The Mpumalanga Men's Study (MPMS): Results of a Baseline Biological and Behavioral HIV Surveillance Survey in Two MSM Communities in South Africa

Abstract

The Mpumalanga Men's Study (MPMS) is the assessment of the Project Boithato HIV prevention intervention for South African MSM. Boithato aims to increase consistent condom use, regular testing for HIV-negative MSM, and linkage to care for HIV-positive MSM. The MPMS baseline examined HIV prevalence and associated risk behaviors, and testing, care, and treatment behaviors among MSM in Gert Sibande and Ehlanzeni districts in Mpumalanga province, South Africa in order to effectively target intervention activities. We recruited 307 MSM in Gert Sibande and 298 in Ehlanzeni through respondent-driven sampling (RDS) between September 2012-March 2013. RDS-adjusted HIV prevalence estimates are 28.3% (95% CI 21.1%–35.3%) in Gert Sibande, and 13.7% (95% CI 9.1%–19.6%) in Ehlanzeni. Prevalence is significantly higher among MSM over age 25 [57.8% (95% CI 43.1%–72.9%) vs. 17.9% (95% CI 10.6%–23.9%), P<0.001 in Gert Sibande; 34.5% (95%CI 20.5%–56.0%) vs. 9.1% (95% CI 4.6%–13.9%), P<0.001 in Ehlanzeni]. In Gert Sibande, prevalence is higher among self-identified gay and transgender MSM vs. other MSM [39.3% (95%CI, 28.3%–47.9%), P<0.01], inconsistent condom users [38.1% (18.1%–64.2%), P<0.05], those with a current regular male partner [35.0% (27.1%–46.4%), P<0.05], and those with lifetime experience of intimate partner violence with men [40.4%, (95%CI 28.9%–50.9%), P<0.05]. Prevalence of previous HIV testing was 65.8% (95%CI 58.8%–74.0%) in Gert Sibande, and 69.3% (95%CI 61.9%–76.8%) in Ehlanzeni. Regular HIV testing was uncommon [(34.6%, (95%CI 27.9%–41.4%) in Gert Sibande; 31.0% (95%CI 24.9%–37.8%) in Ehlanzeni]. Among HIV-positive participants, few knew their status (28.1% in Gert Sibande and 14.5% in Ehlanzeni), or were appropriately linked to care (18.2% and 11.3%, respectively), or taking antiretroviral therapy (13.6% and 9.6% respectively). MPMS results demonstrate the importance of implementing interventions for MSM to increase consistent condom use, regular HIV testing, and linkage and engagement in care for HIV-infected MSM.

HIV risk and prevention among men who have sex with men in rural South Africa

“…In terms of demographics, South African MSM older than 25 have consistently been found to have higher HIV infection rates than other MSM (Baral et al, 2011;Lane et al, 2011;Sandfort, Knox, Collier, Lane, & Reddy, 2015). Psychosocial factors contributing to HIV risk include: sexual self-identity (Lane et al, , 2014Rispel et al, 2011;Sandfort, Lane, Dolezal, & Reddy, 2015); experiences of stigma and homophobia (Arnold, Struthers, McIntyre, & Lane, 2013;Tucker et al, 2014); low self-efficacy for protective behaviours (Tucker et al, 2014); beliefs about trust and condom use in relationships (Knox, Yi, Reddy, Maimane, & Sandfort, 2010); being in a relationship with a regular partner (Arnold et al, 2013;Knox et al, 2010); and experiencing depression (Tucker et al, 2013). Behavioural risk factors for HIV infection identified in previous research include: transactional sex Nel, Yi, Sandfort, & Rich, 2013); high numbers of sexual partners Tucker et al, 2014); and alcohol and drug use Lane, Shade, McIntyre, & Morin, 2008;Parry et al, 2008;Sandfort, Yi, Knox, & Reddy, 2013).…”

“…This means that HIV prevention efforts developed in urban contexts may need to be adapted based on the relative importance of particular risk factors. Potentially important features of the rural context that may affect HIV risk among MSM include: the relative importance of traditional cultural beliefs and practices (Icard et al, 2015); high rates of poverty and unemployment (Neves & du Toit, 2013;Pronyk et al, 2008); high levels of circular migration between urban and rural areas (Hunter, 2010;Neves & du Toit, 2013;Pronyk et al, 2008); and lower levels of educational attainment (Lane et al, 2014). Based on findings among urban and peri-urban MSM, the relatively higher rates of rural unemployment, and lower levels of formal education in rural South Africa may have a disproportionate effect on HIV risk among MSM in these areas.…”

Comparing Provider and Client Preferences for HIV Prevention Services in South Africa among Men Who Have Sex with Men

“…25 Simultaneously, the progress and momentum in South Africa are encouraging; it is the only country in sub-Saharan Africa where gay rights are formally recognized, and national policies emphasized reducing discrimination based on sexual orientation. 26 Men who have sex with men were included for the first time in the 2007 to 2011 National Strategic Plan for HIV, and the South African government has developed specific efforts and resources to combat HIV among MSM, 15,19 including promotion of PrEP and routine HIV testing. 15 One promising approach to HIV prevention is the creation of combination prevention packages that conglomerate individually efficacious HIV-prevention measures into 1 package, which is targeted specifically to the unique needs and risks of a given population.…”

Assessing the Feasibility of Smartphone Apps for HIV-Care Research with MSM and Transgender Individuals in Mpumalanga, South Africa

“…It is estimated that 16.3% to 20.6% of MSM have undiagnosed HIV infection in this setting, complementing different studies with MSM in other African communities that have shown similar high rates of undiagnosed HIV infection. [3][4][5] In this rural setting, 1 in 2 MSM over the age of 25 years are HIV positive with only 18.3% linked to care and 13.6% taking antiretroviral treatment (ART). 3 Although we have good understanding of HIV risk for MSM in African settings, we have limited understanding of HIV risk factors and health-care needs for transgender individuals.…”

“…[3][4][5] In this rural setting, 1 in 2 MSM over the age of 25 years are HIV positive with only 18.3% linked to care and 13.6% taking antiretroviral treatment (ART). 3 Although we have good understanding of HIV risk for MSM in African settings, we have limited understanding of HIV risk factors and health-care needs for transgender individuals. [6][7][8][9] In general, there have been few, and only recent, HIV prevention activities with rural MSM and transgender African communities.…”