HIV prevalence and factors associated with HIV infection among men who have sex with men in Cameroon

Abstract

IntroductionDespite men who have sex with men (MSM) being a key population for HIV programming globally, HIV epidemiologic data on MSM in Central Africa are sparse. We measured HIV and syphilis prevalence and the factors associated with HIV infection among MSM in Cameroon.MethodsTwo hundred and seventy-two and 239 MSM aged ≥18 from Douala and Yaoundé, respectively, were recruited using respondent-driven sampling (RDS) for this cross-sectional surveillance study in 2011. Participants completed a structured questionnaire and HIV and syphilis testing. Statistical analyses, including RDS-weighted proportions, bootstrapped confidence intervals and logistic regressions, were used.ResultsCrude and RDS-weighted HIV prevalence were 28.6% (73/255) and 25.5% (95% CI 19.1–31.9) in Douala, and 47.3% (98/207) and 44.4% (95% CI 35.7–53.2) in Yaoundé. Active syphilis prevalence in total was 0.4% (2/511). Overall, median age was 24 years, 62% (317/511) of MSM identified as bisexual and 28.6% (144/511) identified as gay. Inconsistent condom use with regular male partners (64.1%; 273/426) and casual male and female partners (48.5%; 195/402) was common, as was the inconsistent use of condom-compatible lubricants (CCLs) (26.3%; 124/472). In Douala, preferring a receptive sexual role was associated with prevalent HIV infection [adjusted odds ratio (aOR) 2.33, 95% CI 1.02–5.32]. Compared to MSM without HIV infection, MSM living with HIV were more likely to have ever accessed a health service targeting MSM in Douala (aOR 4.88, 95% CI 1.63–14.63). In Yaoundé, MSM living with HIV were more likely to use CCLs (aOR 2.44, 95% CI 1.19–4.97).ConclusionsHigh HIV prevalence were observed and condoms and CCLs were used inconsistently indicating that MSM are a priority population for HIV prevention, treatment and care services in Douala and Yaoundé. Building the capacity of MSM community organizations and improving the delivery and scale-up of multimodal interventions for MSM that are sensitive to concerns about confidentiality and the complex individual, social, community-level and policy challenges are needed to successfully engage young MSM in the continuum of HIV care. In addition to scaling up condom and CCL access, evaluating the feasibility of novel biomedical interventions, including antiretroviral pre-exposure prophylaxis and early antiretroviral therapy for MSM living with HIV in Cameroon, is also warranted.

“In the Fell Clutch of Circumstance”: HIV and Men Who Have Sex With Men in Sub-Saharan Africa

“…They note that the sexual identities adopted by MSM are frequently linked to their sexual behaviours and that being the receptive partner in anal sex was associated with adopting a more openly homosexual social identity, whereas men who reported being the penetrative partner in anal intercourse tended not to associate themselves with labels signifying gay identity [43]. Similar findings have been reported from South Africa [38], Senegal [36] and Cameroon [25].…”

“…In a cohort study in Senegal, Drame et al [23] report an HIV prevalence of 36 %, while in Togo Ekouevi, Dagnra et al [24] report a prevalence of 19.6 % in a cross sectional study in six cities. And, a recent study in Cameroon found HIV prevalence rates of between 25.5 % and 44.4 % among MSM in two cities [25].…”

“…In terms of HIV infection, Park et al [25] found that gay self identity was associated with being HIV positive among MSM in Douala, Cameroon (OR2.53; 95 % confidence interval (CI) 1.90-7.40), and Vu, Adebajo et al [22] found that heterosexual and bisexual MSM in Ibadan, Nigeria, were significantly more likely to be HIV positive than gay identifying MSM in that city (AOR 9.1; 95 % CI 1.2-70.6).…”

Evaluating Respondent-Driven Sampling as an Implementation Tool for Universal Coverage of Antiretroviral Studies Among Men Who Have Sex With Men Living With HIV

“…This is especially the case in West and Central Africa, where the epidemics appear to be more concentrated among key populations 12,15 . Nigeria has a mixed HIV epidemic including both concentrated epidemics within key populations as well as a more generalized epidemic among reproductive age adults.…”

Depression and Social Stigma Among MSM in Lesotho: Implications for HIV and Sexually Transmitted Infection Prevention

“…Previous studies have linked HIV/STIs with sexual risk behaviors such as inconsistent condom use for anal intercourse and multiple and concurrent sexual partnerships (22, 25). However, although sexual behavior change is an important consideration for HIV/STIs, the epidemic of HIV among MSM is driven substantially by other factors including the social and structural factors that underlie high risk sexual practices (26).…”