Anogenital Human Papillomavirus and HIV Infection in Rwandan Men Who Have Sex With Men

Abstract

Background: Men who have sex with men (MSM) have a high prevalence of anal and penile human papillomavirus (HPV) infections with MSM living with HIV (MSMLH) bearing the highest rates. Data on anogenital high-risk HPV (hrHPV) among MSM in Rwanda and the associated risk factors are scant. Methods: We recruited 350 self-identified MSM aged 18 years living in Kigali, Rwanda, with 300 recruited from the community and 50 from partner clinics. Anal and penile specimens from all participants were analyzed for hrHPV using the AmpFire platform. Logistic regression was used to calculate crude odds ratios (ORs) and adjusted ORs (aORs) with 95% confidence intervals (95% CIs) as a measure of association between various factors and anal and penile hrHPV infection prevalence. Results: Anal hrHPV prevalence was 20.1%, was positively associated with having receptive anal sex with more partners (aOR: 9.21, 95% CI: 3.66 to 23.14), and was negatively associated with having insertive anal sex with more partners (aOR: 0.28, 95% CI: 0.12 to 0.66). Penile hrHPV prevalence was 35.0%, was negatively associated with having receptive anal sex with more partners (aOR: 0.29, 95% CI: 0.13 to 0.66), and differed significantly by HIV status, with 55.2% and 29.7% for MSMLH and HIV-negative MSM, respectively ( P < 0.01). Conclusion: Penile hrHPV prevalence was higher than that of anal hrHPV and it was significantly higher in Rwandan MSMLH than in HIV-negative MSM. The prevalence of anal and penile HPV infections is likely variable at different locations in Africa, according to a number of factors including HIV status and sexual practices.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey

“…An additional 50 participants known to be living with HIV were recruited from health centers considered friendly and caring for key populations living with HIV, including MSM. This recruitment procedure for the cohort has been previously described and published ( Adedimeji et al, 2019 ; Murenzi et al, 2020 ). For this study, we used data from 283 participants who were not living with HIV at baseline and returned for the second study visit ( N = 225).…”

“…Men who have sex with men (MSM) in Rwanda are disproportionately affected by HIV and recognized by the Ministry of Health (MOH) to be a key population for HIV prevention ( MOH, 2018 ). Although national estimates of HIV prevalence among MSM do not exist, studies conducted in Rwanda have reported HIV prevalence two to three times higher among MSM compared with the general population of men ( Murenzi et al, 2020 ; Ntale et al, 2019 ). In Africa, MSM account for 6%–17% of new HIV infections annually ( Bigna & Nansseu, 2019 ).…”

Prevalence of and factors associated with anal high-risk human papillomavirus in urban Tanzanian men who have sex with men, 2011-2012

“…10,12,20,21 One study from Rwanda, adjacent to northwest Tanzania, reported a prevalence of only 19.7% for hrHPV among HIVpositive MSM. 11 HPV-16 prevalence in this study was 17.2%. In comparison, a recent study of cervical HPV in Tanzania reported an HPV-16 prevalence of 3.5% at the cervix.…”

“…1 While societal constructions of minority sexual identities vary across cultures and change over time, 28 it is a repeated finding in SSA countries that either a gay sexual identity (vs bisexual) or engaging in receptive anal sex (vs insertive anal sex) is associated with increased anal hrHPV prevalence. [10][11][12]21 While this suggests that behaviour and/or sexual identity might be utilized in risk-based anal cancer screening algorithms, disclosure of behaviour and sexual identity may not occur since both are highly stigmatized. This barrier not only has consequences for the epidemiologic construction of risk and the interpretation of patterns of vulnerability to STIs and disease outcomes like anal cancer, but it is also possible that persons who generally identify as gay among their social network may not identify as gay to a health care provider.…”

“…8 The benefit of anal cancer screening among HIV-negative MSM is less clear although the Centers for Disease Control and Prevention now encourages screening using DARE among HIV-negative MSM with a history of receptive anal sex. 9 Anal hrHPV prevalence among MSM differs by country and size of city in Africa 10,11 with the prevalence of HPV-16 ranging from 0% in the Central African Republic 12 to 23.1% in a large city in central Nigeria 13 in studies using PCR-based assays. To our knowledge there have been no reports of anal hrHPV prevalence among Tanzanian MSM.…”