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Context in source publication
Context 1
... shown in Table 1, awareness of a test to detect HIV significantly increased among respondents (52 percent to 83 percent; p < 0.001). This increased knowledge co- incided with an increase in the proportion who reported having received an HIV test (16 percent to 64 percent; p < 0.001). ...
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Background:
In Togo, men who have sex with men (MSM) experience disproportionately high rates of human immuno-deficiency virus (HIV), with prevalence at 13% compared to the countrywide general HIV prevalence of 2.5%. Mobile phone adoption has grown rapidly in West Africa in recent years and mobile health (mHealth) provides an opportunity to engage...
Citations
... Selon le Bulletin e pide miologique de surveillance du VIH paru en 2006, la se ropre valence est faible au sein de la population en ge ne rale (0,7 %), mais atteint un niveau alarmant au sein de groupes vulne rables, notamment les travailleuses du sexe (15 a 30% selon les re gions) et les hommes qui ont des relations sexuelles avec d'autres hommes (environ 21 %) (Conseil national de lutte contre le sida, 2008). Plusieurs programmes ont e te e labore s afin de re pondre ade quatement aux besoins de ces personnes en situation de vulne rabilite , par exemple l'e ducation entre pairs et la formation de prestataires de soins de sante (Diouf et al., 2007 ;Moreau et al., 2007). Ces initiatives s'inscrivent dans un processus de de centralisation des services de sante entame en 2001 visant a faciliter l'accessibilite aux soins a travers l'ensemble du territoire se ne galais et a amoindrir les disparite s re gionales quant a la pre valence du VIH/sida et des autres ITSS (Snow, 2005). ...
... Un premier programme de sensibilisation a e te mis sur pied en 2003 afin de sensibiliser les homosexuels au VIH/sida et aux autres infections sexuellement transmissibles (Moreau et al., 2007). Pour ce faire, l'e ducation entre pairs et l'intervention de proximite ont e te privile gie es. ...
... Ces approches signifient que, par l'entremise de leaders reconnus dans leur milieu et forme s par des professionnels de la sante , les messages visant la promotion d'une sexualite se curitaire sont transmis dans la communaute gaie a travers les re seaux respectifs de ces e ducateurs. L'objectif de cette strate gie est de permettre aux acteurs de la lutte contre le VIH/sida de rejoindre directement les homosexuels et d'intervenir aupre s d'eux afin d'amorcer une prise de conscience et un changement de comportements dans une perspective de re duction des risques (Moreau et al., 2007). ...
ASPECTS SOCIOLOGIQUES 35 VIH/sida, homosexualité et innovations sociales en matière de prévention au Sénégal : le rôle des médiateurs de santé Kévin Lavoie La prévalence du VIH/sida au Sénégal est relativement faible, comparativement à d'autres pays africains. Or, les hommes gais et ceux qui ont des relations sexuelles avec d'autres hommes sont particulièrement touchés par le virus, étant donné les inégalités structurelles qui les affectent et les stigmatisations associées à l'homosexualité. Afin de contrer la propagation de l'épidémie au sein de cette communauté, de nouveaux modèles d'intervention ont été développés au cours des dernières années, contribuant à l'émergence de pratiques sociales novatrices. Cet article propose une description détaillée de la médiation en santé telle qu'expérimentée à Dakar, la capitale sénégalaise. À partir d'observations et d'entretiens réalisés auprès de la première cohorte de médiateurs lors d'une expérience de stage de 1er cycle en service social, les apports et les limites de cette pratique sont considérés à l'aune des enjeux qu'elle soulève.
... Niang et al. describe the effect that stigma and discrimination can have on health care-seeking behaviours among MSM in Senegal [6]. When men perceive or experience stigma and discrimination in a health care setting, they are less likely to access health services for STI, resulting in higher rates of untreated STI within sexual networks, thereby mediating HIV transmission [37,38]. ...
Introduction
Men who have sex with men (MSM) are disproportionately burdened by HIV in Senegal, across sub-Saharan Africa and throughout the world. This is driven in part by stigma, and limits health achievements and social capital among these populations. To date, there is a limited understanding of the feasibility of prospective HIV prevention studies among MSM in Senegal, including HIV incidence and cohort retention rates.
Methods
One hundred and nineteen men who reported having anal sex with another man in the past 12 months were randomly selected from a sampling frame of 450 unique members of community groups serving MSM in Dakar. These men were enrolled in a 15-month pilot cohort study implemented by a community-based partner. The study included a structured survey instrument and biological testing for HIV, syphilis and hepatitis B virus at two time points.
Results
Baseline HIV prevalence was 36.0% (43/114), with cumulative HIV prevalence at study end being 47.2% (51/108). The annualized incidence rate was 16% (8/40 at risk for seroconversion over 15 months of follow-up, 95% confidence interval 4.6–27.4%). Thirty-seven men were lost to follow up, including at least four deaths. Men who were able to confide in someone about health, emotional distress and sex were less likely to be HIV positive (OR 0.36, p < 0.05, 95% CI 0.13, 0.97).
Conclusions
High HIV prevalence and incidence, as well as mortality in this young population of Senegalese MSM indicate a public health emergency. Moreover, given the high burden of HIV and rate of incident HIV infections, this population appears to be appropriate for the evaluation of novel HIV prevention, treatment and care approaches. Using a study implemented by community-based organizations, there appears to be feasibility in implementing interventions addressing the multiple levels of HIV risk among MSM in this setting. However, low retention across arms of this pilot intervention, and in the cohort, will need to be addressed for larger-scale efficacy trials to be feasible.
... In addition to information on sexual identity and practices, this study provided important insights about the role of violence and stigma in the lives of MSM and the dearth of appropriate and accessible targeted health services. In response, Senegalese MSM partnered with nongovernmental organizations (NGOs) to implement HIV prevention programs in many parts of the country [7,8]. Moreover, the national Senegalese AIDS strategy identified MSM as a key target population for prevention, and the Senegalese Ministry of Health implemented innovative programs to reach and serve these men [9]. ...
Men who have sex with men (MSM) are at high risk for HIV in Senegal, with a prevalence of 21.5%. In December 2008, nine male HIV prevention workers were imprisoned for "acts against nature" prohibited by Senegalese law. This qualitative study assessed the impact of these arrests on HIV prevention efforts. A purposive sample of MSM in six regions of Senegal was recruited by network referral. 26 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) were conducted in July-August 2009. 14 key informants were also interviewed. All participants reported pervasive fear and hiding among MSM as a result of the December 2008 arrests and publicity. Service providers suspended HIV prevention work with MSM out of fear for their own safety. Those who continued to provide services noticed a sharp decline in MSM participation. An effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law.
In sub-Saharan Africa (SSA), MSM – a high HIV prevalence group – experience strong social stigma and pressure to have female partners. Accordingly, they could constitute a bridging group for HIV transmission to cisgender women. We developed a multilevel summary of MSM sexual behaviors and risk with women in various SSA regions. Following PRISMA guidelines, we conducted a mixed-method systematic review of data of sex with women in MSM in SSA. We performed meta-analyses on quantitative data (i.e. percent of recent sex and condomless sex with women) for each SSA region (when proportions reported in ≥4 studies). Pooled proportions were calculated using random-effects models. Qualitative data were analyzed using the three-step thematic synthesis methodology. The pooled proportion of MSM who had sex with women was 58% (33–83%) in East Africa (in the previous 3 months), and 27% (13–48%) in Southern Africa and 50% (95% CI 39–62%) in West Africa (in the previous 6 months); 23% (16–32%) of MSM in West Africa had condomless sex with a woman (during the most recent encounter). Approximately one quarter of MSM had recent multiple female partners. MSM reported having sex with women because of heteronormative pressure, erotic/romantic attraction, or financial needs leading to transactional sex. MSM may act as a bridging population to women in SSA, as they commonly practice sex with women and risky sexual behaviors with them. HIV programmes and community-based support for MSM should be adapted to this population to reduce this risk.
While still an understudied area, there is a growing body of studies highlighting epidemiologic data on men who have sex with men (MSM) in sub-Saharan Africa (SSA) which challenge the attitudes of complacency and irrelevancy among donors and country governments that are uncomfortable in addressing key populations (KPs). While some of the past inaction may be explained by ignorance, new data document highly elevated and sustained HIV prevalence that is seemingly isolated from recent overall declines in prevalence. The articles in this series highlight new studies which focus on the stark epidemiologic burden in countries from concentrated, mixed and generalized epidemic settings. The issue includes research from West, Central, East and Southern Africa and explores the pervasive impact of stigma and discrimination as critical barriers to confronting the HIV epidemic among MSM and the intersecting stigma and marginalization found between living with HIV and sexual minority status. Interventions to remove barriers to service access, including those aimed at training providers and mobilizing communities even within stigmatized peri-urban settings, are featured in this issue, which further demonstrates the immediate need for comprehensive action to address HIV among MSM in all countries in the region, regardless of epidemic classification.While still an understudied area, there is a growing body of studies highlighting epidemiologic data on men who have sex with men (MSM) in sub-Saharan Africa (SSA) which challenge the attitudes of complacency and irrelevancy among donors and country governments that are uncomfortable in addressing key populations (KPs). While some of the past inaction may be explained by ignorance, new data document highly elevated and sustained HIV prevalence that is seemingly isolated from recent overall declines in prevalence. The articles in this series highlight new studies which focus on the stark epidemiologic burden in countries from concentrated, mixed and generalized epidemic settings. The issue includes research from West, Central, East and Southern Africa and explores the pervasive impact of stigma and discrimination as critical barriers to confronting the HIV epidemic among MSM and the intersecting stigma and marginalization found between living with HIV and sexual minority status. Interventions to remove barriers to service access, including those aimed at training providers and mobilizing communities even within stigmatized peri-urban settings, are featured in this issue, which further demonstrates the immediate need for comprehensive action to address HIV among MSM in all countries in the region, regardless of epidemic classification.
In the anticipated post-2015 development agenda many Western governments, their development agencies and a range of non-governmental organizations (NGOs) seek to advance an integrated 'sexual and reproductive health and rights' (SRHR) framework. The SRHR framework serves as a bold new paradigm for the work of human rights-informed global health. However, the same development actors behind the SRHR framework have scarcely acknowledged the theoretical and practical tensions that their development efforts have posed for sexual rights. This paper analyzes these tensions by asking, 'How has the provision of sexual health impacted sexual rights?' In answering this question, focus is placed on the logic and strategies of USAID-funded HIV/AIDS interventions over 10 years (2004–14) in Ghana for 'key populations' (those populations most-at-risk to HIV). This chapter argues Western-funded sexual health organizations, and a changing socio-political context in Ghana, facilitated a paradox between sexual health and sexual rights in Ghana. In this predicament, the strategic choices of coordinators and implementers of HIV/AIDS interventions with the aim of maximizing uptake of sexual health services among sexual minorities had the effect of 1) co-opting sexual rights efforts, 2) silencing their public activism and 3) incentivizing gender conformity and 'African' conceptions of sexuality among its clients and leadership. The chapter concludes by summarizing the findings and applying them to the SRHR framework to offer suggestions for its implementation in international development and how misconceptions of sexuality led to these problems.
Pooled estimates from across the African diaspora show that black men who have sex with men (MSM) are 15 times more likely to be HIV positive compared with general populations and 8·5 times more likely compared with black populations. Disparities in the prevalence of HIV infection are greater in African and Caribbean countries that criminalise homosexual activity than in those that do not criminalise such behaviour. With the exception of US and African epidemiological studies, most studies of black MSM mainly focus on outcomes associated with HIV behavioural risk rather than on prevalence, incidence, or undiagnosed infection. Nevertheless, black MSM across the African diaspora share common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality during HIV testing or treatment, low access to HIV drugs, threats of violence or incarceration, and few targeted HIV prevention resources.
While male-to-male sexual behavior has been recognized as a primary risk factor for human immunodeficiency virus (HIV), research targeting men who have sex with men (MSM) in less-developed countries has been limited due to high levels of stigma and discrimination. In response, the Population Council's Horizons Program began implementing research activities in Africa and South America beginning in 2001, with the objectives of gathering information on MSM sexual risk behaviors, evaluating HIV-prevention programs, and informing HIV policy makers. The results of this nearly decade-long program are presented in this article as a summary of the Horizons MSM studies in Africa (Senegal and Kenya) and Latin America (Brazil and Paraguay), and include research methodologies, study findings, and interventions evaluated. We also discuss future directions and approaches for HIV research among MSM in developing countries.
