Men Who Have Sex with Men in Kampala, Uganda: Results from a Bio-Behavioral Respondent Driven Sampling Survey

Hladik, Wolfgang; Sande, Enos; Berry, Mark; Ganafa, Samuel; Kiyingi, Herbert; Kusiima, Joy; Hakim, Avi

doi:10.1007/s10461-016-1535-2

Cited by 40 publications

(37 citation statements)

References 13 publications

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“…Globally, the risk of HIV acquisition was 28 times higher among MSM than heterosexual men in 2017 [1,3]. In Uganda, HIV prevalence among MSM is 13.2% compared to 5.9% in the general population and key populations including MSM account for more than a third of new HIV infections [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…HIV testing is the entry point to HIV care; increasing testing coverage is a key step to reaching the first UNAIDS 90-90-90 target, i.e., 90% of people living with HIV knowing their HIV status. However, testing uptake is still low among MSM despite efforts to scale up prevention services for key populations (KP) in Uganda [5][6][7][8]. A recent bio-behavioral survey of Ugandan MSM found that 35% had never tested for HIV [6].…”

Section: Introductionmentioning

confidence: 99%

“…However, testing uptake is still low among MSM despite efforts to scale up prevention services for key populations (KP) in Uganda [5][6][7][8]. A recent bio-behavioral survey of Ugandan MSM found that 35% had never tested for HIV [6]. HIV self-testing (HIVST), in which an individual performs and interprets his/her own HIV test [8][9][10][11][12][13], is an acceptable and innovative approach that could increase knowledge of HIV sero-status among MSM, and is recommended by the World Health Organization and Uganda Ministry of Health [3,[14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, HIVST is convenient since individuals can test at any time, in private, without having to present to a clinic during fixed working hours. In Uganda, healthcare stigma, discrimination, homophobic violence and criminalization are significant barriers to uptake of facilitybased HIV testing among MSM [4,6,8,23]. Scaling up access to HIVST could increase testing coverage among MSM with low access to facility-based services [3,6].…”

Section: Introductionmentioning

confidence: 99%

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Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

et al. 2020

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Introduction One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection. Methods From June to August 2018, we conducted a pilot study of secondary distribution of HIV selftesting (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively. Results A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22-28) compared to 28 years IQR (25-35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

et al. 2020

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“…[8–10] Suicidal ideation is often associated with cognitive processes including hopelessness, pessimism, negative self-perceptions, and poor problem-solving skills that may hinder protective health behavior. [11,12]…”

Section: Introductionmentioning

confidence: 99%

Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM

Rodriguez‐Hart

Nowak

Musci

et al. 2017

Aids

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Objectives Sexual stigma affecting men who have sex with men (MSM) in Nigeria may be an important driver of HIV and other sexually transmitted infections (STIs), but potential mechanisms through which this occurs are not well understood. This study assessed the contributions of suicidal ideation and sexual risk behaviors to causal pathways between stigma and HIV/STIs. Design Data were collected from the TRUST/RV368 Study, a prospective cohort of 1,480 MSM from Abuja and Lagos, Nigeria. Methods Participants enrolled from March 2013-February 2016 were classified into three stigma subgroups based on a latent class analysis of nine stigma indicators. Path analysis was used to test a model where disclosure led to stigma, then suicidal ideation, then condomless sex with casual sex partners, and finally incident HIV infection and/or newly diagnosed STIs, adjusting the model for age, education, having had female sex partners in the past 12 months, and sex position. Both direct and indirect (mediational) paths were tested for significance and analyses were clustered by city. Results As stigma increased in severity, the proportion of incident HIV/STI infections increased in a dose-response relationship (low: 10.6%, medium: 14.2%, high 19.0%, p-value=.008). All direct relationships in the model were significant and suicidal ideation and condomless sex partially mediated the association between stigma and incident HIV/STI infection. Conclusions These findings highlight the importance of the meaningful integration of stigma-mitigation strategies in conjunction with mental health services as part of a broader strategy to reduce STI and HIV acquisitions among Nigerian MSM.

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Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response

et al. 2018

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IntroductionThe UNAIDS 90‐90‐90 targets to diagnose 90% of people living with HIV, put 90% of them on treatment, and for 90% of them to have suppressed viral load have focused the international HIV response on the goal of eliminating HIV by 2030. They are also a constructive tool for measuring progress toward reaching this goal but their utility is dependent upon data availability. Though more than 25% of new infections are among key populations (KP)‐ sex workers, men who have sex with men, transgender people, people who inject drugs, and prisoners‐ and their sex partners, there is a dearth of treatment cascade data for KP. We assess the availability of cascade data and review the opportunities offered by biobehavioral and programme data to inform the HIV response.DiscussionThe emphasis on the collection of treatment cascade data among the general population in higher prevalence countries has not led to a similar increase in the availability of cascade data for KP. The limited data available for KP highlight large gaps in service uptake across the cascade, particularly in the first 90, awareness of HIV status. Biobehavioral surveys (BBS), with linked population size estimation, provide population‐based data on the treatment cascade and should be conducted every two to three years in locations with services for KP. With the inclusion of viral load testing, these surveys are able to monitor the entire treatment cascade among KP regardless of whether these populations access HIV services targeting the general population or KP. BBS also reach people accessing services and those who do not, thereby providing a unique opportunity to learn about barriers to service uptake including stigma and discrimination. At the same time high‐quality programme data can play a complementary role in identifying missed opportunities that can be addressed in real‐time.ConclusionsData are more important than ever for guiding the HIV response toward reaching 90‐90‐90 targets and eliminating HIV, particularly in the face of decreased funding for HIV and specifically for KP. Timely high‐quality BBS data can be triangulated with high‐quality programme data to provide a comprehensive picture of the epidemic response for KP.

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Men Who Have Sex with Men in Kampala, Uganda: Results from a Bio-Behavioral Respondent Driven Sampling Survey

Cited by 40 publications

References 13 publications

Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda: A pilot study

Pathways from sexual stigma to incident HIV and sexually transmitted infections among Nigerian MSM

Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response

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