Population Size, HIV, and Behavior among MSM in Luanda, Angola: Challenges and Findings in the First Ever HIV and Syphilis Biological and Behavioral Survey

Objectives

To conduct the first population size estimation and biological and behavioral surveillance survey among men who have sex with men (MSM) in Angola.

Design

Population size estimation with multiplier method and a cross-sectional study using respondent-driven sampling.

Setting

Luanda Province, Angola. Study was conducted in a large hospital.

Participants

Seven hundred ninety-two self-identified MSM accepted a unique object for population size estimation. Three hundred fifty-one MSM were recruited with respondent-driven sampling for biological and behavioral surveillance survey.

Methods

Interviews and testing for HIV and syphilis were conducted on-site. Analysis used Respondent-Driven Sampling Analysis Tool and STATA 11.0. Univariate, bivariate, and multivariate analyses examined factors associated with HIV and unprotected sex. Six imputation strategies were used for missing data for those refusing to test for HIV.

Main Outcome

A population size of 6236 MSM was estimated. Twenty-seven of 351 individuals were tested positive. Adjusted HIV prevalence was 3.7% (8.7% crude). With imputation, HIV seroprevalence was estimated between 3.8% [95% confidence interval (CI): 1.6 to 6.5] and 10.5% (95% CI: 5.6 to 15.3). Being older than 25 (odds ratio = 10.8, 95% CI: 3.5 to 32.8) and having suffered episodes of homophobia (odds ratio = 12.7, 95% CI: 3.2 to 49.6) significantly increased the chance of HIV seropositivity.

Conclusions

Risk behaviors are widely reported, but HIV seroprevalence is lower than expected. The difference between crude and adjusted values was mostly due to treatment of missing values in Respondent-Driven Sampling Analysis Tool. Solutions are proposed in this article. Although concerns were raised about feasibility and adverse outcomes for MSM, the study was successfully and rapidly completed with no adverse effects.

Below:  Social network of MSM for the outcome of the test HIV obtained by different allocation procedures.

Number of Sexual Partners in the Last 6 Months by Type of Partner

Total No. Sexual Partners in the Last 6 Months	N	Mean	SD	Minimum	Median	Maximum
Only transwomen	52	3.77	3.50	1	3	18
Only men	100	9.24	29.25	1	3	283
Transwomen and men	33	7.30	8.46	2	4	36
Transwomen and women	56	6.05	3.94	2	5	18
Men and women	50	6.98	7.20	2	6	50
Transwomen, men, and women	35	15.71	18.56	4	11	117

Full article at:   http://goo.gl/n5xFjN

By:  Carl Kendall, PhD,* Ligia Regina Franco Sansigolo Kerr, MD, MPH, PhD,† Rosa Maria Salani Mota, MS, PhD,† Socorro Cavalcante, MPH, PhD,‡ Raimunda Hermelinda Maia Macena, MPH, PhD,† Sanny Chen, MPH, PhD,§ Nicholas Gaffga, MD,§ Edgar Monterosso, MPH, MD,§ Fransisco I. Bastos, MD, PhD,|| and Dulcelina Serrano, MD¶

^*Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA

^†Department of Community Health, Federal University of Ceará, Fortaleza, Brazil

^‡Department of Epidemiological Surveillance, Ministry of Health, Fortaleza, Fortaleza, Brazil

^§Centers for Disease Control and Prevention, Atlanta, Georgia, USA

^||Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

^¶Director, National Institute of the Fight against AIDS, Luanda, Angola

Correspondence to: Carl Kendall, PhD, Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112 (Email: moc.liamg@lladnek.lrac)

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