Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa

Abstract

34 Men who have sex with men (MSM) are at much greater risk of HIV infection in 35 Africa. Little is known about their involvement in transactional sex (TS). We 36 aimed to characterize MSM reporting TS (MSM-TS) and to identify factors 37 associated with their sexual practices using data from the prospective cohort study 38 CohMSM conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Our study 39 focused on HIV-negative MSM, recruited between 06/2015 and 01/2018 by a 40 team of trained peer educators. Scheduled study visits at 6, 12 and 18 months 41 included medical examinations, HIV screening, risk-reduction counselling and 42 face-to-face interviews to collect information on their sociodemographic 43 characteristics, sexual behaviours, and HIV risk-reduction strategies. Three 44 stigmatization sub-scores were constructed. The generalized estimating equation 45 method was used for data analysis. Of the 630 HIV-negative participants recruited 46 at baseline, 463, 410 and 244 had a follow-up visit at 6-and 12-and 18-months, 47 respectively. Over a total of 1747 visits, 478 TS encounters were reported by 289 48 MSM-TS (45.9%). Of the latter, 91 participants reported systematic TS (31.5%), 49 55 (19.0 %) stopped reporting TS after baseline, and 53 (18.3%) reported TS after 50 baseline. Ninety participants (31.1 %) reported occasional TS. After adjusting for 51 country of study and follow-up visits, the following factors, reported for the 52 previous 6 months, were associated with a greater likelihood of TS: younger age, 53 an educational level <high-school diploma, satisfaction with current sex life, 54 group sex with men, multiple male sexual partners, condomless anal sex, 55 receptive or versatile anal sex with male sexual partners, giving benefits in 56 exchange for sex with a man, alcohol consumption and drug use during sex, and 57 experiencing stigmatization. The majority of MSM in this study who received 58 benefits in exchange for sex had high-risk HIV infection exposure practices and 59 were characterized by socioeconomic difficulties. 60 61 62 3 63 Introduction 64 Men who have sex with men (MSM) are at a much greater risk of Human 65 Immunodeficiency Virus (HIV) infection globally [1-3]. They constitute a highly 66 heterogeneous group comprising bisexuals, transgender people and homosexuals from 67 different socio-economic contexts and risk environments. These factors may influence 68 their HIV exposure levels and their HIV transmission risk [4-7]. More specifically, age, 69 educational level, economic disparities and income sources, housing stability, multiple 70 sexual relationships and the exchange of benefits for sexual relations within these 71 relationships (i.e., Transactional Sex, (TS)) have all been identified as factors related to 72 different HIV exposure and transmission levels [8-10]. 73 Studies have shown that MSM reporting TS (MSM-TS) are at a much greater risk 74 of acquiring and transmitting HIV than MSM who do not report TS (MSM-NTS) because 75 of high-risk sexual behaviours, including ...