Men who have sex with men
(MSM) are at high risk of HIV. Few data are available on MSM and HIV-related
risk behaviors in West Africa. We aimed to describe risk behaviors and
vulnerability among MSM in Abidjan, Cote d'Ivoire.
We conducted a
cross-sectional respondent-driven sampling survey with 601 MSM in 2011-2012.
Sociodemographic and behavioural data as well as data related to emotional
state and stigma were collected. Population estimates with 95% confidence
intervals were produced. Survey weighted logistic regression was used to assess
factors associated with inconsistent condom use in the prior 12 months.
Most
MSM were 24 years of age or younger (63.9%) and had attained at least primary
education (84.4%). HIV risk behaviors such as low condom and water-based
lubricant use, high numbers of male and female sex partners, and sex work were
frequently reported as well as verbal, physical and sexual abuse. Inconsistent
condom use during anal sex with a male partner in the prior 12 months was
reported by 66.0% of the MSM and was positively associated with history of
forced sex, alcohol consumption, having a regular partner and a casual partner,
having bought sex, and self-perception of low HIV risk. MSM in Abidjan exhibit
multiple and frequent HIV-related risk behaviors.
To address those behaviours,
a combination of individual but also structural interventions will be needed
given the context of stigma, homophobia and violence.
Table 1
Sociodemographic characteristics, emotional state, history of abuse and other descriptives of MSM in Abidjan (N = 601).
| Variables | Unweighteda % (n) | Weightedb % (95% CI) |
| Sociodemographic characteristics and self-reported STD symptoms | ||
| Age (median 23, range 18–51) | ||
| 18–24 | 59.1 (355) | 63.9 (57.2–70.5) |
| 25–29 | 25.8 (155) | 23.8 (18.5–29.4) |
| 30–34 | 9.1 (55) | 8.7 (5.1–12.1) |
| 35–39 | 3.8 (23) | 2.8 (1.2–5.5) |
| 40+ | 2.2 (13) | 0.8 (0.1–1.7) |
| Nationality | ||
| Ivoirian | 95.0 (571) | 95.0 (92.9–97.2) |
| Other | 5.0 (30) | 5.0 (2.8–7.2) |
| Marital status | ||
| Never married | 91.5 (550) | 92.4 (89.5–95.3) |
| Married | 0.8 (5) | 0.9 (0.0–2.3) |
| Divorced, separated, widow | 0.3 (2) | 0.2 (0.0–0.7) |
| Married or cohabitating with a woman | 2.7 (16) | 2.9 (1.2–4.7) |
| Cohabitating with a man | 4.7 (28) | 3.6 (1.7–5.7) |
| Highest education level started | ||
| Never been to school | 5.8 (35) | 6.3 (3.5–8.8) |
| Primary | 7.0 (42) | 9.3 (5.8–13.1) |
| Secondary | 55.9 (336) | 59.6 (54.3–66.7) |
| Post-secondary | 31.3 (188) | 24.8 (19.1–29.7) |
| Work status | ||
| Unemployed | 14.5 (87) | 17.5 (12.5–22.2) |
| Student | 40.4 (243) | 40.6 (34.7–46.6) |
| Shopkeeper, retailer, hotel worker | 18.6 (112) | 14.5 (10.8–19.2) |
| Laborer, driver, artist | 15.0 (90) | 17.2 (12.4–22.7) |
| Clerical, professional | 5.1 (31) | 4.6 (2.4–6.9) |
| Sex workers | 0.7 (4) | 0.1 (0.0–0.3) |
| Other | 5.7 (34) | 5.5 (3.2–8.2) |
| Sexual identity | ||
| Homosexual | 43.9 (264) | 40.2 (34.7–46.4) |
| Bisexual | 54.4 (327) | 57.6 (51.4–62.8) |
| Heterosexual | 1.4 (8) | 1.8 (0.5–3.9) |
| Don't know | 0.3 (2) | 0.4 (0.0–1.5) |
| Age at first sex with a man | ||
| ≤10 | 5.6 (31) | 6.0 (2.9–9.4) |
| 11–15 | 21.7 (121) | 18.6 (14.4–24.2) |
| 16–20 | 54.2 (302) | 50.2 (43.2–56.8) |
| 21–25 | 12.9 (72) | 17.4 (11.8–22.8) |
| 26–30 | 5.0 (28) | 6.8 (3.5–11.0) |
| >31 | 0.6 (3) | 1.1 (0.0–2.9) |
| Self-reported STD symptoms in the past 12 months | 19.0 (114) | 19.2 (14.5–24.0) |
| Emotional state and history of abuse | ||
| Dominant feeling related to whole life in general | ||
| Positive feeling | 46.0 (276) | 44.1 (38.7–50.8) |
| Ambivalent feeling | 13.8 (83) | 11.5 (8.3–14.7) |
| Negative feeling | 40.2 (241) | 44.3 (38.0–50.1) |
| PHQ-2 Screen for depression in the past 2 weeks | ||
| Screen not depressed | 74.7 (447) | 74.3 (69.9–78.8) |
| Screen depressed | 25.3 (151) | 25.7 (21.2–30.1) |
| History of harassment or abuse because of MSM status | 44.9 (270) | 38.5 (32.4–43.6) |
| History of verbal harassment (threats, insults) because of MSM status | 40.9 (246) | 33.0 (27.5–37.9) |
| History of emotional abuse (isolation, exclusion) because of MSM status | 9.5 (57) | 6.3 (3.9–8.9) |
| History of physical abuse because of MSM status | 13.8 (83) | 8.5 (5.5–11.4) |
| History of forced sex | 24.5 (147) | 21.4 (16.6–26.0) |
| Alcohol and drug use | ||
| Alcohol use in the past 30 days | ||
| Never | 27.4 (165) | 32.4 (26.0–38.3) |
| Once a week or less | 49.1 (295) | 18.4 (14.5–22.9) |
| More than once a week | 23.1 (139) | 49.1 (43.4–55.6) |
| Non-intravenous drug use in the past 12 months | 9.3 (56) | 9.6 (6.2–13.5) |
| Exposure to HIV interventions | ||
| HIV test in the past 12 months | 37.9 (228) | 32.1 (26.6–37.0) |
| Had had an education session with a NGO or a health agent in the past 12 months (not related to HIV testing) | 48.1 (289) | 39.9 (34.4–45.5) |
a. Unweighted: sample proportions.
b. Weighted: population proportions.
Full article at: http://goo.gl/z25NKz
By:
1Department of Public Health, Institute of
Tropical Medicine, Antwerp, Belgium
2Centers for Disease Control and
Prevention, Atlanta, Georgia, United States of America
3Family Health International 360, Kinshasa,
Democratic Republic of Congo
4Family Health International 360, Abidjan,
Cote d′Ivoire
5Centers for Disease Control and
Prevention, Abidjan, Cote d′Ivoire
6Program for Highly Vulnerable Populations,
Ministry of Health and Fight against AIDS, Abidjan, Cote d′Ivoire
Rollins School of
Public Health, United States of America
* E-mail: ac.oohay@ohaesoj
More at: https://twitter.com/hiv_insight
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