Changes in risky sexual behaviours among West African MSM enrolled in a quarterly HIV testing and counselling prevention programme (CohMSM ANRS 12324 – Expertise France)

Abstract

ObjectivesWhether regular HIV testing and counselling reduce risky sexual behaviours in African men who have sex with men (MSM) is still a matter for debate. We aimed to identify behavioural trajectories based on HIV risk exposure (HRE) and factors affecting their evolution.MethodsData were collected from 621 HIV-negative West African MSM (Mali, Cote d'Ivoire, Burkina Faso and Togo) included in a community-based cohort providing quarterly HIV testing and counselling. Sociobehavioural data were collected every 6 months. HRE was defined as reporting inconsistent condom use during receptive anal sex with male partners of unknown HIV status in the previous 6 months. Using 18-month follow-up data, group-based trajectory modelling helped identify behavioural trajectories and determine the factors associated with their evolution. HIV seroconversions (n=67) were specified in each group trajectory.ResultsTwo distinct group trajectories were identified: medium-risk exposure MSM (ME-MSM) (61%, 6.4% of whom having seroconverted) and high-risk exposure MSM (HE-MSM) (39%, 17.5% of whom having seroconverted). A significant declining trend in the probability of reporting HRE over time ((95% CI)) was observed for HE-MSM (from 0.59 (0.48 to 0.70) at M0 to 0.31 (0.22 to 0.41) at M18), while it remained constant for ME-MSM (0.034 (0.0 to 0.079)). This can be explained by a progressive use of risk reduction strategies (less receptive anal sex, better knowledge of their partners’ status and increasing condom use). Being younger, living in Burkina Faso, self-considering both a man and a woman and reporting a higher level of depression were all associated with HE membership. Among HE-MSM, HRE was higher in those practising transactional or group sex and those experiencing psychological harassment.ConclusionsQuarterly HIV testing and counselling seem to reduce risky sexual behaviours in HIV-negative MSM at greatest risk of infection. Specific support for young MSM, focusing on identity and mental health, is needed to strengthen HIV prevention in West African MSM.

Intervening for HIV prevention and mental health: a review of global literature

“…Several studies demonstrated that poorer mental health (especially severe depression, depression and PTSD, or anxiety) was associated with less consistent condom use or less perceived condom self-efficacy among MSM [80], young women who sold sex [81], and homeless men who also used drugs and traded sex [82]. Condom use self-efficacy and depression were partial mediators of the relationship between sexual stigma and inconsistent condom use among MSM [83].…”

HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey

“…4 A significant increase in condom use among MSM following preventive education has recently been reported in a cohort of MSM in west Africa. 23 We found that condom use with paying partners (commercial sex) was associated with a 60% lower likelihood of HIV infection in this study. This increase in protected commercial sex may partly explain the decreased HIV prevalence observed in this study.…”

Adherence to quarterly HIV prevention services and its impact on HIV incidence in men who have sex with men in West Africa (CohMSM ANRS 12324 – Expertise France)

“…In a previous analysis, we found that MSM at greater risk of exposure to HIV infection decreased their risky sexual behaviours during their follow-up in CohMSM, suggesting a potential positive effect of the quarterly prevention services on those who need it most [25]. However, the high HIV incidence and the lack of association between adherence to these services and incident HIV infections observed in the present analysis strongly suggest that this intervention alone is insu cient to signi cantly reduce the burden of the epidemic in this population.…”