HIV/Sexually Transmitted Infection Prevalence and Sexual Behavior of Men Who Have Sex With Men in 3 Districts of Botswana

Background Substance use and its relation to HIV risk among men who have sex in Africa, a population at high risk for HIV, has received little attention. Methods This systematic review summarizes and discusses findings from 68 empirical studies, published between 1980 and 2016 that included data about substance use in MSM in Africa. Results Substance use has rarely been the primary focus of studies in African MSM. In general, measurement of substance use was suboptimal. Whereas prevalence of alcohol use varied across studies, partly resulting from variety in assessment strategies, it seemed higher than in the general male population across countries. Alcohol use was associated with sexual risk practices, but not with HIV infection. The most frequently reported drug used by African MSM was cannabis. Use of other drugs, such as cocaine and heroin seemed relatively rare, although injection drug use was exceptionally high in a few studies. As alcohol, drugs were regularly used in conjunction with sex. Both alcohol and drug use were often associated with other risk factors for HIV infection, including violence and transactional sex. No interventions were found addressing substance use among African MSM. Conclusion Given high HIV-risk and prevalence in this population, substance use should be studied more in-depth, taking into account the specific social and cultural context. Assessment of substance use practices in this population has to be improved. The available information suggests, though, that there is an urgent need for interventions addressing substance use tailored to the needs of this critical population.

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“…38 One other study asked whether men had six or more drinks before anal sex in the last week. 39 None of the studies assessed alcohol dependence.…”

Section: Resultsmentioning

confidence: 99%

Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review

Sandfort

Knox²,

Alcala

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Studies in this systematic review included diverse MSM populations, including international studies in Asia [15,16,17,18,19,20], Africa [21,22,23], South America [24,25], and Europe [26,27] (41%); Black and Latino persons in the United States [28,29,30,31,32,33,34,35] (25%); and young adults or adolescents [36,37,38,39] (13%). Half of studies (50%) used only community-based surveys [15,16,18,20,21,24,25,28,29,32,35,37,38,40,41,42], 38% ( n = 12) used population-based surveys [17,19,22,23,26,33,34,36,39,43,44,45], 9% ( n = 3) used both community and population-based surveys [27,30,31], and one study (3%) used surveillance data to conduct their analysis [46]. All studies were quantitative in nature and assessed the association between HIV infection and various demographic and behavioral characteristics among MSM.…”

Section: Resultsmentioning

confidence: 99%

“…These proxies were assessed using self-identified sexual orientation (i.e., heterosexual, gay/homosexual, bisexual, or not sure) or same-sex partners during the previous 12 months or lifetime. In total, 9% ( n = 3) [34,43,46] used proxies exclusively (i.e., sexual identity or partner gender), 82% ( n = 26) [15,16,17,18,19,20,21,22,23,25,26,27,28,29,32,33,35,36,37,38,39,40,41,42,44,45] used sexual risk behaviors and did not rely on proxy measures, and 9% ( n = 3) [24,30,31] used a combination of these measures to evaluate HIV transmission among MSM.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 32 studies assessing the association of HIV infection with high risk sexual behaviors or proxy variables, 12% ( n = 4) [28,33,38,39] did not report any potential misclassification and 82% ( n = 26) [15,16,17,18,19,20,21,22,23,24,25,26,27,29,32,34,35,36,37,40,41,42,43,44,45,46] only discussed misclassification of sexual behavior or MSM classification as a potential limitation. In one such study, clearly stated by Reisner et al [34], “There was no assessment of recent HIV sexual risk behavior (e.g., unprotected vaginal or anal intercourse) in the NESARC data; therefore, we could not describe or consider recent behavioral risk patterns that may have led to incident HIV infections in our study.” Similar approaches in reporting potential misclassification bias was observed in other articles; however, among these studies, statistical techniques to adjust for misclassification were not employed.…”

Section: Resultsmentioning

confidence: 99%

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Bias Adjustment Techniques Are Underutilized in HIV Sexual Risk Estimation: A Systematic Review

Tran

Goldstein

Welles

2018

IJERPH

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Background: Valid measurement of determinants of HIV infection among men who have sex with men (MSM) is critical for intervention planning and resource allocation. However, sexual minority research concerning HIV risk often relies on proxy exposures of sexual behaviors such as sexual orientation and partner gender. Inferring high risk sexual behaviors (i.e., condomless anal intercourse) from these proxies inaccurately captures HIV risk, but few studies have attempted to correct for this bias. Methods: We performed a systematic review of methodological practices for estimating risk of HIV infection among MSM. Results: We identified 32 studies in which high risk sexual behavior was assessed: 82% (n = 26) measured and used sexual risk behaviors (e.g., condomless anal intercourse or sexual positioning) to assess risk of HIV infection; 9% (n = 3) used proxy measures; and 9% (n = 3) used both behavior and proxy variables. Various treatments of misclassification reported by investigators included the following: 82% (n = 26) discussed misclassification of sexual behavior as a potential limitation; however, among these studies, no attempts were made to correct misclassification; 12% (n = 4) did not report exposure misclassification, and 6% (n = 2) explicitly considered this information bias and conducted a Bayesian approach to correct for misclassification. Conclusions: Our systematic review indicates that a majority of studies engaging in collecting primary data have taken additional steps to acquire detailed information regarding sexual risk behaviors. However, reliance on population-based surveys may still lead to potentially biased estimates. Thus, bias analytic techniques are potential tools to control for any suspected biases.

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“…This finding has important implications; finding one person from a specific hard-to reach population could serve as a gateway to others from this same population. This phenomenon has been observed with frequency in sub-Saharan African high-risk populations, such as sex workers, injection drug users and men who have sex with men, [17][18][19][20][21][22][23] but this phenomenon is less well described among patients with STI who primarily experience risk from heterosexual sexual contact with the general population. [24][25][26][27] This observation is important since heterosexual transmission in the general population is the primary source of HIV transmission in sub-Saharan Africa.…”

Section: Discussionmentioning

confidence: 99%

Recruiting the social contacts of patients with STI for HIV screening in Lilongwe, Malawi: process evaluation and assessment of acceptability

Rosenberg

Stanley²,

Rutstein

et al. 2016

Sex Transm Infect

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Objectives To explore acceptability of recruiting social contacts for HIV and STI screening in Lilongwe, Malawi. Methods In this observational study, three groups of “seed” patients were enrolled: 45 HIV-infected STI patients, 45 HIV-uninfected STI patients, and 45 community controls, who were also tested for HIV as part of the study. Each seed was given five coupons and asked to recruit up to five social contacts to the STI clinic. Seeds were told the programme for contacts would include HIV testing, STI screening, and general health promotion. Seeds were asked to return after one month to report on the contact recruitment process. Seeds received $2 for each successfully recruited contact. Results Eighty-nine seeds (66%) returned for one-month follow-up with no difference between the three seed groups (p=0.9). Returning seeds reported distributing most of their coupons (mean=4.1) and discussing each feature of the programme with most contacts—HIV testing (90%), STI screening (87%), and health promotion (91%). Seeds reported discussing their own HIV status with most contacts (52%), with a lower proportion of HIV-infected seeds discussing their HIV status (22%) than HIV-uninfected seeds (81%) or community seeds (64%) (p<0.001). Contact recruitment did not vary with socioeconomic status. Conclusions Most seeds distributed all coupons and reported describing all aspects of the programme to most contacts. STI patients are able to act as health promoters within their social networks and may be a critical link to increasing STI and HIV status awareness among high risk groups.

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HIV/Sexually Transmitted Infection Prevalence and Sexual Behavior of Men Who Have Sex With Men in 3 Districts of Botswana

Abstract: HIV prevalence of MSM was lower than what has been reported in other sub-Saharan African countries with generalized epidemics; however, their degree of participation in heterosexual sex signifies sexual networks beyond the MSM subpopulation.

Cited by 15 publications

References 11 publications

Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review

Substance Use and HIV Risk Among Men Who Have Sex With Men in Africa: A Systematic Review

Bias Adjustment Techniques Are Underutilized in HIV Sexual Risk Estimation: A Systematic Review

Recruiting the social contacts of patients with STI for HIV screening in Lilongwe, Malawi: process evaluation and assessment of acceptability

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