Changes in Sexual Risk Behavior among MSM Participating in a Research Cohort in Coastal Kenya

OBJECTIVE:

To describe changes in sexual risk behavior among Kenyan MSM who received regular risk reduction counseling (RRC).

DESIGN:

Data were derived from two cohorts of HIV-1-negative and HIV-1-positive MSM in Kenya. Behavioral data were collected at enrollment and at monthly or quarterly scheduled follow-up visits. At each visit, RRC was provided to all men and HIV-1 testing to seronegative men.

METHODS:

Random effects logistic and Poisson regression models with time since study entry as main variable of interest were used to evaluate changes in number of sex partners and unprotected sex in the past week, and insertive, receptive, and unprotected anal intercourse in the past 3 months. Analyses were adjusted for HIV-1-status, calendar year of follow-up, and several baseline characteristics. Trends over follow-up time were allowed to differ by HIV-1-status. Men were censored when they seroconverted for HIV.

RESULTS:

Number of regular and casual sex partners and unprotected anal intercourse decreased in both HIV-1-negative and HIV-1-positive men. Unprotected sex with both regular and casual sex partners decreased more strongly early in follow-up in HIV-1-positive men than in HIV-1-negative men. Decreases in insertive anal intercourse were found for HIV-1-positive men only, whereas decreases in receptive anal intercourse were found for HIV-1-negative men only.

CONCLUSION:

MSM who were regularly exposed to RRC showed some reductions in sexual risk behavior, but it is uncertain if these reductions are sustained over time. As HIV-1 incidences in Kenyan MSM are very high, RRC should be supported by comprehensive biomedical interventions.

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By:  Möller LM1, Stolte IG, Geskus RB, Okuku HS, Wahome E, Price MA, Prins M, Graham SM, Sanders EJ.

• 1aDepartment of Infectious Diseases Research and Prevention, Public Health Service Amsterdam, the Netherlands bDepartment of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, the Netherlands cCentre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya dInternational AIDS Vaccine Initiative, New York City, New York eDepartment of Epidemiology and Biostatistics, University of California, San Francisco, California, USA fDepartment of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands gDepartments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA hNuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Headington, UK iDepartment of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. *Lisanne M. Möller and Ineke G. Stolte contributed equally to the writing of this article. 

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