Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): Implications for HIV and STI transmission

Adedimeji, Adebola; Sinayobye, Jean d’Amour; Asiimwe‐Kateera, Brenda; Chaudhry, Junaid; Buzinge, Lydia; Gitembagara, Andre; Murenzi, Gad; Mugenzi, Pacifique; Patel, Viraj V.; Castle, Philip E.; Mutesa, Léon; Palefsky, Joel M.; Anastos, Kathryn

doi:10.1371/journal.pone.0211099

Cited by 35 publications

(37 citation statements)

References 35 publications

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“…The few studies performed among Rwandan MSM have shown evidence that this population is at particularly high risk of HIV infection and other sexually transmitted infections due to risky sexual behavior. 19 , 20 Ntale et al found the prevalence of HIV infection among Rwandan MSM to be 4.8%, 19 which is slightly higher than that among the general population, estimated at 3.0%. 21 Risky sexual behavior among Rwandan MSM includes high numbers of male and female sexual partners, providing commercial sex with both men and women, low condom use during anal and vaginal sex, and high mobility.…”

Section: Introductionmentioning

confidence: 96%

“… 22 This is further complicated by intense societal stigma, social isolation, and discrimination, which play a significant role in individual susceptibility to engage in risky sexual behavior. 20 A recent study performed in Togo found the prevalence of HIV and anal hrHPV infections among MSM to be 26.1% and 44.9%, respectively, with anal hrHPV infection being higher among MSMLH than HIV-negative MSM, 23 indicating a high burden of HIV and anogenital HPV among this key population.…”

Section: Introductionmentioning

confidence: 97%

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

Murenzi

Kim

Munyaneza

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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.

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Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 97%

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

Murenzi

Kim

Munyaneza

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…A 2015 study estimated an HIV prevalence among MSM (4.8%) higher than the national average (15). Furthermore, these studies described existence of bisexual partnerships among Rwandan MSM similar to settings around the world where same‐sex practices are stigmatized and sustained relationships are challenged (16‐18). However, whether MSM who have sex with both men and women in Rwanda have differential HIV and STIs risks remains unknown.…”

Section: Introductionmentioning

confidence: 99%

HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study

Rwema

Lyons

Herbst

et al. 2020

J. Intern. AIDS Soc.

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Introduction: Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali. Methods: MSM and TGW ≥ 18 years were recruited using respondent-driven sampling (RDS) from March-August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade. Results: A total of 736 participants were enrolled. The mean age was 27 years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS-adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (p < 0.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection. Overall, 61% (45/74) of respondents reported knowing their HIV-positive status. Among these, 98% (44/45) reported antiretroviral therapy use (ART); 75% (33/44) were virally suppressed using a cutoff of <200 copies/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11/29) were virally suppressed. Cumulatively, 59% (44/74) of all participants living with HIV were virally suppressed. Conclusions: These data show a high burden of HIV among MSM/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive screening for all sexual practices and preferences in the provision of comprehensive HIV prevention services in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV-related outcomes for MSM in Rwanda.

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“…At the meso level, family, social network and community characteristics powerfully shape women's knowledge and behaviors about health, including cervical-cancer, as well as facilitate access to resources for support. The importance of social networks in influencing health-related knowledge and behaviors have been previously described (22,23,24). Studies have also documented ways in which social networks can be important sources of support for promoting health and wellbeing (25,26,27).…”

Section: Discussionmentioning

confidence: 97%

Challenges and opportunities associated with cervical cancer screening programs in a low income, high HIV prevalence context

Adedimeji

Ajeh

Pierz

et al. 2020

Preprint

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Background Cervical-cancer is a leading cause of death among Cameroon women. The burden of cervical-cancer is in part traceable to the inadequate understanding of contextual determinants of access to expanding screening and prevention opportunities. We explored multilevel individual, community and structural factors that facilitate or inhibit cervical-cancer prevention in women at risk in a high HIV prevalence context. Methods We utilized an exploratory qualitative approach to obtain data through focus group discussions and in-depth interviews from May to August, 2018. A two-stage systematic sampling strategy was used to select 80 women and 20 men who participated in 8 focus group discussions and 8 in-depth interviews. The socio-ecological model guided data analyses to identify micro-, meso-, and macro-level determinants of cervical-cancer screening. Results Micro-level factors including lack of awareness and knowledge about cervical-cancer, lack of access to information on and excessive costs for cervical-cancer screening, low risk perceptions, and poor health seeking behaviors were major barriers for women seeking cervical-cancer screening. Meso-level factors, such as social networks, socio-cultural norms, perceptions of the role of men and HIV-related stigma when screening is integrated into HIV care, also engender negative attitudes and behaviors. Macro-level barriers to cervical-cancer screening included poorly equipped health facilities and a lack of national cancer prevention policies and programs. Conclusion In the context of the call for elimination of cervical-cancer as a public health problem, our findings highlight challenges and opportunities that can inform the design of effective interventions to increase uptake of cervical-cancer screening.

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Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): Implications for HIV and STI transmission

Cited by 35 publications

References 35 publications

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

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

HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross‐sectional study

Challenges and opportunities associated with cervical cancer screening programs in a low income, high HIV prevalence context

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