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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: 0] [Impact Index Per Article: 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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Stone J, Mukandavire C, Boily M, Fraser H, Mishra S, Schwartz S, Rao A, Looker KJ, Quaife M, Terris‐Prestholt F, Marr A, Lane T, Coetzee J, Gray G, Otwombe K, Milovanovic M, Hausler H, Young K, Mcingana M, Ncedani M, Puren A, Hunt G, Kose Z, Phaswana‐Mafuya N, Baral S, Vickerman P. Estimating the contribution of key populations towards HIV transmission in South Africa. J Int AIDS Soc 2021; 24:e25650. [PMID: 33533115 PMCID: PMC7855076 DOI: 10.1002/jia2.25650] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In generalized epidemic settings, there is insufficient understanding of how the unmet HIV prevention and treatment needs of key populations (KPs), such as female sex workers (FSWs) and men who have sex with men (MSM), contribute to HIV transmission. In such settings, it is typically assumed that HIV transmission is driven by the general population. We estimated the contribution of commercial sex, sex between men, and other heterosexual partnerships to HIV transmission in South Africa (SA). METHODS We developed the "Key-Pop Model"; a dynamic transmission model of HIV among FSWs, their clients, MSM, and the broader population in SA. The model was parameterized and calibrated using demographic, behavioural and epidemiological data from national household surveys and KP surveys. We estimated the contribution of commercial sex, sex between men and sex among heterosexual partnerships of different sub-groups to HIV transmission over 2010 to 2019. We also estimated the efficiency (HIV infections averted per person-year of intervention) and prevented fraction (% IA) over 10-years from scaling-up ART (to 81% coverage) in different sub-populations from 2020. RESULTS Sex between FSWs and their paying clients, and between clients with their non-paying partners contributed 6.9% (95% credibility interval 4.5% to 9.3%) and 41.9% (35.1% to 53.2%) of new HIV infections in SA over 2010 to 2019 respectively. Sex between low-risk groups contributed 59.7% (47.6% to 68.5%), sex between men contributed 5.3% (2.3% to 14.1%) and sex between MSM and their female partners contributed 3.7% (1.6% to 9.8%). Going forward, the largest population-level impact on HIV transmission can be achieved from scaling up ART to clients of FSWs (% IA = 18.2% (14.0% to 24.4%) or low-risk individuals (% IA = 20.6% (14.7 to 27.5) over 2020 to 2030), with ART scale-up among KPs being most efficient. CONCLUSIONS Clients of FSWs play a fundamental role in HIV transmission in SA. Addressing the HIV prevention and treatment needs of KPs in generalized HIV epidemics is central to a comprehensive HIV response.
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Affiliation(s)
- Jack Stone
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | - Christinah Mukandavire
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | - Marie‐Claude Boily
- Department of Infectious Disease EpidemiologyImperial CollegeLondonUnited Kingdom
| | - Hannah Fraser
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
| | | | - Sheree Schwartz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Amrita Rao
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Matthew Quaife
- London School of Hygiene and Tropical MedicineLondonUnited Kingdom
| | | | - Alexander Marr
- University of California San FranciscoSan FranciscoCAUSA
| | - Tim Lane
- Equal InternationalWashingtonDCUSA
| | - Jenny Coetzee
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- South African Medical Research CouncilCape TownSouth Africa
| | - Glenda Gray
- South African Medical Research CouncilCape TownSouth Africa
| | - Kennedy Otwombe
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Minja Milovanovic
- Perinatal HIV Research UnitFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | | | | | - Adrian Puren
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Gillian Hunt
- National Institute of Communicable DiseasesJohannesburgSouth Africa
| | - Zamakayise Kose
- Research and Innovation OfficeNorth West UniversityPotchefstroomSouth Africa
| | | | - Stefan Baral
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Peter Vickerman
- Population Health SciencesUniversity of BristolBristolUnited Kingdom
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Stannah J, Dale E, Elmes J, Staunton R, Beyrer C, Mitchell KM, Boily MC. HIV testing and engagement with the HIV treatment cascade among men who have sex with men in Africa: a systematic review and meta-analysis. Lancet HIV 2019; 6:e769-e787. [PMID: 31601542 PMCID: PMC6993044 DOI: 10.1016/s2352-3018(19)30239-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND HIV disproportionately affects gay, bisexual, and other men who have sex with men (MSM) in Africa, where many countries criminalise same-sex behaviour. We assessed changes in the engagement of African MSM with HIV testing and treatment cascade stages over time, and the effect of anti-LGBT legislation and stigma. METHODS We systematically searched Embase, Global Health, MEDLINE, Scopus, and Web of Science for peer-reviewed cross-sectional or longitudinal studies recruiting at least ten MSM, published from Jan 1, 1980, to Oct 10, 2018. We extracted or derived estimates of HIV testing, engagement with the HIV treatment cascade, or both among African MSM from published reports. We derived pooled estimates using inverse-variance random-effects models. We used subgroup and meta-regression analysis to assess associations between testing and status awareness outcomes and study and participant characteristics, including the severity of country-level anti-LGBT legislation. FINDINGS Our searches identified 75 independent eligible studies that provided estimates for 44 993 MSM across one or more of five testing and treatment cascade outcomes. HIV testing increased significantly over time overall, with pooled proportions of MSM ever tested for HIV of 67·3% (95% CI 62·1-72·3; 44 estimates) and tested in the past 12 months of 50·1% (42·4-57·8, 31 estimates) after 2011, which were 14·8 percentage points and 17·9 percentage points higher than before 2011, respectively. After 2011, ever testing was highest in southern Africa (80·0%), and lowest in northern Africa (34·4%), with the greatest increase in western Africa (from 42·4% to 70·9%). Levels of testing ever, in the past 12 months, and status awareness were statistically significantly lower in countries with the most severe anti-LGBT legislation compared with countries with the least severe legislation (57·4% vs 71·6%, p=0·0056; 35·5% vs 49·3%, p=0·010; 6·7% vs 22·0%, p=0·0050). Few estimates were available for later stages of the treatment cascade. Available data after 2011 suggest that the pooled proportion of MSM HIV-positive aware has remained low (18·5%, 12·5-25·3; 28 estimates), whereas proportions of current antiretroviral therapy (ART) use were 23·7% (15·5-33·0; 13 estimates) among all MSM living with HIV and 60·1% (48·6-71·1; five estimates) among MSM HIV-positive aware of their status. Pooled levels of viral suppression among MSM currently on ART were 75·6% (64·4-85·5; four estimates), but only 24·7% (18·8-31·2; four estimates) among all MSM living with HIV. INTERPRETATION Despite improvements in HIV testing among MSM in Africa, HIV status awareness, ART coverage, and viral suppression remain much lower than required to achieve UNAIDS 90-90-90 targets. Further studies are urgently needed to provide more accurate estimates of levels of status awareness, engagement in care, ART coverage, and viral suppression among MSM to inform prevention efforts aimed at improving access to HIV services for MSM. Severe anti-LGBT legislation might be associated with lower HIV testing and status awareness; therefore, further research is needed to assess the effect of such legislation on HIV testing and engagement with the HIV treatment cascade among MSM. FUNDING US National Institutes of Health, UK Medical Research Council.
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Affiliation(s)
- James Stannah
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Elizabeth Dale
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Roisin Staunton
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Kate M Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK.
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Luvuno ZP, Mchunu G, Ncama B, Ngidi H, Mashamba-Thompson T. Evidence of interventions for improving healthcare access for lesbian, gay, bisexual and transgender people in South Africa: A scoping review. Afr J Prim Health Care Fam Med 2019; 11:e1-e10. [PMID: 31296011 PMCID: PMC6620546 DOI: 10.4102/phcfm.v11i1.1367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background The lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers’ heteronormative attitudes compromise the quality of care to the LGBT population. Aim The objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review. Setting This is a secondary literature review. Methods An electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Abstract and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011. Results Seventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised. Discussion It emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa.
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Affiliation(s)
- Zamasomi P Luvuno
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
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Abaver DT, Cishe EN. Violence, abuse and discrimination: key factors militating against control of HIV/AIDS among the LGBTI sector. SAHARA J 2018; 15:60-70. [PMID: 30025496 PMCID: PMC6060376 DOI: 10.1080/17290376.2018.1492960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) South Africans continue to face considerable challenges, including societal stigma, homophobic violence (particularly corrective rape), and high rates of sexually transmitted diseases and infections (particularly Human Immunodeficiency Virus (HIV)/AIDS) even when discrimination based on sexual orientation was outlawed by South African’s post-apartheid constitution. This study was conducted to ascertain violence, abuse and discrimination against the LGBTI sector as key factors that hinder the smooth implementation of HIV/AIDS programme among sexually minority (LGBTI) group in Walter Sisulu University, South Africa. The self-structured questionnaire was used to collect data. The study involved 3048 purposively selected participants (1285 male and 1763 female) aged 17–38 years. About 70.5% of the participants witnessed physical attack as a form of violence against people in same-gender relationship; 47.7% disagreed that violent targeted at this sexually minority group is justified. The LGBTI face challenges which include verbal insults (937, 32.4%), bullying (532, 18.4%) and name-calling (1389, 48%). Discrimination against members of the LGBTI sector was witnessed in various forms: non-acceptance (981, 33.9%), disapproval of act of homosexuals (1308, 45.2) and denial of rights (327, 11.3). Violence, abuse and discrimination which constitute stigmatisation among the LGBTI sector are received with mix feeling. Some respondents justified the use of one or more of these key elements of stigmatisation against the LGBTI (6.6%, supports violence), others condemned these acts of stigmatisation (28.8%), against discrimination). Social stigma which resulted from violence, abuse and discrimination exist in this institution and is responsible for the unwillingness of disclosure of sexual orientation among the LGBTI members. An enabling environment should be created where the LGBTI members could come out freely to access programmes targeted at the prevention and control of HIV/AIDS.
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Affiliation(s)
- Dominic Targema Abaver
- a Division of Academic Affairs and Research, Directorate of Research, Innovation and Development , Walter Sisulu University, NMD , Mthatha , South Africa
| | - Elphina Nomabandla Cishe
- b Directorate of Research Innovation and Development , Walter Sisulu University , Nelson Mandela Drive, Mthatha , Eastern Cape
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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: 1] [Impact Index Per Article: 0.2] [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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Maleke K, Daniels J, Lane T, Struthers H, McIntyre J, Coates T. How social stigma sustains the HIV treatment gap for MSM in Mpumalanga, South Africa. Glob Health Promot 2017; 26:6-13. [PMID: 29168662 DOI: 10.1177/1757975917737509] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are gaps in HIV care for men who have sex with men (MSM) in African settings, and HIV social stigma plays a significant role in sustaining these gaps. We conducted a three-year research project with 49 HIV-positive MSM in two districts in Mpumalanga Province, South Africa, to understand the factors that inform HIV care seeking behaviors. Semi-structured focus group discussions and interviews were conducted in IsiZulu, SiSwati, and some code-switching into English, and these were audio-recorded, transcribed, and translated into English. We used a constant comparison approach to analyze these data. HIV social stigma centered around gossip that sustained self-diagnosis and delayed clinical care with decisions to use traditional healers to mitigate the impact of gossip on their lives. More collaboration models are needed between traditional healers and health professionals to support the global goals for HIV testing and treatment.
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Affiliation(s)
| | - Joseph Daniels
- Department of Health Sciences, Lehman College of CUNY, New York, NY, USA
| | - Tim Lane
- Center for AIDS Prevention Science, UCSF, San Francisco, CA, USA
| | | | | | - Thomas Coates
- Center for World Health, David Geffen School of Medicine, UCLA Los Angeles, CA, USA
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Shaver J, Sullivan P, Siegler A, de Voux A, Phaswana-Mafuya N, Bekker LG, Baral SD, Wirtz AL, Beyrer C, Brown B, Stephenson R. Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2017; 16:562-571. [PMID: 29108450 DOI: 10.1177/2325957417736611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Combination prevention efforts are now recommended toward reducing HIV incidence among men who have sex with men (MSM). Understanding the perceptions of both MSM and service providers is critical to informing the development of prevention packages and ultimately improving intervention effectiveness. This study assessed the preferences of MSM and health service providers in the administration of HIV-prevention efforts. Qualitative data were gathered from a series of separate MSM and health care provider focus groups in 2 South African cities. Participants discussed HIV-prevention services and MSM client experiences within South Africa and identified the 3 most important clinic characteristics and 3 most important HIV-prevention services for MSM clients. Priorities indicated by both MSM and health care providers were confidentiality of visit, friendly staff, and condoms, while discrepancies existed between MSM and providers regarding provider consistency and the provision of pre-exposure prophylaxis/post-exposure prophylaxis (PrEP/PEP) and lubricant as prevention methods. Effective interventions must address these discrepancies through the design of intervention and provider training to optimally accommodate MSM.
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Affiliation(s)
- John Shaver
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Patrick Sullivan
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex de Voux
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Phaswana-Mafuya
- 3 HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa.,4 Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Linda-Gail Bekker
- 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,5 Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stefan D Baral
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea L Wirtz
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- 6 Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ben Brown
- 4 Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Rob Stephenson
- 1 Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Maleke K, Makhakhe N, Peters RP, Jobson G, De Swardt G, Daniels J, Lane T, McIntyre JA, Imrie J, Struthers H. HIV risk and prevention among men who have sex with men in rural South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 16:31-38. [PMID: 28367747 DOI: 10.2989/16085906.2017.1292925] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Rural South African men who have sex with men (MSM) are likely to be underserved in terms of access to relevant healthcare and HIV prevention services. While research in urban and peri-urban MSM populations has identified a range of factors affecting HIV risk in South African MSM, very little research is available that examines HIV risk and prevention in rural MSM populations. This exploratory study begins to address this lack by assessing perceptions of HIV risk among MSM in rural Limpopo province. Using thematic analysis of interview and discussion data, two overarching global themes that encapsulated participants' understandings of HIV risk and the HIV risk environment in their communities were developed. In the first theme, "community experience and the rural social environment", factors affecting HIV risk within the broad risk environment were discussed. These included perceptions of traditional value systems and communities as homophobic; jealousy and competition between MSM; and the role of social media as a means of meeting other MSM. The second global theme, "HIV/AIDS knowledge, risk and experience", focused on factors more immediately affecting HIV transmission risk. These included: high levels of knowledge of heterosexual HIV risk, but limited knowledge of MSM-specific risk; inconsistent condom and lubricant use; difficulties in negotiating condom and lubricant use due to uneven power dynamics in relationships; competition for sexual partners; multiple concurrent sexual partnerships; and transactional sex. These exploratory results suggest that rural South African MSM, like their urban and peri-urban counterparts, are at high risk of contracting HIV, and that there is a need for more in-depth research into the interactions between the rural context and the specific HIV risk knowledge and behaviours that affect HIV risk in this population.
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Affiliation(s)
- Kabelo Maleke
- a Anova Health Institute , Johannesburg , South Africa
| | | | | | | | | | - Joseph Daniels
- e Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine , University of California , Los Angeles , USA
| | - Timothy Lane
- g Center for AIDS Prevention Studies , University of California San Francisco , USA
| | - James A McIntyre
- a Anova Health Institute , Johannesburg , South Africa.,f School of Public Health & Family Medicine , University of Cape Town , Cape Town , South Africa
| | - John Imrie
- a Anova Health Institute , Johannesburg , South Africa.,c Centre for Sexual Health and HIV Research, Faculty of Population Health Sciences , University College , London , UK.,d Africa Centre for Health and Population Studies , University of KwaZulu-Natal , Mtubatuba , KwaZulu-Natal , South Africa
| | - Helen Struthers
- a Anova Health Institute , Johannesburg , South Africa.,b Division of infectious Diseases and HIV Medicine, Department of Medicine , University of Cape Town , Cape Town , South Africa
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Bazzi AR, Fergus KB, Stephenson R, Finneran CA, Coffey-Esquivel J, Hidalgo MA, Hoehnle S, Sullivan PS, Garofalo R, Mimiaga MJ. A Dyadic Behavioral Intervention to Optimize Same Sex Male Couples' Engagement Across the HIV Care Continuum: Development of and Protocol for an Innovative Couples-based Approach (Partner Steps). JMIR Res Protoc 2016; 5:e168. [PMID: 27562905 PMCID: PMC5016626 DOI: 10.2196/resprot.6271] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/22/2022] Open
Abstract
Background An estimated one- to two-thirds of new human immunodeficiency virus (HIV) infections among US men who have sex with men (MSM) occur within the context of primary partnerships. Thus, HIV interventions that recognize and harness the power of relationships are needed. Increasingly, HIV prevention efforts are being directed toward improving engagement across the HIV care continuum from testing to linkage to care, antiretroviral therapy (ART) adherence, engagement in care, and viral suppression. However, to our knowledge, no behavioral interventions have attempted to address the HIV care continuum using a dyadic approach. Objective The objective of this paper is to describe the development of and protocol for an innovative couples-based approach to improving treatment adherence and engagement in care among HIV serodiscordant and concordant HIV-positive same sex male couples in the United States. Methods We developed the Partner Steps intervention by drawing from relationship-oriented theory, existing efficacious individual-level ART adherence interventions, couple-focused HIV prevention interventions, and expert consultation. We incorporated new content to address all aspects of the HIV care continuum (eg, linkage to and retention in care) and to draw on relationship strengths through interactive activities. Results The resulting theory-based Partner Steps intervention is delivered by a trained bachelors-level counselor (interventionist) over 2 in-person sessions with male-male dyads in which at least 1 partner has recent suboptimal engagement in HIV care. Each session is designed to use relationship strengths to increase motivation for HIV care and treatment, and cover sequential intervention “steps” relating to specific challenges in HIV care engagement and barriers to ART adherence. For each step, couples work with a trained interventionist to identify their unique challenges, actively problem-solve with the interventionist, and articulate and commit to working together to implement a plan in which each partner agrees to complete specific tasks. Conclusions We drew on theory and evidence to develop novel intervention strategies that leverage strengths of relationships to address engagement across the entire HIV care continuum. We provide details on intervention development and content that may be of use to researchers as well as medical and mental health professionals for whom a dyadic approach to HIV prevention and care may best suit their patient population.
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Affiliation(s)
- Angela Robertson Bazzi
- Boston University School of Public Health, Department of Community Health Sciences, Boston University, Boston, MA, United States
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Evans MGB, Cloete A, Zungu N, Simbayi LC. HIV Risk Among Men Who Have Sex With Men, Women Who Have Sex With Women, Lesbian, Gay, Bisexual and Transgender Populations in South Africa: A Mini-Review. Open AIDS J 2016; 10:49-64. [PMID: 27347271 PMCID: PMC4893624 DOI: 10.2174/1874613601610010049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/10/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The HIV epidemic in South Africa is characterized mainly by heterosexual transmission. Recently, the importance of targeting key populations and marginalized groups, including men who have sex with men (MSM) and transgender people, has been added to the national agenda. OBJECTIVES This mini-review explores the current state of empirical research on HIV risk and MSM, women who have sex with women (WSW), lesbian, gay, bisexual and transgender (LGBT) populations in South Africa in order to assess the current state of research and identify gaps in the literature. METHOD Peer-reviewed empirical social and behavioral articles on HIV prevalence and risk focusing on MSM, WSW, and LGBT populations published since 2006 were included in this mini-review. RESULTS In total 35 articles were included: 30 on MSM, gay, and/or bisexual male-identified populations, three on WSW, lesbian, and/or bisexual female-identified populations, two on LGB youth, and none on transgender populations. CONCLUSION Despite South Africa being the country with the largest number of people living with HIV in the world, there is a limited amount of research in South Africa on HIV and non-normative gender identities and sexualities, especially WSW, lesbian, and/or bisexual female-identified populations, transgender populations, and LGB youth. Research with MSM, WSW, and LGBT populations should be prioritized in South Africa in order to appropriately inform HIV prevention strategies that meet the specific needs of these marginalized groups.
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Affiliation(s)
- Meredith G. B. Evans
- HUMA (Institute for Humanities in Africa) and Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Allanise Cloete
- HAST (HIV/AIDS, STIs and TB) Program, Human Sciences Research Council, Cape Town, South Africa
| | - Nompumelelo Zungu
- HAST (HIV/AIDS, STIs and TB) Program, Human Sciences Research Council, Cape Town, South Africa
| | - Leickness C. Simbayi
- HAST (HIV/AIDS, STIs and TB) Program, Human Sciences Research Council, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Sandfort T, Bos H, Knox J, Reddy V. Gender Nonconformity, Discrimination, and Mental Health Among Black South African Men Who Have Sex with Men: A Further Exploration of Unexpected Findings. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:661-70. [PMID: 26067298 PMCID: PMC4676953 DOI: 10.1007/s10508-015-0565-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/03/2015] [Accepted: 03/28/2015] [Indexed: 05/18/2023]
Abstract
Using data from a study about HIV risk among Black South African MSM, we aimed to ascertain whether unexpected findings about the relationship between gender nonconformity, discrimination, and mental health in this population, as reported by Cook, Sandfort, Nel, and Rich (2013), could be replicated, and to explore more in-depth how gender nonconformity relates to health. Cook et al. found that feminine men were not more likely to be depressed despite the observation that they were more likely to be discriminated against and that discrimination increased the likelihood of depression. This is in contrast to what studies among gay and bisexual men in Western countries have consistently shown. In the current study, 196 Black South African MSM (ages between 18 and 40; M age, 26.65 years) were surveyed. Assessments included stressors (identity confusion, internalized homophobia, and sexual orientation-based discrimination) and resilience factors (openness about one's sexual orientation, social support, and identification with the gay community). We observed that gender-nonconforming men were not more likely to be depressed despite having experienced more discrimination, which was associated with depression. The same relationships were observed when considering anxiety as the mental health outcome. We found an indirect negative effect of gender nonconformity on depression through internalized homophobia, suggesting that, in this population, internalized homophobia masks the effect of discrimination on mental distress. Implications for the sexual minority stress model, used to guide our analyses, are discussed. Further research is needed to disentangle the complex relationship between gender nonconformity and mental health among MSM populations.
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Affiliation(s)
- Theo Sandfort
- Division of Gender, Sexuality and Health, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive Unit 15, New York, NY 10032,
| | - Henny Bos
- Department of Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands,
| | - Justin Knox
- Mailman School of Public Health, Columbia University, 722 west 168 Street, NY 10032,
| | - Vasu Reddy
- Human and Social Development, Human Sciences Research Council, 134 Pretorius Street, Pretoria, South Africa 0002 and University of KwaZulu-Natal, Durban, South Africa,
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Bekker LG, Rebe K, Venter F, Maartens G, Moorhouse M, Conradie F, Wallis C, Black V, Harley B, Eakles R. Southern African guidelines on the safe use of pre-exposure prophylaxis in persons at risk of acquiring HIV-1 infection. South Afr J HIV Med 2016; 17:455. [PMID: 29568613 PMCID: PMC5843155 DOI: 10.4102/sajhivmed.v17i1.455] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.
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Affiliation(s)
| | - Kevin Rebe
- Anova Health Institute, Johannesburg, South Africa
| | - Francois Venter
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Gary Maartens
- Department of Medicine, University of Cape Town, South Africa
| | | | - Francesca Conradie
- Right to Care and Clinical HIV Research Unit, University of the Witwatersrand, South Africa
| | - Carole Wallis
- BARC, Johannesburg, South Africa.,Lancet Laboratories, Johannesburg, South Africa
| | - Vivian Black
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Beth Harley
- City Health, City of Cape Town, South Africa
| | - Robyn Eakles
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
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Pines HA, Goodman-Meza D, Pitpitan EV, Torres K, Semple SJ, Patterson TL. HIV testing among men who have sex with men in Tijuana, Mexico: a cross-sectional study. BMJ Open 2016; 6:e010388. [PMID: 26846899 PMCID: PMC4746448 DOI: 10.1136/bmjopen-2015-010388] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES HIV testing is critical to the delivery of comprehensive HIV prevention and care services, yet coverage of sexual minorities by HIV testing programmes remains insufficient in many low- and middle-income countries, including Mexico. The objective of this study was to identify the prevalence and correlates of HIV testing among men who have sex with men (MSM) in Tijuana, Mexico. METHODS We conducted a cross-sectional study (2012-2013) among 189 MSM recruited via respondent-driven sampling (RDS). RDS-weighted logistic regression was used to identify correlates of prior HIV testing. RESULTS RDS-adjusted prevalence of prior and recent (≤ 12 months) HIV testing was 63.5% (95% CI 51.9% to 73.5%) and 36.8% (95% CI 25.4% to 46.4%), respectively. Prior HIV testing was positively associated with older age (adjusted OR (AOR)=1.09, 95% CI 1.04 to 1.15), being born in Tijuana (AOR=2.68, 95% CI 1.05 to 6.86), higher levels of education (AOR=2.65, 95% CI 1.08 to 6.53), identifying as homosexual or gay (AOR=3.73, 95% CI 1.48 to 9.42), being more 'out' about having sex with men (AOR=1.28, 95% CI:1.02 to 1.62), and a history of sexual abuse (AOR=3.24, 95% CI 1.06 to 9.86). Prior HIV testing was negatively associated with reporting more condomless anal intercourse acts (past 2 months) (AOR=0.95, 95% CI 0.92 to 0.98) and greater internalised homophobia (AOR=0.92, 95% CI 0.86 to 0.99). CONCLUSIONS Our findings indicate an urgent need for expanded HIV testing services for MSM in Tijuana. Innovative, non-stigmatising, confidential HIV testing interventions targeted at young, less educated, migrant and non-gay identifying MSM may facilitate HIV testing and timely linkage to HIV care and treatment within this population.
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Affiliation(s)
- Heather A Pines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - David Goodman-Meza
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Eileen V Pitpitan
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Karla Torres
- Agencia Familiar Binacional, AC, Tijuana, Mexico
| | - Shirley J Semple
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
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Gender Expression and Risk of HIV Infection Among Black South African Men Who Have Sex with Men. AIDS Behav 2015; 19:2270-9. [PMID: 25869555 DOI: 10.1007/s10461-015-1067-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To explore demographic, behavioral and psychosocial risk factors for HIV infection in South African MSM we recruited 480 MSM (aged 18 and 44 years) using respondent-driven sampling. Data were collected through individual computer-assisted face-to-face interviews. Participants were tested for HIV. RDS-adjusted HIV prevalence is 30.1 % (unadjusted 35.6 %). Few participants had ever engaged in both receptive and insertive anal sex; sex with women was frequently reported. Independent demographic and behavioral correlates of HIV infection include age, education, number of male sexual partners, ever having been forced to have sex, and ever having engaged in transactional sex; engagement in sex with women was a protective factor. Psychosocial risk factors independently associated with HIV infection were feminine identification, internalized homophobia, and hazardous drinking. Our findings confirm what has been found in other studies, but also suggest that the dynamics and context of sexual transmission among MSM in South Africa differ from those among MSM in Western countries.
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de Voux A, Baral S, Bekker LG, Beyrer C, Phaswana-Mafuya N, Siegler A, Sullivan P, Winskell K, Stephenson R. A social network typology and sexual risk-taking among men who have sex with men in Cape Town and Port Elizabeth, South Africa. CULTURE, HEALTH & SEXUALITY 2015; 18:509-23. [PMID: 26569376 PMCID: PMC4930490 DOI: 10.1080/13691058.2015.1096419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite the high prevalence of HIV among men who have sex with men in South Africa, very little is known about their lived realities, including their social and sexual networks. Given the influence of social network structure on sexual risk behaviours, a better understanding of the social contexts of men who have sex with men is essential for informing the design of HIV programming and messaging. This study explored social network connectivity, an understudied network attribute, examining self-reported connectivity between friends, family and sex partners. Data were collected in Cape Town and Port Elizabeth, South Africa, from 78 men who have sex with men who participated in in-depth interviews that included a social network mapping component. Five social network types emerged from the content analysis of these social network maps based on the level of connectivity between family, friends and sex partners, and ranged from disconnected to densely connected networks. The ways in which participants reported sexual risk-taking differed across the five network types, revealing diversity in social network profiles. HIV programming and messaging for this population can greatly benefit from recognising the diversity in lived realities and social connections between men who have sex with men.
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Affiliation(s)
- Alex de Voux
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Phaswana-Mafuya
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa
| | - Aaron Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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Correlates of HIV Testing Among Men Who have Sex with Men in Three Urban Areas of Mozambique: Missed Opportunities for Prevention. AIDS Behav 2015; 19:1978-89. [PMID: 25987189 PMCID: PMC4598353 DOI: 10.1007/s10461-015-1044-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This is the first study to identify levels of recent HIV testing and associated factors among men who have sex with men (MSM) in Mozambique. Using data from Maputo (n = 493), Beira (n = 572), and Nampula/Nacala (n = 347), collected via respondent-driven sampling in 2011, and excluding those with prior known infection, we found that 30.4 % [95 % confidence interval (CI) 25.0–36.3 %], 42.1 % (95 % CI 36.8–47.3 %) and 29.8 % (95 % CI 22.9–36.9 %), respectively, had recently tested for HIV (≤12 months), while between three and five out of 10 MSM had never tested. A range of factors was associated with recent HIV testing such as familiarity with the modes of transmission, knowledge of antiretroviral treatment for HIV, contact with peer educators and awareness of partner serostatus; yet, surprisingly recent healthcare utilization was not associated with recent testing. Findings provide evidence that structural and behavioral interventions among MSM may play an important role in increasing HIV testing.
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Correlates of prior HIV testing among men who have sex with men in Cameroon: a cross-sectional analysis. BMC Public Health 2014; 14:1220. [PMID: 25424530 PMCID: PMC4258040 DOI: 10.1186/1471-2458-14-1220] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Regular HIV testing is vital for timely linkage to the HIV care continuum and ensuring the success of behavioral and biomedical interventions to prevent HIV acquisition. Men who have sex with men (MSM) are a key population for HIV prevention, treatment, and care efforts globally. This study measures the factors associated with prior HIV testing among MSM in Cameroon. Methods In 2011, 272 and 239 MSM aged ≥ 18 were recruited from Douala and Yaoundé respectively using respondent-driven sampling (RDS) for a cross-sectional surveillance study. Participants completed a structured socio-behavioral survey and were offered HIV and syphilis testing and counseling. Results The majority of men self-reported ever testing for HIV (81.6%; 413/506) and receiving their last HIV test result (95.4%; 394/413). Testing in the last 12 months was more prevalent in Douala (63.3%; 169/267) compared to Yaoundé (55.9%; 132/236). Median frequency of testing was every 18 months in Douala and every two years in Yaoundé. In multivariate RDS-weighted analysis, correlates of ever testing for HIV in Douala were: having higher than secondary education compared to having secondary education or less (aOR = 3.51, 95% CI: 1.32-9.34), ever accessing a community-based HIV service for MSM (aOR = 3.37, 95% CI: 1.57-7.24) and having ≥4 male oral or anal sexual partners in the past 12 months (aOR = 2.49, 1.08-5.74). In Yaoundé, having higher than secondary education (aOR = 7.96, 95% CI: 1.31-48.41) was associated with ever testing for HIV. Conclusions Supporting regular HIV testing and linkage to care is important in a context of high HIV prevalence and limited use of condoms and condom-compatible lubricants. Building the capacity of MSM organizations and mainstream health services to deliver affordable, integrated, confidential, and MSM-sensitive HIV testing may assist in effectively engaging more MSM in the HIV treatment cascade. Giving specific attention to MSM who are younger, of lower socioeconomic status and less connected to community-based MSM organizations may increase HIV testing uptake. Given the levels of HIV testing and high HIV prevalence among MSM in Cameroon, optimizing the safe and effective provision and uptake of antiretroviral-based prevention and treatment approaches is paramount in changing the trajectory of the HIV epidemic among these men and within their sexual networks.
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Pylli M, Middleton N, Charalambous A, Raftopoulos V. HIV prevalence, sexual and HIV testing behaviors among men who have sex with men in the Republic of Cyprus: 2011-2012 data from a cross-sectional study. BMC Infect Dis 2014; 14:432. [PMID: 25100634 PMCID: PMC4131022 DOI: 10.1186/1471-2334-14-432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022] Open
Abstract
Background The Republic of Cyprus is recognized as a low level HIV epidemic country with strong evidence of an increase in the transmission through the male to male sexual contact. Little is known about the factors that influence the sexual and HIV testing behavior in the Republic of Cyprus. Methods This is the first bio-behavioral study among men who have sex with men (MSM) in three major cities in the Republic of Cyprus, conducted between 2011 and 2012. Eligible participants were sampled in gay venues by using time-location sampling. Results Estimated HIV prevalence was 2.5%. The mean age of the sample was 29 ± 6.6 years old. One out of three MSM has not been tested for HIV in the last year. Multivariate logistic regression analysis revealed that the educational level (AOR 0.23, 95% CI 0.09-0.55), the cocaine use (AOR 3.78, 95% CI 1.21-11.83) as well as the type of sexual partner i.e. steady vs casual (AOR 0.18, 95% 0.08-0.45) were significantly associated with condom use in the last anal intercourse. Conclusions HIV prevalence among MSM in the Republic of Cyprus remains low; however more efforts are needed in order to increase HIV awareness and prevent the expansion of HIV epidemic in broader community.
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Affiliation(s)
| | | | | | - Vasilios Raftopoulos
- Cyprus University of Technology, Nursing Department, Mediterranean Research Centre for Public Health and Quality of Care, 15, Vragadinou Str, 3041 Limassol, Cyprus.
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Outcomes of a community-based HIV-prevention pilot programme for township men who have sex with men in Cape Town, South Africa. J Int AIDS Soc 2013; 16 Suppl 3:18754. [PMID: 24321116 PMCID: PMC3852355 DOI: 10.7448/ias.16.4.18754] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/17/2013] [Accepted: 10/02/2013] [Indexed: 02/08/2023] Open
Abstract
Introduction Men who have sex with men (MSM) in Cape Town's townships remain in need of targeted HIV-prevention services. In 2012, a pilot community-based HIV-prevention programme was implemented that aimed to reach MSM in five Cape Town townships, disseminate HIV-prevention information and supplies, and promote the use of condoms and HIV services. Methods Convenience sampling was used to recruit self-identified MSM who were 18 years old or older in five Cape Town townships. The six-month pilot programme trained five community leaders who, along with staff, provided HIV-prevention information and supplies to MSM through small-group meetings, community-based social activities and inter-community events. After the completion of the pilot programme, in-depth interviews and focus group discussions (FGDs) were conducted with a subset of conveniently sampled participants and with each of the community leaders. Qualitative data were then analyzed thematically. Results Overall, 98 mostly gay-identified black MSM consented to participate, 57 community-based activities were facilitated and 9 inter-community events were conducted. Following their enrolment, 60% (59/98) of participants attended at least one pilot activity. Of those participants, 47% (28/59) attended at least half of the scheduled activities. A total of 36 participants took part in FGDs, and five in-depth interviews were completed with community leaders. Participants reported gaining access to MSM-specific HIV-prevention information, condoms and water-based lubricant through the small-group meetings. Some participants described how their feelings of loneliness, social isolation, self-esteem and self-efficacy were improved after taking part. Conclusions The social activities and group meetings were viable strategies for disseminating HIV-prevention information, condoms and water-based lubricant to MSM in this setting. Many MSM were also able to receive social support, reduce social isolation and improve their self-esteem. Further research is needed to explore factors affecting attendance and the sustainability of these activities. Perspectives of MSM who did not attend pilot activities regularly were not equally represented in the final qualitative interviews, which could bias the findings. The use of community-based activities and small-group meetings should be explored further as components to ongoing HIV-prevention interventions for MSM in this setting.
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Kaighobadi F, Knox J, Reddy V, Sandfort T. Age and sexual risk among Black men who have sex with men in South Africa: the mediating role of attitudes toward condoms. J Health Psychol 2013; 19:1271-8. [PMID: 23818509 DOI: 10.1177/1359105313488977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The results of research linking age and sexual risk among men who have sex with men have been inconsistent. This study assessed the relationship between age and sexual risk among 193 Black men who have sex with men in Pretoria. Older men who have sex with men reported engaging in more frequent unprotected insertive anal intercourse. We examined whether components of Information-Motivation-Behavioral Skills model mediated this relationship. Results showed that (1) older age predicts less positive attitudes toward condoms, (2) less positive attitudes predict more frequent unprotected insertive anal intercourse, and (3) attitudes mediate the relationship between age and frequency of unprotected insertive anal intercourse. We consider two possible explanations for these findings: a developmental trajectory and a cohort effect.
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Affiliation(s)
- Farnaz Kaighobadi
- HIV Center for Clinical & Behavioral Studies at Columbia University and New York State Psychiatric Institute, USA
| | - Justin Knox
- Columbia University Mailman School of Public Health, USA
| | - Vasu Reddy
- Human Sciences Research Council, South Africa University of KwaZulu-Natal, South Africa
| | - Theo Sandfort
- HIV Center for Clinical & Behavioral Studies at Columbia University and New York State Psychiatric Institute, USA
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Stephenson R, Chard A, Finneran C, Sullivan P. Willingness to use couples voluntary counseling and testing services among men who have sex with men in seven countries. AIDS Care 2013; 26:191-8. [PMID: 23786340 DOI: 10.1080/09540121.2013.808731] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The willingness of male-male dyads to use couples voluntary HIV counseling and testing (CVCT) has not been previously investigated globally among men who have sex with men (MSM). Using online advertisements, data were collected from 3245 MSM in seven countries who were ≥ 18 years of age and had ≥1 male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT. The willingness to utilize CVCT was compellingly high, ranging from 79% in Australia and UK to 90% in Brazil. Older MSM and those who reported not knowing their sero-status reported lower odds of willingness to use CVCT. The relationship between being in a relationship and willingness to use CVCT varied across countries, perhaps reflecting varied local understandings of the nature and content of CVCT. Further work is required to examine willingness to use CVCT among a more heterogeneous population of MSM, and to examine how CVCT services are locally perceived in order to provide information vital for the development of locally appropriate messages to promote CVCT for MSM.
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Affiliation(s)
- Rob Stephenson
- a Hubert Department of Global Health, Rollins School of Public Health , Emroy University , Atlanta , GA , USA
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Muraguri N, Temmerman M, Geibel S. A decade of research involving men who have sex with men in sub-Saharan Africa: current knowledge and future directions. SAHARA J 2013; 9:137-47. [PMID: 23237068 DOI: 10.1080/17290376.2012.744176] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
It has been just over 10 years since the first large behavioral survey of men who have sex with men (MSM) was implemented in Senegal in 2001. Since then, behavioral and/or HIV prevalence surveys have been conducted in over 14 other countries in sub-Saharan Africa. Current available evidence and review have established that HIV prevalence among MSM in these countries are significantly higher than corresponding general populations, that MSM engage in sexual risk behaviors that place them and sexual partners at higher risk, and that issues of discrimination and stigmatization inhibit HIV interventions for MSM. This paper summarizes the existing knowledge, describes limitations of this evidence, and proposes new and enhanced research approaches to fulfill needed gaps to inform national HIV responses for MSM populations.
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Stephenson R, Rentsch C, Sullivan P, McAdams-Mahmoud A, Jobson G, Struthers H, McIntyre J. Attitudes toward couples-based HIV counseling and testing among MSM in Cape Town, South Africa. AIDS Behav 2013; 17 Suppl 1:S43-50. [PMID: 22961498 PMCID: PMC3529975 DOI: 10.1007/s10461-012-0293-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Couples-based voluntary HIV counseling and testing (CVCT) allows couples to receive their HIV test results together and has been demonstrated to be effective in reducing HIV transmission, increasing and sustaining condom use, and reducing sexual risk-taking among at-risk heterosexual couples. However, the acceptability of CVCT among MSM has yet to be evaluated in an African setting. The results from seven focus group discussions and 29 in-depth interviews conducted in Cape Town, South Africa exhibit overwhelmingly high acceptance of CVCT. Participants were attracted to the counseling components of the service, stating that these would allow for the couple to increase their commitment and to explore methods of how to effectively reduce their risk of acquiring or transmitting HIV in the presence of a trained counselor. These results suggest CVCT would be highly welcomed and could work to fill the significant lack of services available and accessible to MSM couples in Cape Town.
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Affiliation(s)
- Rob Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, #7025, Atlanta, GA 30322, USA.
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Imrie J, Hoddinott G, Fuller S, Oliver S, Newell ML. Why MSM in rural South African communities should be an HIV prevention research priority. AIDS Behav 2013. [PMID: 23196857 PMCID: PMC3627851 DOI: 10.1007/s10461-012-0356-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Research into HIV and men who have sex with men’s (MSM) health in South Africa has been largely confined to the metropolitan centres. Only two studies were located making reference to MSM in rural contexts or same-sex behaviors among men in the same. There is growing recognition in South Africa that MSM are not only disproportionately affected by HIV and have been underserved by the country’s national response, but that they contribute significantly to sustaining the high number of new infections recorded each year. We argue that to meet the objectives of the country’s national strategic plan for HIV, STI and TB it is important we know how these behaviours may be contributing to the sustained rural HIV epidemic in the youngest age groups and determine what constitutes appropriate and feasible programmatic response that can be implemented in the country’s public sector health services.
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Nel JA, Yi H, Sandfort TGM, Rich E. HIV-untested men who have sex with men in South Africa: the perception of not being at risk and fear of being tested. AIDS Behav 2013; 17 Suppl 1:S51-9. [PMID: 23054041 DOI: 10.1007/s10461-012-0329-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A community-based needs assessment among men who have sex with men (MSM) in South Africa found that 27 % (n = 280/1,045) of MSM had never been tested for HIV. The most frequently reported reasons for not having been tested were the perception of not being at risk (57 %) and fear of being tested (52 %). This article explores factors associated with these two reasons among the untested MSM. In multiple logistic regressions, the perception of not being at risk of HIV infection was negatively associated with being black, coloured or Indian, being sexually active, knowing people living with HIV, and a history of sexually transmitted infections (STIs) in the past 24 months (adj. OR = .24, .32, .38, and .22, respectively). Fear of being tested for HIV was positively associated with being black, coloured or Indian, preferred gender expression as feminine, being sexually active, a history of STIs, and experience of victimization on the basis of sexual orientation (adj. OR = 2.90, 4.07, 4.62, 5.05, and 2.34, respectively). Results suggest that HIV prevention programs directed at South African MSM will be more effective if testing and treatment of STIs are better integrated into HIV testing systems. Finally, social exclusion on the basis of race and sexual orientation ought to be addressed in order to reach hidden, at-risk, populations of MSM.
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Social Determinants of Health Associated with Self-Reported HIV Testing among Women. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:436-42. [PMID: 23785685 PMCID: PMC3684732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There currently is lack of knowledge about HIV testing practices in Iran. The purpose of this pilot study was to evaluate the prevalence of self-reported HIV testing and its associated factors among women. METHODS This cross-sectional study was conducted in Sanandaj City, located in the west of Iran, in 2012. Data were collected using self-administered questionnaire including demographics characteristics and the main outcome variable was self-reported HIV testing. The univariate and multivariate logistic regression models using STATA software was used for data analysis. RESULTS A total of 1200 women were interviewed during the study (Response rate=87.5%). The mean age was 29.67 years (SD: 7.01 years), 49% were aged 28 years or younger, 39.2% were single, 16.9% were pregnant and 60% did not have academic education. The proportion of women that were HIV-tested was, 32.1% (CI 95%: 29.2%, 35.0%). HIV testing was associated with younger age, knowledge of HIV/AIDS, household wealth, pregnancy, academic education, occupation and duration time of occupation, rating of quality of health services and substance use history in her husband. CONCLUSION The self-reported HIV testing rate among our sample women is 32.1%, lower than the HIV testing rate in other studies. Therefore, interventions to expand HIV testing and increase awareness of HIV risk are urgently needed in Iran.
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Cook SH, Sandfort TG, Nel JA, Rich EP. Exploring the relationship between gender nonconformity and mental health among black South african gay and bisexual men. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:327-30. [PMID: 23440563 PMCID: PMC3636307 DOI: 10.1007/s10508-013-0087-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Stephanie H. Cook
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th St., Room 556, New York, NY 10032
| | - Theo G.M. Sandfort
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY
| | - Juan A. Nel
- Department of Psychology, University of South Africa, Pretoria, South Africa
| | - Eileen P. Rich
- Department of Psychology, University of South Africa, Pretoria, South Africa
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Dunkle KL, Jewkes RK, Murdock DW, Sikweyiya Y, Morrell R. Prevalence of consensual male-male sex and sexual violence, and associations with HIV in South Africa: a population-based cross-sectional study. PLoS Med 2013; 10:e1001472. [PMID: 23853554 PMCID: PMC3708702 DOI: 10.1371/journal.pmed.1001472] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 05/09/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus. METHODS AND FINDINGS In a cross-sectional study conducted in 2008, men aged 18-49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male-male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26-12.3), and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22-7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24-7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58; 95% CI 1.17-10.9). CONCLUSIONS In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male-female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been common. These findings suggest that HIV prevention messages regarding male-male sex in South Africa should be mainstreamed with prevention messages for the general population, and sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence.
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Affiliation(s)
- Kristin L. Dunkle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Center for AIDS Research, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Rachel K. Jewkes
- Gender and Health Research Unit, Medical Research Council of South Africa, Pretoria, South Africa
- * E-mail:
| | - Daniel W. Murdock
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Center for AIDS Research, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Yandisa Sikweyiya
- Gender and Health Research Unit, Medical Research Council of South Africa, Pretoria, South Africa
| | - Robert Morrell
- Programme for the Enhancement of Research Capacity, University of Cape Town, Cape Town, South Africa
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Makofane K, Gueboguo C, Lyons D, Sandfort T. Men who have sex with men inadequately addressed in African AIDS National Strategic Plans. Glob Public Health 2012; 8:129-43. [PMID: 23252398 DOI: 10.1080/17441692.2012.749503] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Through an analysis of AIDS National Strategic Plans (NSPs), this study investigated the responses of African governments to the HIV epidemics faced by men who have sex with men (MSM). NSPs from 46 African countries were systematically analysed, with attention focused on (1) the representation of MSM and their HIV risk, (2) the inclusion of epidemiologic information on the HIV epidemic among MSM and (3) government-led interventions addressing MSM. Out of 46 NSPs, 34 mentioned MSM. While two-thirds of these NSPs acknowledged the vulnerability of MSM to HIV infection, fewer than half acknowledged the role of stigma or criminalisation. Four NSPs showed estimated HIV prevalence among MSM, and one included incidence. Two-thirds of the NSPs proposed government-led HIV interventions that address MSM. Those that did plan to intervene planned to do so through policy interventions, social interventions, HIV-prevention interventions, HIV-treatment interventions and monitoring activities. Overall, the governments of the countries included in the study exhibited little knowledge of HIV disease dynamics among MSM and little knowledge of the social dynamics behind MSM's HIV risk. Concerted action is needed to integrate MSM into NSPs and governmental health policies in a way that acknowledges this population and its specific HIV/AIDS-related needs.
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Affiliation(s)
- Keletso Makofane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Millett GA, Jeffries WL, Peterson JL, Malebranche DJ, Lane T, Flores SA, Fenton KA, Wilson PA, Steiner R, Heilig CM. Common roots: a contextual review of HIV epidemics in black men who have sex with men across the African diaspora. Lancet 2012; 380:411-23. [PMID: 22819654 DOI: 10.1016/s0140-6736(12)60722-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8·5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM across the African diaspora share common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality during HIV testing or treatment, low access to HIV drugs, threats of violence or incarceration, and few targeted HIV prevention resources.
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Affiliation(s)
- Gregorio A Millett
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 20201, USA.
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Knox J, Sandfort T, Yi H, Reddy V, Maimane S. Social vulnerability and HIV testing among South African men who have sex with men. Int J STD AIDS 2012; 22:709-13. [PMID: 22174050 DOI: 10.1258/ijsa.2011.010350] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined whether social vulnerability is associated with HIV testing among South African men who have sex with men (MSM). A community-based survey was conducted with 300 MSM in Pretoria in 2008. The sample was stratified by age, race and residential status. Social vulnerability was assessed using measures of demographic characteristics, psychosocial determinants and indicators of sexual minority stress. Being black, living in a township and lacking HIV knowledge reduced MSM's likelihood of ever having tested for HIV. Among those who had tested, lower income and not self-identifying as gay reduced men's likelihood of having tested more than once. Lower income and internalized homophobia reduced men's likelihood of having tested recently. Overall, MSM in socially vulnerable positions were less likely to get tested for HIV. Efforts to mitigate the effects of social vulnerability on HIV testing practices are needed in order to encourage regular HIV testing among South African MSM.
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Affiliation(s)
- J Knox
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
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Lorente N, Henry E, Fugon L, Yomb Y, Carrieri MP, Eboko F, Spire B. Proximity to HIV is associated with a high rate of HIV testing among men who have sex with men living in Douala, Cameroon. AIDS Care 2012; 24:1020-7. [PMID: 22519605 DOI: 10.1080/09540121.2012.668172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In low- and middle-income countries, men who have sex with men (MSM) are 19 times more likely to be HIV positive compared with background populations. Criminalisation and social rejection of homosexuality in most sub-Saharan African countries reinforce stigma and exclude MSM from prevention activities, including HIV testing. This paper's purpose is to identify factors associated with never having been HIV tested (NHT), among a sample of Cameroonian MSM. In 2008, a community-based study was conducted in Douala, the economic capital city of Cameroon, by a local NGO Alternatives-Cameroun, recruiting participants through the snowball technique and administering a questionnaire during face-to-face interviews. Proximity to HIV was investigated according to the following criteria: knowing at least one person living with HIV and having been exposed to HIV prevention interventions. NHT was defined as reporting to have never been HIV tested. A logistic regression was used to identify factors associated with NHT. Among the 165 MSM of our study group who reported that they were not HIV positive, 19% reported NHT. Factors independently associated with NHT were as follows: being younger, being Muslim, not having a steady male partner, not knowing any person living with HIV and never having been exposed to HIV prevention interventions. In this MSM population, a small proportion reported that they had never been HIV tested and among these, the percentage was higher among individuals not in proximity to HIV. Despite the hostile context of sub-Saharan African countries towards MSM, local and national HIV testing campaigns to date may have played a substantial role in raising HIV awareness in the MSM population living in Douala, and peer-based counselling may have educated those in contact with Alternatives-Cameroun regarding the positive value of HIV testing. This result is a further argument for continuing community-based prevention and extending it to difficult-to-reach MSM.
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Fan S, Lu H, Ma X, Sun Y, He X, Li C, Raymond H, McFarland W, Sun J, Ma W, Jia Y, Xiao Y, Shao Y, Ruan Y. Behavioral and serologic survey of men who have sex with men in Beijing, China: implication for HIV intervention. AIDS Patient Care STDS 2012; 26:148-55. [PMID: 22248333 DOI: 10.1089/apc.2011.0277] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed HIV prevalence and associated behaviors and risk factors among men who have sex with men (MSM) in Beijing, China. Five hundred MSM were recruited for a biological and behavioral survey using respondent-driven sampling (RDS) in 2009. Serologic specimens were tested for markers of HIV and syphilis infection. A computer-assisted personal interview (CAPI) administered questionnaire gathered information including demographic characteristics, sexual behaviors, HIV testing, and social norms concerning condom use. The adjusted HIV prevalence was 8.0%, syphilis 22.0%. HIV testing and disclosure was low; only 39.3% had HIV tested in the past 12 months, 49.7% knew their own HIV status and 22.8% knew their last male partner's HIV status. HIV infection was associated with syphilis, ever having sex with a woman, not knowing the HIV status of the most recent male partner, and never buying condoms in the past 12 months. Stronger endorsement of positive social norms around condom use strongly and predicted lower prevalence of HIV infection. Compared to surveys of similar design in the recent past, HIV continues to spread rapidly among Beijing's MSM. Our results identify points of intervention that, if addressed in time, may still alter the course of the epidemic including the promotion of HIV testing and partner disclosure, syphilis control and particularly changing social norms around condom use.
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Affiliation(s)
- Song Fan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Hongyan Lu
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiaoyan Ma
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Yanming Sun
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiong He
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Chunmei Li
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - H.F. Raymond
- San Francisco Department of Public Health, San Francisco, California
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jiangping Sun
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Wei Ma
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Yujiang Jia
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yan Xiao
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
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Stephenson R, Rentsch C, Sullivan P. High levels of acceptability of couples-based HIV testing among MSM in South Africa. AIDS Care 2011; 24:529-35. [PMID: 22007940 PMCID: PMC3279614 DOI: 10.1080/09540121.2011.617413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The acceptability of couples-based voluntary HIV counseling and testing (CVCT) has not been previously investigated among men who have sex with men (MSM) in South Africa. Using online advertisements, data were collected from 486 MSM, who were 18 years of age or older with a current residence in South Africa and had at least one male sex partner in the previous 12 months. The analysis examined associations between individual characteristics and willingness to utilize CVCT services. The willingness to utilize CVCT services was compellingly high (89%) among this sample of mostly White/European African (89%) and HIV-negative (83%) men. MSM who reported higher numbers of completed school years were less likely to report willingness to use CVCT. Willingness did not vary significantly across other individual demographic or behavioral characteristics. Our results show an overwhelmingly high acceptance of CVCT services. Future studies should survey a more heterogeneous population of MSM, explore the complex nature of same-sex male relationships, and why respondents would or would not use these HIV testing services.
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Affiliation(s)
- Rob Stephenson
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
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Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, McIntyre J. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men's Study. AIDS Behav 2011; 15:626-34. [PMID: 19662523 PMCID: PMC2888758 DOI: 10.1007/s10461-009-9598-y] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 07/27/2009] [Indexed: 11/28/2022]
Abstract
The Soweto Men’s Study assessed HIV prevalence and associated risk factors among MSM in Soweto, South Africa. Using respondent driven sampling (RDS) recruitment methods, we recruited 378 MSM (including 15 seeds) over 30 weeks in 2008. All results were adjusted for RDS sampling design. Overall HIV prevalence was estimated at 13.2% (95% confidence interval 12.4–13.9%), with 33.9% among gay-identified men, 6.4% among bisexual-identified men, and 10.1% among straight-identified MSM. In multivariable analysis, HIV infection was associated with being older than 25 (adjusted odds ratio (AOR) 3.8, 95% CI 3.2–4.6), gay self-identification (AOR 2.3, 95% CI 1.8–3.0), monthly income less than ZAR500 (AOR 1.4, 95% CI 1.2–1.7), purchasing alcohol or drugs in exchange for sex with another man (AOR 3.9, 95% CI 3.2–4.7), reporting any URAI (AOR 4.4, 95% CI 3.5–5.7), reporting between six and nine partners in the prior 6 months (AOR 5.7, 95% CI 4.0–8.2), circumcision, (AOR 0.2, 95% CI 0.1–0.2), a regular female partner (AOR 0.2, 95% CI 0.2–0.3), smoking marijuana in the last 6 months (AOR 0.6, 95% CI 0.5–0.8), unprotected vaginal intercourse in the last 6 months (AOR 0.5, 95% CI 0.4–0.6), and STI symptoms in the last year (AOR 0.7, 95% CI 0.5–0.8). The results of the Soweto Men’s Study confirm that MSM are at high risk for HIV infection, with gay men at highest risk. HIV prevention and treatment for MSM are urgently needed.
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Affiliation(s)
- Tim Lane
- Center for AIDS Prevention Studies, University of California San Francisco, USA.
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Gu J, Lau JTF, Tsui H. Psychological factors in association with uptake of voluntary counselling and testing for HIV among men who have sex with men in Hong Kong. Public Health 2011; 125:275-82. [PMID: 21419466 DOI: 10.1016/j.puhe.2011.01.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the prevalence and factors associated with uptake of voluntary counselling and testing (VCT) for human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Hong Kong. STUDY DESIGN Cross-sectional study. METHODS A total of 389 MSM were recruited from gay venues. An additional 188 MSM were recruited through the Internet. Data were collected via face-to-face interviews using a self-administered anonymous questionnaire or via an electronic questionnaire accessible via local gay-friendly websites. The associations between independent and dependent variables (VCT uptake in lifetime and in last 12 months) were examined by logistic regression models. RESULTS The prevalence rates for lifetime and 12-month uptake of VCT were 56.5% and 39.4%, respectively. Adjusting for significant background variables, all cognitive variables (attitudes, subjective norms, perceived control and behavioural intention) that were derived from the Theory of Planned Behaviours (TPB) were significantly associated with both lifetime and 12-month uptake of VCT [adjusted odds ratio (AOR) 0.56-4.71, P < 0.05]. Perceived fear of contracting HIV and perceived discrimination towards local MSM were associated with a lower likelihood of 12-month uptake of VCT (AOR 0.63, P < 0.05) and lifetime uptake (AOR 0.65, P < 0.05). In the summary models, variables derived from the TPB (subjective norms, perceived control and behavioural intention) were independently associated with lifetime and 12-month uptake of VCT (OR 0.64-2.78, P < 0.05; OR 2.39-3.21, P < 0.05, respectively). Fear of contracting HIV was associated with VCT uptake in the last 12 months (OR 0.55, P < 0.05). CONCLUSIONS Psychological factors are associated with VCT uptake. The TPB and other health behavioural theories should be taken into account when designing VCT promotion campaigns.
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Affiliation(s)
- J Gu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Knox J, Yi H, Reddy V, Maimane S, Sandfort T. The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa. PSYCHOL HEALTH MED 2010; 15:660-71. [PMID: 21154019 PMCID: PMC3058799 DOI: 10.1080/13548506.2010.507772] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study is to assess (1) whether beliefs about trust and condom use affect sexual risk behaviour, and (2) if beliefs about trust and condom use impact sexual risk behaviour directly or if this relationship is mediated by other determinants. The Information-Motivation-Behavioural Skills model was used as a framework for the mediation analysis. A diverse cohort of three hundred 18-40 year old men who have sex with men (MSM) residing in Pretoria, South Africa, were recruited and surveyed for this project. Findings indicate that men who report a high frequency of past unprotected anal intercourse are more likely to believe that it is not necessary to use condoms with a trusted or steady partner regardless of their current partnership status. This fallacy of intimacy appears to affect sexual risk behaviour through intentions and attitudes regarding safer sex practices. Based on these findings, we recommend that more attention be given in gaining a better understanding of how beliefs about trust and condom use are formed and how they can be changed among MSM in South Africa.
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Affiliation(s)
- Justin Knox
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA.
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40
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Geibel S, Tun W, Tapsoba P, Kellerman S. HIV vulnerability of men who have sex with men in developing countries: Horizons studies, 2001-2008. Public Health Rep 2010; 125:316-24. [PMID: 20297760 PMCID: PMC2821861 DOI: 10.1177/003335491012500222] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While male-to-male sexual behavior has been recognized as a primary risk factor for human immunodeficiency virus (HIV), research targeting men who have sex with men (MSM) in less-developed countries has been limited due to high levels of stigma and discrimination. In response, the Population Council's Horizons Program began implementing research activities in Africa and South America beginning in 2001, with the objectives of gathering information on MSM sexual risk behaviors, evaluating HIV-prevention programs, and informing HIV policy makers. The results of this nearly decade-long program are presented in this article as a summary of the Horizons MSM studies in Africa (Senegal and Kenya) and Latin America (Brazil and Paraguay), and include research methodologies, study findings, and interventions evaluated. We also discuss future directions and approaches for HIV research among MSM in developing countries.
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Rispel LC, Metcalf CA. Breaking the silence: South African HIV policies and the needs of men who have sex with men. REPRODUCTIVE HEALTH MATTERS 2009; 17:133-42. [PMID: 19523590 DOI: 10.1016/s0968-8080(09)33442-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although the HIV epidemic among men who have sex with men (MSM) in South Africa preceded the onset of the generalised HIV epidemic by several years, current policies and programmes focus on heterosexual transmission and mother-to-child transmission. We used an adaptation of the UNAIDS Country Harmonised Alignment Tool (CHAT) to assess whether existing HIV policies and programmes in South Africa address the needs of MSM. This covered mapping of key risk factors and epidemiology of HIV among MSM; participation of MSM in the HIV response; and an enabling environment for service provision, funding and human resources. We found that current policies and programmes are unresponsive to the needs of MSM and that epidemiologic information is lacking, in spite of policy on MSM in the National Strategic Plan. We recommend that government initiate sentinel surveillance to determine HIV prevalence among MSM, social science research on the contexts of HIV transmission among MSM, and appropriate HIV prevention and care strategies. MSM should be closely involved in the design of policies and programmes. Supportive programme development should include dedicated financial and human resources, appropriate guidelines, and improved access to and coverage of HIV prevention, treatment and care services for MSM.
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Affiliation(s)
- Laetitia C Rispel
- Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
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Abstract
Globally, men who have sex with men (MSM) continue to bear a high burden of HIV infection. In sub-Saharan Africa, same-sex behaviours have been largely neglected by HIV research up to now. The results from recent studies, however, indicate the widespread existence of MSM groups across Africa, and high rates of HIV infection, HIV risk behaviour, and evidence of behavioural links between MSM and heterosexual networks have been reported. Yet most African MSM have no safe access to relevant HIV/AIDS information and services, and many African states have not begun to recognise or address the needs of these men in the context of national HIV/AIDS prevention and control programmes. The HIV/AIDS community now has considerable challenges in clarifying and addressing the needs of MSM in sub-Saharan Africa; homosexuality is illegal in most countries, and political and social hostility are endemic. An effective response to HIV/AIDS requires improved strategic information about all risk groups, including MSM. The belated response to MSM with HIV infection needs rapid and sustained national and international commitment to the development of appropriate interventions and action to reduce structural and social barriers to make these accessible.
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Affiliation(s)
- Adrian D Smith
- Department of Public Health, University of Oxford, Oxford, UK.
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