High HIV seroprevalence, rectal STIs and risky sexual behaviour in men who have sex with men in Dar es Salaam and Tanga, Tanzania

Abstract

ObjectivesTo assess HIV and sexually transmitted infection (STI) prevalence and associated risk factors in men who have sex with men (MSM) in two cities in mainland Tanzania.MethodsWe conducted respondent-driven sampling of 300 MSM in Dar es Salaam and Tanga.ResultsIn Dar es Salaam, 172 (86%) men (median age 23, IQR 21–28) consented to HIV/STI testing, and 30.2% were HIV seropositive. Only five reported a previous positive HIV test: >90% were new HIV detections. 2.5% were syphilis-exposed and none hepatitis B positive, but 21.4% had a curable STI. Over 90% of the gonorrhoea and chlamydia was rectal. In Tanga, 11.1% of MSM were HIV seropositive, 8% hepatitis B positive and 0% were syphilis-exposed, with 4.4% having a curable STI. Predictors of HIV infection were number of MSM known, city, identifying as gay and having first sex with a man. Predictors for STIs were recent unprotected receptive anal intercourse, and number of MSM seen in the last month. 30% of the sample reported that they sold sex. There was no significant association between HIV and STI infection.ConclusionsHIV and STI rates were substantially lower in MSM in a provincial city than in a large metropolis and rates appear to depend on larger numbers of MSM known. Most HIV detected were new cases, and there was a high burden of asymptomatic curable rectal STIs (>1 in 5 MSM). Owing to stigma, MSM may not report homosexuality and thus not have rectal STIs treated. High need for tailored HIV testing and STI screening and treatment of MSM in Tanzania is apparent.

HIV Vulnerability and Coexisting Psychosocial Health Problems amongTanzanian Men who have Sex with Men from the Perspective of an African Syndemic Model

“…The public health implication of this gendered sexual practice was substantively established by Beyrer et al who confirmed that the high probability of HIV transmission per act through the practice of receptive anal intercourse plays a central role in explaining the disproportionate disease burden in MSM [37]. It is not surprising that Ross et al later found that condomless receptive anal intercourse is significantly associated with sexually transmitted infections among MSM in Tanzania [38].…”

“…Culturally relevant factors: These two items have also been used in MSM in Africa and found to be reliable [38].…”

Seroprevalence of Syphilis in Patient Attending Tertiary Care Hospital, Valsad, India

“…Syphilis and HIV co-infection presents a complex interaction. The increased incidence of HIV in homosexual and heterosexual individuals afflicted with STD, including syphilis is epidemiologically documented in numerous studies (Ross et al, 2014). HIV alters the course of syphilis as well as the response to treatment.…”

Syndemic Production of HIV Infection among Tanzanian MSM

“…Two hundred MSM from Dar es Salaam and 100 MSM from Tanga were recruited to participate using respondent-driven sampling (RDS) [21,23]. RDS, a snowball sampling method, employs 'seed' individuals to refer who they know; the latter then refer individuals they know using a predetermined number of coupons throughout the network [7].…”

“…Although childhood sexual abuse (CSA) has been implicated in HIV transmission among behaviorally heterosexual men, there are no published reports of the rate of CSA or its syndemic potential specifically among Tanzanian MSM [21][22][23][24][25][26][27][28].…”