HIV risk among these men has yet to be characterized

HIV risk among these men has yet to be characterized in the majority of countries. A cross-sectional anonymous probe of 537 men recruited with non-probability sampling among men who reported ever having had sex with another man was conducted in Malawi, Namibia, and Botswana using a structured survey instrument and HIV screening with the OraQuick© rapid test kit. The HIV prevalence among those between the ages of 18 and 23 was 8.3% (20/241); 20.0% (42/210) among those 24-29; and 35.7% (30/84) among those older than 30 for an overall prevalence of 17.4% (95% CI 14.4-20.8). In multivariate logistic regressions, being older than 25 (aOR 4.0, 95% CI 2.0-8.0), and not always wearing condoms during sex (aOR 2.6, 95% CI 1.3-4.9) were significantly associated with being HIV-positive. Sexual concurrency was common with 16.6% having ongoing concurrent stable relationships with a man and a woman and 53.7% had both male and female sexual partners in proceeding 6 months. Unprotected anal intercourse was common and the use of petroleum-based lubricants was also common when using condoms. Human rights abuses, including blackmail and denial of housing and health care was prevalent with 42.1% (222/527) reporting at least one human rights abuse. Men who have sex with men are at higher risk of HIV exposure for HIV infection and human rights abuses in Malawi, Namibia, and Botswana. Concurrency of sexual partnerships with partners of both genders may play important roles in HIV spread in these populations. Further epidemiologic and evaluative research is needed to assess the contribution of men who have sex with men to southern Africa’s HIV epidemics and how best to mitigate this. These countries should initiate and adequately fund evidence-based and targeted HIV prevention programs for men who have sex with men.

Editors’ note: This simple epidemiology and human rights study, the first to link individual level rights abrogation to HIV biological outcomes in the African context, was implemented through collaboration with local community groups and can be replicated in similar settings. The overall findings of a high risk of exposure to both HIV and human rights abuses, in these three high HIV prevalence countries that criminalize same sex behaviour among consenting adults, are striking. Effective HIV prevention programming for men who have sex with men, particularly younger men, in Botswana, Malawi, and Namibia requires urgent governmental attention with dedicated funding and creative innovations, including use of the internet to reach this hidden population, training of health care providers, and strategies to address and minimise human rights abuses.

HIV This Week Issue #69

HIV This Week Issue #69

Welcome to the 69th issue of HIV This Week! In this issue, we cover men who have sex with men (time to act: an innovative study in Malawi, Namibia, and Botswana links HIV and human rights abuses; does anal human papilloma virus infection increase risk for HIV acquisition?; sex drugs and HIV risk: effects beyond drug-induced disinhibition?), biomedical prevention tools (efficacious drug delivery through vaginal rings; the ‘female condom’ and anal sex), behavioural change: mobilising men (Nigerian men respond to a culturally-tailored intervention; South African men respond in different ways to gender-based violence and alcohol reduction interventions), epidemiology (5 years of sustained high HIV incidence in a rural KwaZulu Natal community cause for concern; how data from Uganda’s antenatal surveillance and national population-based survey compare; was there a second HIV incidence peak in Thailand due to the Asian financial crisis?), tuberculosis (survival improves with earlier HIV treatment and care for co-infected Thai TB patients), health care delivery (male circumcision training: practice makes perfect; a paediatric AIDS corps treating kids in Botswana, Lesotho, Swaziland, Malawi, and Burkina Faso ; lessons learned about improving sexual assault services in rural South Africa), novel treatment approaches: gene therapy(glimmers of light from a Phase II anti-HIV ribozyme trial), workplace responses (a toast to a pioneer private sector HIV workplace programme in Africa), HIV transmission on antiretroviral treatment (an estimated risk of 1 in 7900 heterosexual acts?; community viral load in Vancouver’s downtown eastside mirrors HIV incidence in individual injecting drug users), communications (22,894 storylines for films reveal how young Africans perceive HIV), blood donor deferral (science sheds light on blood donation deferral periods for men who have sex with men), and human rights (how and why structural-rights interventions should underpin combination prevention and treatment in Zimbabwe and everywhere else).