HIV Prevalence, Risks for HIV Infection, and Human Rights among Men Who Have Sex with Men (MSM) in Malawi, Namibia, and Botswana

Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
PLoS ONE (Impact Factor: 3.23). 02/2009; 4(3):e4997. DOI: 10.1371/journal.pone.0004997
Source: PubMed
In the generalized epidemics of HIV in southern Sub-Saharan Africa, men who have sex with men have been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in southern Africa are among the sparsest globally, and 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 in Malawi, Namibia, and Botswana using a structured survey instrument and HIV screening with the OraQuick(c) 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 abuse.
MSM are a high-risk group 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 MSM 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 MSM.

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    • "A number of studies have documented that MSM who are in concurrent sexual relationships with men and women are exposed to sexual practices that expose them to HIV infection such as inconsistent condom use due to the long term attachments and intimacy with concurrent sexual partners [23, 27] . Moreover , Baral et al. documented that bi-sexual men were less likely to use condoms with both committed and casual female sexual partners [28]. These HIV risky sexual practices may have a role to play in influencing higher willingness to take PrEP among bi-sexual MSM. "
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    • "Men who have sex with men and women (MSMW) represent an important subgroup of MSM. Studies among MSM in sub-Saharan Africa (SSA) have reported that approximately half of MSM had sex with both men and women in a predetermined period before each survey, being 12 months: 74.1 % in Senegal [6] 46.2 % in Cameroon [10], 46.4 % in Swaziland [11], 56.2 % in Cote d'Ivoire [12] and 6 months: 60.9 % in South Africa [8], 46.7 % in Malawi [13], 37.6 % in Botswana [14], 50.7 % in Namibia [7] and past 2 months: 48.1 % in Nigeria [15]. Yet, most studies of MSM in SSA fail to distinguish between men who have sex only with men (MSMO) and men who have sex with men and women in their analysis of HIV risks. "
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    • "titutional Review Board of the Johns Hopkins Bloomberg School of Public Health, the Research Ethics Committee of the University of Cape Town, the University of Namibia Institutional Review Board, and the Ministry of Health of Botswana. In Malawi, the local CBO, CEDEP, employed a previously-described internal review mechanism and approved the study. [10] Limitations"
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