The World Health Organization identified men as an essential group to target with HIV testing and treatment strategies;: men who have sex with men (MSM) and male clients of female sex workers (CFSW) account for 35% of new HIV infections globally. Using a cross-sectional design from a community-based HIV prevention project in Tanzania (October 2015–September 2018) and multivariable logistic regression, we identified predictors of HIV seropositivity among men. Of 1,041,343 men on their initial visit to the project, 36,905 (3.5%) were MSM; 567,005 (54.5%) were CFSW; and 437,343 (42.0%) were other men living near hotspots (OMHA). Three predictors of HIV seropositivity emerged across all three groups: being uncircumcised, having sexually transmitted infection symptoms, and harmful drinking of alcohol before sex. Any reported form of gender-based violence among MSM and OMHA and inconsistent condom use among CFSW were associated with HIV seropositivity. These findings may inform community HIV strategies like self-testing, delivery of pre-exposure prophylaxis and antiretroviral therapy, and behavioral change communication targeting men at higher risk of infection.

Background Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. Objective This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. Methods A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Results Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. Conclusions Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. Trial Registration ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243

Background Globally, men who have sex with other men (MSM) increasingly use virtual platforms for networking and soliciting sexual partners due to unrelenting stigma and discrimination. However, most studies estimating the MSM population for HIV prevention coverage in sub-Saharan Africa focus on physical sites, failing to account for MSM using virtual platforms. This study aimed to examine the feasibility of estimating the MSM population using virtual spaces in Tanzania. Methods MSM recruited from civil society organisations collected data on two levels: First, a participatory ranking method involving key informants was used to identify virtual sites, and on each site, they listed all profiles used by MSM in selected towns. Secondly, research assistants logged in to those platforms three times a day (morning, afternoon, and evening) and counted all those who were active online at every time point for seven days. Those online were invited to participate in a voluntary short survey. The number of profiles recorded was generated by aggregating the virtual site profiles for MSM registered daily. Data collected in the short survey were then applied as correction factors to adjust for MSM counted twice or more on different days of the week and for those who may have been missed in the survey. Results A total of 4,480 active profiles were observed. Of the 4,480 unadjusted profiles, only 2,429 were unique. 598 male virtual site users aged 18 + years were interviewed to collect data on correction factors. Approximately 91% of participants on virtual sites also visited physical venues. Nearly 90% of participants in the short survey used virtual sites for socialising and sexual networking several times a week. Conclusion This study shows that virtual mapping is a feasible strategy to capture estimates of MSM who cannot be counted through venue-based approaches, especially in contexts where MSM face legal and societal stigmatisation and discrimination.