subsaharienne. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:123-132. [PMID: 37336726 DOI: 10.3917/spub.hs2.0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION In sub-Saharan Africa, as in the rest of the world, men who have sex with men (MSM) are at greater risk of HIV infection than the general population. Bisexuals are often perceived to be more at risk than exclusive gay men. PURPOSE OF RESEARCH We propose a review of epidemiological surveys conducted in sub-Saharan Africa since 2005 to provide an overview of knowledge on HIV exposure among gay/bisexual men. RESULTS We reviewed 355 publications and identified 62 measures of the association between bisexuality and HIV prevalence and 8 measures of the association between bisexuality and incidence. Except for 4 of 62 measures, the HIV prevalence observed among bisexuals was equal to or lower than that observed among exclusive gay men. In terms of incidence, all but one of the identified studies observed lower or equal HIV incidence among bisexuals. From a behavioural perspective, most studies found no difference in condom use. Bisexuals may have less frequent sex and consistently less receptive anal sex. They mainly started their sexual lives with men later, had fewer partners, and were less likely to know their HIV status. CONCLUSIONS Bisexuals are less likely to be at risk of HIV than exclusive gay men, partly because of behavioural differences. Prevention and treatment programs for MSM must take the specificities of bisexuals into account and design differentiated services.
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Kloek M, Bulstra CA, van Noord L, Al‐Hassany L, Cowan FM, Hontelez JAC. HIV prevalence among men who have sex with men, transgender women and cisgender male sex workers in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc 2022; 25:e26022. [PMID: 36419343 PMCID: PMC9684687 DOI: 10.1002/jia2.26022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Developing effective targets, policies and services for key populations requires estimations of population sizes and HIV prevalence across countries and regions. We estimated the relative and absolute HIV prevalence among men who have sex with men (MSM), transgender women and men, and male and transgender sex workers (MSW and TGSW) in sub-Saharan African countries using peer-reviewed literature. METHODS We performed a systematic review of peer-reviewed studies assessing HIV prevalence in MSM, transgender women and men, MSW and TGSW in sub-Saharan Africa between 2010 and 2021, following PRISMA guidelines. We searched Embase, Medline Epub, Africa Index Medicus, Africa Journal Online, Web of Science and Google Scholar. We calculated HIV prevalence ratios (PRs) between the study prevalence, and the geospatial-, sex, time and age-matched general population prevalence. We extrapolated results for MSM and transgender women to estimate HIV prevalence and the number living with HIV for each country in sub-Saharan Africa using pooled review results, and regression approximations for countries with no peer-reviewed data. RESULTS AND DISCUSSION We found 44 articles assessing HIV prevalence in MSM, 10 in transgender women, five in MSW and zero in transgender men and TGSW. Prevalence among MSM and transgender women was significantly higher compared to the general population: PRs of 11.3 [CI: 9.9-12.9] for MSM and 8.1 [CI: 6.9-9.6] for transgender women in Western and Central Africa, and, respectively, 1.9 [CI: 1.7-2.0] and 2.1 [CI: 1.9-2.4] in Eastern and Southern Africa. Prevalence among MSW was significantly higher in both Nigeria (PR: 12.4 [CI: 7.3-21.0]) and Kenya (PR: 8.6 [CI: 4.6-15.6]). Extrapolating our findings for MSM and transgender women resulted in an estimated HIV prevalence of 15% or higher for about 60% of all sub-Saharan African countries for MSM, and for all but two countries for transgender women. CONCLUSIONS HIV prevalence among MSM and transgender women throughout sub-Saharan Africa is alarmingly high. This high prevalence, coupled with the specific risks and vulnerabilities faced by these populations, highlights the urgent need for risk-group-tailored prevention and treatment interventions across the sub-continent. There is a clear gap in knowledge on HIV prevalence among transgender men, MSW and TGSW in sub-Saharan Africa.
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Affiliation(s)
- Mariëlle Kloek
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Caroline A. Bulstra
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands,Heidelberg Institute of Global HealthMedical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
| | - Laura van Noord
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Lina Al‐Hassany
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Frances M. Cowan
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR) ZimbabweHarareZimbabwe,Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Jan A. C. Hontelez
- Department of Public HealthErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands,Heidelberg Institute of Global HealthMedical Faculty and University HospitalHeidelberg UniversityHeidelbergGermany
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Smith AD, Fearon E, Kabuti R, Irungu E, Kungu M, Babu H, Nyabuto C, Muthoga P, Weatherburn P, Bourne A, Kimani J. Disparities in HIV/STI burden and care coverage among men and transgender persons who have sex with men in Nairobi, Kenya: a cross-sectional study. BMJ Open 2021. [PMCID: PMC8719220 DOI: 10.1136/bmjopen-2021-055783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectivesThe study aimed to estimate the prevalence of, and associations, with HIV and metrics of HIV care engagement in a representative population of gay, bisexual and other men who have sex with men (GBMSM) and transgender persons (TP) who have sex with men (GBMSM/TP)SettingUrban districts of Nairobi, Kenya.DesignCross-sectional.Participants608 eligible participants were identified through respondent-driven sampling over 19 waves of recruitment arising from ten seeds between May and December 2017. Inclusion criteria were: age >18 years; Nairobi residence; male sex assignment at birth or current identification as male, and recent consensual sex with male partners. Exclusion criteria were: missing or invalid recruitment coupon; repeat registration; intoxication at study visit.Primary and secondary outcome measuresHIV status measured using Determine Alere HIV 1/2 and First Response HIV 1–2.0 and GeneXpert HIV-1 Qual. Self-reported metrics of HIV status awareness, antiretroviral use and objective quantification of viral suppression using GeneXpert HIV-1 VL.Results26.4% (286/618) were HIV positive of whom 76.6% were status aware, 65.3% were on antiretroviral therapy (ART), and 47.4% were virally suppressed (<50 copies/mL). Participants 18–22 years were less likely to be status aware, be receiving ART or to have achieved viral suppression. Mean log viral load was 3.14 log higher in 18–22 years compared with older participants. Bacterial sexually transmitted infections were common at both urethral and rectal sites and most infections were asymptomatic by self-report (rectal 82.2%, urethral 82.3%).ConclusionsEngagement in the HIV diagnosis and care cascade among GBMSM/TP in Nairobi is markedly better than in most sub-Saharan African countries, yet falls short of achievements for the general population in Kenya and for GBMSM in high income settings. Young GBMSM/TP are least well served by the current configuration of adult key population services, and programmes should identify and address the sexual, social and developmental needs of adolescent and young key populations.
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Affiliation(s)
- Adrian D Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth Fearon
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rhoda Kabuti
- Partners for Health and Development, Nairobi, Kenya
| | | | - Mary Kungu
- Partners for Health and Development, Nairobi, Kenya
| | - Hellen Babu
- Partners for Health and Development, Nairobi, Kenya
| | | | - Peter Muthoga
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua Kimani
- Department of Global Health & Development, Partners for Health and Development, Nairobi, Kenya
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Nduva GM, Nazziwa J, Hassan AS, Sanders EJ, Esbjörnsson J. The Role of Phylogenetics in Discerning HIV-1 Mixing among Vulnerable Populations and Geographic Regions in Sub-Saharan Africa: A Systematic Review. Viruses 2021; 13:1174. [PMID: 34205246 PMCID: PMC8235305 DOI: 10.3390/v13061174] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/19/2022] Open
Abstract
To reduce global HIV-1 incidence, there is a need to understand and disentangle HIV-1 transmission dynamics and to determine the geographic areas and populations that act as hubs or drivers of HIV-1 spread. In Sub-Saharan Africa (sSA), the region with the highest HIV-1 burden, information about such transmission dynamics is sparse. Phylogenetic inference is a powerful method for the study of HIV-1 transmission networks and source attribution. In this review, we assessed available phylogenetic data on mixing between HIV-1 hotspots (geographic areas and populations with high HIV-1 incidence and prevalence) and areas or populations with lower HIV-1 burden in sSA. We searched PubMed and identified and reviewed 64 studies on HIV-1 transmission dynamics within and between risk groups and geographic locations in sSA (published 1995-2021). We describe HIV-1 transmission from both a geographic and a risk group perspective in sSA. Finally, we discuss the challenges facing phylogenetic inference in mixed epidemics in sSA and offer our perspectives and potential solutions to the identified challenges.
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Affiliation(s)
- George M. Nduva
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi 80108, Kenya;
| | - Jamirah Nazziwa
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
| | - Amin S. Hassan
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi 80108, Kenya;
| | - Eduard J. Sanders
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Kilifi 80108, Kenya;
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford OX1 2JD, UK
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, 205 02 Malmö, Sweden; (G.M.N.); (J.N.); (A.S.H.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford OX1 2JD, UK
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Fiorentino M, Eubanks A, Coulaud PJ, Couderc C, Keita BD, Anoma C, Dah E, Mensah E, Maradan G, Bourrelly M, Riegel L, Rojas-Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Homonegativity, sexual violence and condom use with women in men who have sex with men and women in West Africa. AIDS 2021; 35:681-687. [PMID: 33306548 DOI: 10.1097/qad.0000000000002782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aimed to explore longitudinal interactions between homonegativity and sexual behaviors with female partners among HIV-negative West African men who have sex with men and women (MSMW). DESIGN AND METHOD The community-based cohort CohMSM ANRS 12324 - Expertise France enrolled MSM in Togo, Burkina Faso, Côte d'Ivoire and Mali. Sociobehavioral data were collected every 6 months. Using 30-month follow-up data, a multiprobit analysis was performed to investigate the relationship between psychosocial and behavioral variables ex-ante (t - 1) and ex-post (t). RESULTS MSMW (n = 326) accounted for half of all participants in CohMSM. They reported inconsistent condom use with women in 39% of visits. Perceived and internalized homonegativity at t - 1 tended to lead to sexual violence toward women at t (P < 0.1), which was associated with inconsistent condom use with them at t (P < 0.05). CONCLUSION Given the high HIV prevalence in West African MSM, widespread condom-less sex with women in MSMW, and the aggravating effect of social and internalized homonegativity, more research in the MSMW subpopulation is needed to assess the risk of HIV bridging to women and to design support activities.
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Affiliation(s)
- Marion Fiorentino
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | - August Eubanks
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | - Pierre-Julien Coulaud
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | | | | | | | - Elias Dah
- Association African Solidarité, Ouagadougou
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Gwenaëlle Maradan
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | - Michel Bourrelly
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | | | | | - Issifou Yaya
- IRD, INSERM, Univ Montpellier, TransVIHMI, Montpellier, France
| | - Bruno Spire
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
| | | | - Luis Sagaon-Teyssier
- INSERM, IRD, Aix Marseille Univ, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale
- ORS PACA, Observatoire régional de la santé, Provence-Alpes-Côte d'Azur, Marseille
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Öhman J, Larsson M, Kashiha J, Agardh A. 'Fighting an uphill battle': a qualitative study of the challenges encountered by pharmacy workers when providing services to men who have sex with men in Dar es Salaam, Tanzania. Glob Health Action 2020; 13:1770985. [PMID: 32508263 PMCID: PMC7448846 DOI: 10.1080/16549716.2020.1770985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Previous research suggests that Tanzanian MSM might prefer consulting pharmacies and drugstores, rather than public healthcare services, when in need of STI medicines and treatment. Yet, few studies have explored the experiences of providing services to MSM clients among those working at pharmacies and drugstores and examined what challenges they encounter in providing these services. Objective To gain increased knowledge and understanding of the perceived challenges encountered by pharmacists and drugstore workers when providing STI services to MSM clients in Dar es Salaam, Tanzania. Method In early 2016, 16 semi-structured interviews were conducted with persons working at private pharmacies and drugstores in Dar es Salaam. Data were interpreted through qualitative content analysis. Results The overarching theme that emerged was labelled ‘Fighting an uphill battle’, which reflected the challenges pharmacy workers experienced during interactions with MSM clients, and in particular service provision. Pharmacy workers tried to act upon the best of their knowledge to meet the needs of clients, given their understanding of risks and obstacles that MSM faced. Yet, the lack of educational and professional preparedness and insufficient financial and human resources, regarded as necessary to meet the needs of a stigmatised client group, formed barriers for effective service delivery. Conclusions In order to support pharmacists and drug-store workers in Tanzania to address perceived challenges for service delivery to MSM clients, systematic and continuous training on MSM’s sexual health is required. Furthermore, inter-professional cooperation that harnesses provider involvement from all tiers in the healthcare system is essential to offer complementary services to ensure proper STI care and treatment. Thus, interventions that focus on inter-professional communication and interaction between pharmacists and physicians could have a positive impact on timely referrals of suspected STI cases among marginalised populations.
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Affiliation(s)
- Joakim Öhman
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University , Malmö, Sweden
| | - Markus Larsson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University , Malmö, Sweden
| | - John Kashiha
- Community Health Education Services & Advocacy (CHESA) , Dar es Salaam, Tanzania
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University , Malmö, Sweden
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Bhattacharjee P, Isac S, Musyoki H, Emmanuel F, Olango K, Kuria S, Ongaro MK, Walimbwa J, Musimbi J, Mugambi M, Kaosa S, Kioko J, Njraini M, Melon M, Onyoni J, Bartilol K, Becker M, Lorway R, Pickles M, Moses S, Blanchard J, Mishra S. HIV prevalence, testing and treatment among men who have sex with men through engagement in virtual sexual networks in Kenya: a cross-sectional bio-behavioural study. J Int AIDS Soc 2020; 23 Suppl 2:e25516. [PMID: 32589341 PMCID: PMC7319161 DOI: 10.1002/jia2.25516] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM)). METHODS We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status. RESULTS 177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040). CONCLUSIONS Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions.
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Affiliation(s)
- Parinita Bhattacharjee
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Shajy Isac
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
- India Health Action TrustNew DelhiIndia
| | - Helgar Musyoki
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Faran Emmanuel
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | | | | | | | | | - Janet Musimbi
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Mary Mugambi
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Shem Kaosa
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Japheth Kioko
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Margret Njraini
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Memory Melon
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Juddie Onyoni
- Technical Support UnitPartners for Health and Development in AfricaNairobiKenya
| | - Kigen Bartilol
- National AIDS and STI Control ProgrammeMinistry of HealthNairobiKenya
| | - Marissa Becker
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Robert Lorway
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | | | - Stephen Moses
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - James Blanchard
- Centre for Global Public HealthUniversity of ManitobaWinnipegCanada
| | - Sharmistha Mishra
- St. Michael’s HospitalDepartment of MedicineUniversity of TorontoTorontoCanada
- Institute of Medical SciencesUniversity of TorontoTorontoCanada
- Institute of Health Policy Management and EvaluationDalla Lana School of Public HealthUniversity of TorontoTorontoCanada
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Nduva GM, Hassan AS, Nazziwa J, Graham SM, Esbjörnsson J, Sanders EJ. HIV-1 Transmission Patterns Within and Between Risk Groups in Coastal Kenya. Sci Rep 2020; 10:6775. [PMID: 32317722 PMCID: PMC7174422 DOI: 10.1038/s41598-020-63731-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/30/2020] [Indexed: 11/09/2022] Open
Abstract
HIV-1 transmission patterns within and between populations at different risk of HIV-1 acquisition in Kenya are not well understood. We investigated HIV-1 transmission networks in men who have sex with men (MSM), injecting drug users (IDU), female sex workers (FSW) and heterosexuals (HET) in coastal Kenya. We used maximum-likelihood and Bayesian phylogenetics to analyse new (N = 163) and previously published (N = 495) HIV-1 polymerase sequences collected during 2005-2019. Of the 658 sequences, 131 (20%) were from MSM, 58 (9%) IDU, 109 (17%) FSW, and 360 (55%) HET. Overall, 206 (31%) sequences formed 61 clusters. Most clusters (85%) consisted of sequences from the same risk group, suggesting frequent within-group transmission. The remaining clusters were mixed between HET/MSM (7%), HET/FSW (5%), and MSM/FSW (3%) sequences. One large IDU-exclusive cluster was found, indicating an independent sub-epidemic among this group. Phylodynamic analysis of this cluster revealed a steady increase in HIV-1 infections among IDU since the estimated origin of the cluster in 1987. Our results suggest mixing between high-risk groups and heterosexual populations and could be relevant for the development of targeted HIV-1 prevention programmes in coastal Kenya.
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Affiliation(s)
- George M Nduva
- Lund University, Lund, Sweden
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Amin S Hassan
- Lund University, Lund, Sweden
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Susan M Graham
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- University of Washington, Seattle, WA, USA
| | - Joakim Esbjörnsson
- Lund University, Lund, Sweden.
- The University of Oxford, Oxford, United Kingdom.
| | - Eduard J Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- The University of Oxford, Oxford, United Kingdom
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12
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Berg RC, Molin SB, Nanavati J. Women Who Trade Sexual Services from Men: A Systematic Mapping Review. JOURNAL OF SEX RESEARCH 2020; 57:104-118. [PMID: 31264896 DOI: 10.1080/00224499.2019.1624680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Most research on transactional sex frame men as buyers and females as sellers of sex. We conducted a systematic mapping review of the empirical research on transactional sex where women form the demand (buyer) and men the supply (seller). We included 46 studies, of which 25 explicitly researched women as buyers of sex from male sellers, and 21 studies where this topic was a subset of larger topics. The majority of research on women who trade sexual services from men is published in the last 15 years, by female researchers, using cross-sectional or qualitative/ethnographic design, and from the perspective of males as sellers. While the women appear to be mature and financially independent, the men are young and socioeconomically vulnerable. Men's main motivation for the sexual-economic exchanges with women is financial, whereas women's motivations are largely satisfaction of sexual needs and a stereotyped erotic fantasy of black male hypersexuality. Condoms are often not used. Our review shows that there is a - possibly growing and diversifying - female consumer demand for male sexual services, and transactional sex where women trade sex from men is a complex social phenomenon firmly grounded in social, economic, political, and sexual relations.
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Affiliation(s)
- Rigmor C Berg
- Division of Health Services, Norwegian Institute of Public Health and Department of Community Medicine, University of Tromso
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13
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Seidu AA, Darteh EKM, Kumi-Kyereme A, Dickson KS, Ahinkorah BO. Paid sex among men in sub-Saharan Africa: Analysis of the demographic and health survey. SSM Popul Health 2019; 11:100459. [PMID: 32875050 PMCID: PMC7451820 DOI: 10.1016/j.ssmph.2019.100459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 06/12/2019] [Accepted: 07/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Paying for sex is regarded as a risky sexual behavior (RSB) among heterosexual men. Men paying for sex are considered to be a bridging population for sexually transmitted infections (STIs). Despite the link between paid sex and sexual and reproductive health outcomes such as STIs, little is known about the prevalence and factors associated with paid sex among men in sub-Saharan Africa. This study examined the prevalence of paid sex and the socio-demographic factors associated with it among men in sub-Saharan Africa. Methods The study made use of pooled data from the Demographic and Health Surveys (DHS) conducted from January 1, 2010 to December 3, 2016 in 27 countries in sub-Saharan Africa. Binary and multivariable logistic regression models were used to investigate the relationship between the explanatory and the outcome variables. Results The results of the study showed that of the 139,427 men who participated in the study, 4.3% reported they had paid for sex in the 12 months preceding the survey. Men in Mozambique had the highest proportion (13.6%) of paying for sex in the 12 months preceding the survey. The results of the multivariable analysis indicated that men from DR Congo [AOR = 9.74; 95% CI = 7.45-12.73], men who had completed only primary level of education [AOR = 1.31; 95% CI = 1.18-1.45], men aged 25-34 years [AOR = 2.84; 95% CI = 2.26-3.56], men belonging to "other" religious groups [AOR = 1.20; 95% CI = 1.09-1.32] and men who were employed [AOR = 1.73; 95% CI = 1.58-1.90] had higher odds of paying for sex. Men who were divorced [AOR = 4.52; 95% = 3.89-5.25], men who read newspaper/magazine almost every day [AOR = 1.34; 95% CI = 1.12-1.63], men who listened to radio almost every day [AOR = 1.19; 95% CI = 1.05-1.36] and men who watched television at least once a week [AOR = 1.10; 95% CI = 1.01-1.19] also had higher odds of paying for sex. On the other hand, men in rural areas [AOR = 0.88; 95%CI = 0.82-0.95], men in the richest wealth quintile [AOR = 0.83; 95%CI = 0.74-0.93] and those with tertiary level of education [AOR = 0.77; 95% CI = 0.65-0.90] had lower odds of paying for sex. Conclusion The odds of paid sex were high among men with only primary level of education, men aged 25-34, men who professed 'other' religious affiliation, men who are employed and men who are divorced. However, paid sex was low among men in the richest wealth quintile, men with tertiary level of education and men living in rural areas. This means that the decision to pay for sex is influenced by several social and demographic factors. Hence, these factors should be taken into consideration for sexual and reproductive health interventions and services. Policy and interventional measures should aim at reducing high-risk behavior of men who pay for sex.
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Affiliation(s)
- Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Ghana
- Corresponding author.
| | | | | | | | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Australia
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14
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Bhattacharjee P, Rego D, Musyoki H, Becker M, Pickles M, Isac S, Lorway R, Musimbi J, Walimbwa J, Olango K, Kuria S, Ongaro MK, Sahai A, Mugambi M, Emmanuel F, Mishra S, Bartilol K, Moses S, Blanchard J. Evaluation of community-based HIV self-testing delivery strategies on reducing undiagnosed HIV infection, and improving linkage to prevention and treatment services, among men who have sex with men in Kenya: a programme science study protocol. BMC Public Health 2019; 19:986. [PMID: 31337368 PMCID: PMC6652006 DOI: 10.1186/s12889-019-7291-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND HIV prevalence among men having sex with men (MSM) in Kenya is 18.2%. Despite scale-up of HIV testing services, many MSM remain unaware of their HIV status and thus do not benefit from accessing HIV treatment or prevention services. HIV self-testing (HIVST) may help address this gap. However, evidence is limited on how, when, and in what contexts the delivery of HIVST to MSM could increase awareness of HIV status and lead to early linkage to HIV treatment and prevention. METHODS The study will be embedded within existing MSM-focused community-based HIV prevention and treatment programmes in 3 counties in Kenya (Kisumu, Mombasa, Kiambu). The study is designed to assess three HIV testing outcomes among MSM, namely a) coverage b) frequency of testing and c) early uptake of testing. The study will adopt a mixed methods programme science approach to the implementation and evaluation of HIVST strategies via: (i) a baseline and endline bio-behavioural survey with 1400 MSM; (ii) a socio-sexual network study with 351 MSM; (iii) a longitudinal qualitative cohort study with 72 MSM; (iv) routine programme monitoring in three sites; (v) a programme-specific costing exercise; and (vi) mathematical modelling. This protocol evaluates the impact of community-based implementation of HIV self-testing delivery strategies among MSM in Kenya on reducing the undiagnosed MSM population, and time for linkage to prevention, treatment and care following HIV self-testing. Baseline data collection started in April 2019 and the endline data collection will start in July 2020. DISCUSSION This study is one of the first programme science studies in Sub-Saharan Africa exploring the effectiveness of integrating HIVST interventions within already existing HIV prevention and treatment programmes for MSM in Kenya at scale. Findings from this study will inform national best approaches to scale up HIVST among MSM in Kenya.
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Affiliation(s)
- Parinita Bhattacharjee
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada. .,Partners for Health and Development in Africa, University of Manitoba, Geomaps Building, Upper Hill, Nairobi, Kenya.
| | | | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Marissa Becker
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | | | - Shajy Isac
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.,India Health Action Trust, New Delhi, India
| | - Robert Lorway
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Janet Musimbi
- Partners for Health and Development in Africa, University of Manitoba, Geomaps Building, Upper Hill, Nairobi, Kenya
| | | | | | | | | | - Amy Sahai
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Mary Mugambi
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Faran Emmanuel
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Sharmistha Mishra
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Canada.,Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kigen Bartilol
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Stephen Moses
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - James Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
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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: 18] [Impact Index Per Article: 3.6] [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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Alcala-Alezones C, Sandfort T, Serafino S, Reddy V. South African Men Who Have Sex With Both Men and Women and How They Differ From Men Who Have Sex With Men Exclusively. JOURNAL OF SEX RESEARCH 2018; 55:1048-1055. [PMID: 29505283 PMCID: PMC6123288 DOI: 10.1080/00224499.2018.1437117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The label "men who have sex with men" (MSM) is used to categorize a diverse population exclusively on the basis of its sexual behavior. Understanding the diversity that this label comprises is critical for the development of health interventions that effectively reach the various populations subsumed under this label. In this cross-sectional study of South African MSM (N = 480) recruited through respondent-driven sampling (RDS), we explored differences between men who had sex with both men and women (MSMW) and men who had sex with men exclusively (MSME). We found significant differences between these two groups in terms of sexual attraction, sexual identity, sexual preferences, sexual histories, and current sexual practices. MSMW were more likely to be confused about their same-sex attraction, to experience internalized homophobia, and to have paid for sex in the previous year, while MSME were more gender nonconforming and more likely to have been forced to have sex in the previous year. These findings underscore that the MSM label comprises a diverse population and that exclusive sexual engagement with other men is a critical distinction to take into account in understanding this diversity and fully grasping the lived experiences of men who have sex with men.
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Affiliation(s)
| | - Theo Sandfort
- Columbia University, HIV Center for Clinical and Behavioral Studies
- University of Pretoria, Department of Psychology
| | | | - Vasu Reddy
- University of Pretoria, Faculty of the Humanities
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17
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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PrEP as a feature in the optimal landscape of combination HIV prevention in sub-Saharan Africa. J Int AIDS Soc 2016; 19:21104. [PMID: 27760682 PMCID: PMC5071752 DOI: 10.7448/ias.19.7.21104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/08/2016] [Accepted: 07/12/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction The new WHO guidelines recommend offering pre-exposure prophylaxis (PrEP) to people who are at substantial risk of HIV infection. However, where PrEP should be prioritised, and for which population groups, remains an open question. The HIV landscape in sub-Saharan Africa features limited prevention resources, multiple options for achieving cost saving, and epidemic heterogeneity. This paper examines what role PrEP should play in optimal prevention in this complex and dynamic landscape. Methods We use a model that was previously developed to capture subnational HIV transmission in sub-Saharan Africa. With this model, we can consider how prevention funds could be distributed across and within countries throughout sub-Saharan Africa to enable optimal HIV prevention (that is, avert the greatest number of infections for the lowest cost). Here, we focus on PrEP to elucidate where, and to whom, it would optimally be offered in portfolios of interventions (alongside voluntary medical male circumcision, treatment as prevention, and behaviour change communication). Over a range of continental expenditure levels, we use our model to explore prevention patterns that incorporate PrEP, exclude PrEP, or implement PrEP according to a fixed incidence threshold. Results At low-to-moderate levels of total prevention expenditure, we find that the optimal intervention portfolios would include PrEP in only a few regions and primarily for female sex workers (FSW). Prioritisation of PrEP would expand with increasing total expenditure, such that the optimal prevention portfolios would offer PrEP in more subnational regions and increasingly for men who have sex with men (MSM) and the lower incidence general population. The marginal benefit of including PrEP among the available interventions increases with overall expenditure by up to 14% (relative to excluding PrEP). The minimum baseline incidence for the optimal offer of PrEP declines for all population groups as expenditure increases. We find that using a fixed incidence benchmark to guide PrEP decisions would incur considerable losses in impact (up to 7%) compared with an approach that uses PrEP more flexibly in light of prevailing budget conditions. Conclusions Our findings suggest that, for an optimal distribution of prevention resources, choices of whether to implement PrEP in subnational regions should depend on the scope for impact of other possible interventions, local incidence in population groups, and total resources available. If prevention funding were to become restricted in the future, it may be suboptimal to use PrEP according to a fixed incidence benchmark, and other prevention modalities may be more cost-effective. In contrast, expansions in funding could permit PrEP to be used to its full potential in epidemiologically driven prevention portfolios and thereby enable a more cost-effective HIV response across Africa.
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