Sexually transmitted infections associated with alcohol use and HIV infection among men who have sex with men in Kampala, Uganda

Abstract

Objectives Few studies have been conducted in Africa to assess prevalence of sexually transmitted infections (STIs) and risk factors among men who have sex with men (MSM). We report findings from the first behavioural survey to include STI testing among MSM in Kampala, Uganda. Methods Respondent-driven sampling (RDS) was used to recruit MSM for a biobehavioural survey. Eligible participants were men who reported anal sex with another man in the previous 3 months, were 18 years or older, and resided in Kampala. Information was collected on demographics, sexual behaviour, alcohol and drug use, and STI symptoms. Blood, urine and rectal specimens were tested for syphilis, HIV, rectal and urethral gonorrhoea, and chlamydia. Analyses weighted for RDS were conducted to assess associations with STI diagnosis. Results A total of 295 MSM participated in the survey. Almost half (weighted percentage: 47.3%) reported STI symptoms in the last 6 months and 12.9% tested HIV-positive. Prevalence of non-HIV STI was 13.5%; syphilis prevalence was 9.0%. Adjusting for age and education, STI was associated with HIV (adjusted OR (AOR)=3.46, 95% CI 1.03 to 11.64), alcohol use before sex (AOR=4.99, 95% CI 1.86 to 13.38) and having sold sex in the last 3 months (AOR=3.17, 95% CI 1.25 to 8.07), and inversely associated with having anonymous sex partners (AOR=0.20, 95% CI 0.07 to 0.61). Conclusions We observed high levels of self-reported STI symptoms and STI prevalence associated with alcohol use and HIV among MSM in Kampala. Public health interventions supporting MSM are needed to address STI risk and facilitate access to diagnosis and treatment services.

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

“…With two exceptions, 30,31 alcohol or drug use was not the primary focus of these studies. Studies included diverse MSM populations [e.g., male sex workers, 32 MSM living with HIV, 33 gay, lesbian and bisexual persons, 34 and participants in a pre-exposure prophylaxis (PrEP) trial 35 a few studies exclusively surveyed substance users.…”

“…For instance, almost two-thirds of men in a Kenyan study 43 and 82.5% in a study in Botswana 39 reported having used alcohol in that period. Using alcohol once or more than once a week in the past month was reported by 61.7% and 67.5% among men in Uganda 31 and Cote d’Ivoire. 44 Chapman et al 45 reported that 22.4% of the studied MSM in Rwanda drank alcohol every day in the past month.…”

“…31 For example, Aho et al 44 found that the frequency of alcohol consumption in the past 30 days was associated with unprotected anal intercourse, independently of a series of other risk factors; among those who had not used alcohol in past 30 days, 52.2% had inconsistent condom use versus 70.7% among those who had used alcohol once a week or less, and 74.4% among those who used alcohol more than once a week [adjusted odds ratio (AOR) and 95% confidence interval (95%CI): 2.05 (1.14, 3.69) and 2.48 (1.13, 5.44), respectively]. Geibel et al 50 found, in a study among male sex workers, that condomless sex with clients was independently associated with frequent alcohol use (3–7 drinking days per week; AOR: 1.63; 95%CI: 1.05, 2.54).…”

“…One study found a relationship of alcohol use with sexually transmitted infections (STI), but not with HIV infection: men who reported using alcohol before sex were almost five times more likely to test positive for STI compared to men who reported not using alcohol before sex. 31 …”

Highlights from this issue

“…If you look through our archive, you will find many examples of research from “difficult” settings—such as our blockbuster special issue on Middle East and North African research in 2013 7. We are delighted this month to publish a population based survey on STI related symptoms from Iran,8 a report on STI and HIV in MSM from Uganda,9 and an exploration of rectal microbicide preferences in Peruvian MSM 10…”