FRLBX03 - Oral Abstract
HIV prevalence, sexual risks and HIV knowledge among men who have sex with men (MSM) in Malawi: understanding risks among a stigmatized population and opportunities for interventions
Presented by Andrea Wirtz (United States).
A. Wirtz1, G. Trapence2, V. Jumbe3, E. Umar3, S. Ketende1, D. Kamba2, M. Berry1,4, S. Stromdahl1,5, C. Beyrer1, S. Baral1
1Johns Hopkins Bloomberg School of Public Health, Epidemiology, Baltimore, United States, 2Center for the Development of People, Blantyre, Malawi, 3Malawi College of Medicine, Blantyre, Malawi, 4Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, United States, 5Karolinska Institutet, Public Health Sciences, Stockholm, Sweden
Background: Malawi has a generalized HIV epidemic with approximately 11.0% of adults living with HIV, though preliminary data highlight significant HIV-related vulnerabilities among key populations, such as MSM. There is limited understanding of vulnerabilities among MSM; this study aimed to fill this gap and provide population-based estimates of HIV prevalence and associations of infection among MSM in Malawi.
Methods: 339 men reporting anal sex with another man in the previous year were accrued into a respondent-driven-sampling study from August 2011-March 2012 in Blantyre. Study activities included a structured survey instrument and biological assessment of HIV and syphilis.
Results: Participants were a mean age of 25.1yrs. (range:18-49), 46.6% were unemployed, over half were gay-identified (61.9%), and 10.3%(35/339) were currently married to a woman. Participants reported a mean of 3 male sex partners in the last 12mo. (range:1-50). Concurrent relationships were common: 30.4%(99/326) reported recent partnerships with two or more men and 14.7%(48/306) reported concurrent partnerships that included at least one female. HIV prevalence was 14.8%(49/330); among those with HIV infection, 91%(45/49) were unaware of their HIV status and 39.9%(19/39) had never tested for HIV. Nearly 60%(176/304) reported that vaginal sex was the highest risk form of sex, indicating low knowledge of transmission risk. Multivariate analysis demonstrated that age >26yrs (aOR: 4.26, CI:2.17-9.47), history of imprisonment (aOR:1.72; CI: 0.82-3.58), and having >1 child (aOR:2.25; 95%CI:1.50-7.01) were associated with HIV infection, while rural residency (aOR: 0.32; 95%CI:0.11-0.93) and secondary education or higher (aOR:0.81; 95%CI:0.41-1.63) were inversely associated.
Conclusions: As of May, 2012, the changing government in Malawi publicly announced intention to decriminalize homosexuality. The data here reinforce the need to take advantage of this opportunity to provide services to MSM, given the limited HIV-related knowledge and high-risk practices. This study demonstrates that MSM are an important population in Malawi's HIV epidemic and deserve targeted HIV prevention services.
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