The Epidemiology of HIV and Prevention Needs of Men Who Have Sex with Men in Abidjan, Cote d’Ivoire

Abstract

To determine HIV prevalence and associated risk factors among men who have sex with men (MSM) in Abidjan, Côte d’Ivoire. We conducted a cross-sectional RDS survey of MSM in Abidjan from October 2011 to February 2012. Eligibility criteria included age ≥ 18 years and having had oral or anal sex with another man in the last 12 months. Weighted data analysis was conducted with RDSAT and SAS. We enrolled 603 participants, of whom 601 (99.7%) completed the questionnaire and 581 (96.7%) consented to HIV testing. HIV population prevalence was estimated as 18.0% (95% CI: 13.0-23.1); 86.4% (95% CI: 75.1-94.9) of HIV-positive MSM were unaware of their serostatus. In multivariable analysis, adjusting for age, education, and income, HIV infection was associated with unprotected sex at last sex with a woman, more than two male anal sex partners in last 12 months, inconsistent condom use during anal sex with a man, self-perceived risk of HIV, history of forced sex, history of physical abuse due to MSM status, and not receiving last HIV test result prior to study. HIV prevalence among MSM in Abidjan is more than four times as high as that of general population men. MSM engage in high-risk sexual behavior and most HIV-positive MSM are unaware of their serostatus. Greater access to HIV prevention, care, and treatment services targeted to MSM is necessary.

A Cross-sectional Survey of HIV Transmission and Behavior among Men Who Have Sex with Men in Different Areas of Inner Mongolia Autonomous Region, China

“…Most MSM from the Inner Mongolia Autonomous Region of China in our sample were between 23 and 35 years old; this finding is consistent with the survey results of Luo et al of 259 MSM in Hangzhou (74.5 %) [40] but inconsistent with those of Hakim et al, who found that 35.9 % of 603 MSM in Abidjan were between 23 and 35 years old [41]. …”

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

“…12,19,23,24,49,65–67 Sandfort et al 21 found that men in South Africa who tested HIV-positive in the study were more likely to be categorized as hazardous drinkers as measured by the AUDIT than HIV-negative men (54.5% versus 40.0%; AOR: 1.81; 95%CI: 1.06, 3.07). Baral et al 68 reported that men in Swaziland who drank alcohol at least one day in the preceding month were not more likely to be HIV infected than other men (AOR based on weighted data: 2.18; CI95%: 0.60, 7.95).…”

“…Baral et al 68 reported that men in Swaziland who drank alcohol at least one day in the preceding month were not more likely to be HIV infected than other men (AOR based on weighted data: 2.18; CI95%: 0.60, 7.95). Hakim et al, 67 with a more sensitive measure, found that men who drank alcohol once a week or less and men who drank more than once a week were not more likely to be HIV positive compared to men who reported never using any alcohol (OR 0.89; 95%CI: 0.62, 1.28; and OR 1.12; 95%CI: 0.82,1.52, respectively). Sanders et al 16 reported HIV incidence among non-alcohol users incidence as 7.6 per 100 person years (PY; 95%CI: 5.0, 11.5) compared to 9.3 per 100 PY; 95%CI: 6.8, 12.5; unadjusted incidence rate ratio: 1.2; 95%CI: 0.7, 2.1) among men who had used any alcohol in the preceding month.…”

HIV vulnerability and the erasure of sexual and gender diversity in Abidjan, Côte d'Ivoire

“…In sub-Saharan Africa, approximately 5% of the general population is living with HIV, compared to nearly 18% of men who have sex with men (Beyrer et al, 2012). This distribution is strikingly similar in Abidjan, where 5.1% of the general population is HIV+ (PEPFAR, 2013), while 18% of men who have sex with men in Abidjan are living with HIV (Aho et al, 2014, Hakim et al, 2015; Vuylsteke et al, 2012). However, this universalizing category of practice, which eschews identity in favor of behavior, erases a significant amount of heterogeneity.…”

“…Though they did ask survey respondents whether or not they identified as travestis, only 2% of the sample identified as such, providing little evidence about how their experience might differ from that of gender normative branchés. Descriptive statistics of these categories were only presented in the original report (Semde-Abla 2012) but were ignored entirely in subsequent publications (Vuylsteke et al 2012; Aho et al 2013; Hakim et al 2015). Furthermore, questions posed about the gender of respondents' sex partners did not include travestis or transgender persons as an option, providing minimal information about the extent to which gender-normative men who have sex with men engage sexually with travesti and transgender partners.…”