A pilot cohort study to assess the feasibility of HIV prevention science research among men who have sex with men in Dakar, Senegal

Abstract

IntroductionMen who have sex with men (MSM) are disproportionately burdened by HIV in Senegal, across sub-Saharan Africa and throughout the world. This is driven in part by stigma, and limits health achievements and social capital among these populations. To date, there is a limited understanding of the feasibility of prospective HIV prevention studies among MSM in Senegal, including HIV incidence and cohort retention rates.MethodsOne hundred and nineteen men who reported having anal sex with another man in the past 12 months were randomly selected from a sampling frame of 450 unique members of community groups serving MSM in Dakar. These men were enrolled in a 15-month pilot cohort study implemented by a community-based partner. The study included a structured survey instrument and biological testing for HIV, syphilis and hepatitis B virus at two time points.ResultsBaseline HIV prevalence was 36.0% (43/114), with cumulative HIV prevalence at study end being 47.2% (51/108). The annualized incidence rate was 16% (8/40 at risk for seroconversion over 15 months of follow-up, 95% confidence interval 4.6–27.4%). Thirty-seven men were lost to follow up, including at least four deaths. Men who were able to confide in someone about health, emotional distress and sex were less likely to be HIV positive (OR 0.36, p < 0.05, 95% CI 0.13, 0.97).ConclusionsHigh HIV prevalence and incidence, as well as mortality in this young population of Senegalese MSM indicate a public health emergency. Moreover, given the high burden of HIV and rate of incident HIV infections, this population appears to be appropriate for the evaluation of novel HIV prevention, treatment and care approaches. Using a study implemented by community-based organizations, there appears to be feasibility in implementing interventions addressing the multiple levels of HIV risk among MSM in this setting. However, low retention across arms of this pilot intervention, and in the cohort, will need to be addressed for larger-scale efficacy trials to be feasible.

Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review

“…Having a confidant—someone one to confide in regarding health, emotional distress and sex—was associated with lower odds of alcohol use (OR 0.22, p < 0.01, CI95% 0.078 – 0.64). 46 Qualitative interviews indicated that for some African men using alcohol is a way of coping with the stigma of being MSM, 40,47 as has been previously suggested. 39,48 …”

Enhancing Benefits or Increasing Harms

“…8 Community norms and values that stigmatize same-sex sexual behavior present significant barriers to accessing HIV prevention services. 40,[51][52][53] Statistically significant community and social associations with beneficial HIV-related outcomes include having a confidant, believing in collective efficacy, participating in a public event, being out as an MSM, and knowing other MSM in one's city 30,37,44,45 (Table 1). Reduced utilization of health and HIV services by MSM, due to actual or perceived discrimination, may limit knowledge of the risks of unprotected anal intercourse and access to prevention methods.…”

“…Study participants commonly report violent physical assaults because of their sexuality-76.2% abuses in Lesotho, for example. 30 One of the most extreme manifestations of communitylevel stigma affecting MSM is criminalization of same-sex practices. 58 In Cameroon, men who were living with HIV were more likely to have obtained health services, thanks mainly to a dynamic community-based organization in the study city that provides HIV prevention, care, and treatment specifically for the lesbian, gay, bisexual, and transgender population (adjusted odds ratio, 4.9; 95% confidence interval, 1.6 to 14.6).…”

“In the Fell Clutch of Circumstance”: HIV and Men Who Have Sex With Men in Sub-Saharan Africa

“…In Nigeria, for example, Vu, Adebajo et al [22] report HIV prevalence rates ranging from 11.3 to 34.9 % among MSM in three cities, and note that these rates are 4-10 times higher than HIV prevalence in the general population. In a cohort study in Senegal, Drame et al [23] report an HIV prevalence of 36 %, while in Togo Ekouevi, Dagnra et al [24] report a prevalence of 19.6 % in a cross sectional study in six cities. And, a recent study in Cameroon found HIV prevalence rates of between 25.5 % and 44.4 % among MSM in two cities [25].…”