Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, MD, USA;
J Int AIDS Soc. 2013 Dec 2;16 Suppl 3(4Suppl 3):18742. doi: 10.7448/IAS.16.4.18742.
There are limited data characterizing the burden of HIV among men who have sex with men (MSM) in Malawi. Epidemiologic research and access to HIV prevention, treatment and care services have been traditionally limited in Malawi by criminalization and stigmatization of same-sex practices. To inform the development of a comprehensive HIV prevention intervention for Malawian MSM, we conducted a community-led assessment of HIV prevalence and correlates of infection.
From April 2011 to March 2012, 338 MSM were enrolled in a cross-sectional study in Blantyre, Malawi. Participants were recruited by respondent-driven sampling methods (RDS), reaching 19 waves. Trained staff administered the socio-behavioural survey and HIV and syphilis voluntary counselling and testing.
Crude HIV and syphilis prevalence estimates were 15.4% (RDS-weighted 12.5%, 95% confidence interval (CI): 7.3-17.8) and 5.3% (RDS-weighted 4.4%, 95% CI: 3.1-7.6), respectively. Ninety per cent (90.4%, unweighted) of HIV infections were reported as being previously undiagnosed. Participants were predominantly gay-identified (60.8%) or bisexually identified (36.3%); 50.7% reported recent concurrent relationships. Approximately half reported consistent condom use (always or almost always) with casual male partners, and proportions were relatively uniform across partner types and genders. The prevalence of perceived and experienced stigma exceeded 20% for almost all variables, 11.4% ever experienced physical violence and 7% were ever raped. Current age >25 years (RDS-weighted adjusted odds ratio (AOR) 3.9, 95% CI: 1.2-12.7), single marital status (RDS-weighted AOR: 0.3; 95% CI: 0.1-0.8) and age of first sex with a man <16 years (RDS-weighted AOR: 4.3, 95% CI: 1.2-15.0) were independently associated with HIV infection.
Results demonstrate that MSM represent an underserved, at-risk population for HIV services in Malawi and merit comprehensive HIV prevention services. Results provide a number of priorities for research and prevention programmes for MSM, including providing access to and encouraging regular confidential HIV testing and counselling, and risk reduction counselling related to anal intercourse. Other targets include the provision of condoms and compatible lubricants, HIV prevention information, and HIV and sexually transmitted infection treatment and adherence support. Addressing multiple levels of HIV risk, including structural factors, may help to ensure that programmes have sufficient coverage to impact this HIV epidemic among MSM.
在马拉维，男男性行为者（MSM）中的艾滋病毒负担数据有限。由于同性行为的刑事定罪和污名化，传统上马拉维的流行病学研究和艾滋病毒预防、治疗和护理服务都受到限制。为了为马拉维的 MSM 制定全面的艾滋病毒预防干预措施，我们进行了一项社区主导的艾滋病毒流行率和感染相关因素评估。
2011 年 4 月至 2012 年 3 月，338 名 MSM 在马拉维布兰太尔参加了一项横断面研究。参与者通过回应驱动抽样方法（RDS）招募，共招募了 19 波。经过培训的工作人员进行了社会行为调查以及艾滋病毒和梅毒自愿咨询和检测。
未经加权的 HIV 和梅毒粗患病率估计分别为 15.4%（RDS 加权 12.5%，95%置信区间[CI]：7.3-17.8）和 5.3%（RDS 加权 4.4%，95%CI：3.1-7.6）。90%（未加权）的 HIV 感染报告为先前未确诊。参与者主要是同性恋（60.8%）或双性恋（36.3%）；50.7%报告最近同时存在同性和异性关系。大约一半的人报告与偶然的男性伴侣始终或几乎始终使用安全套，并且在伴侣类型和性别方面比例相对均匀。几乎所有变量的感知和经历的耻辱感都超过 20%，11.4%的人曾经历过身体暴力，7%的人曾被强奸。目前年龄>25 岁（RDS 加权调整后的优势比[OR]为 3.9，95%CI：1.2-12.7）、单身婚姻状况（RDS 加权 OR：0.3；95%CI：0.1-0.8）和与男性的初次性行为年龄<16 岁（RDS 加权 OR：4.3，95%CI：1.2-15.0）与 HIV 感染独立相关。
结果表明，MSM 是马拉维艾滋病毒服务的服务不足、高危人群，值得提供全面的艾滋病毒预防服务。结果为 MSM 的研究和预防计划提供了一些优先事项，包括提供和鼓励定期保密的艾滋病毒检测和咨询，以及与肛门性交相关的减少风险咨询。其他目标包括提供避孕套和相容的润滑剂、艾滋病毒预防信息以及艾滋病毒和性传播感染的治疗和坚持支持。解决包括结构因素在内的多个艾滋病毒风险因素，可能有助于确保方案有足够的覆盖面，以影响 MSM 中的这一艾滋病毒流行。
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