Ruiseñor-Escudero Horacio, Grosso Ashley, Ketende Sosthenes, Pitche Vincent, Simplice Anato, Tchalla Jules, Sodji Dometo, Liestman Ben, Kapesa Laurent, Baral Stefan
a Department of Psychiatry , Michigan State University , East Lansing , MI , USA.
b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
AIDS Care. 2017 Sep;29(9):1169-1177. doi: 10.1080/09540121.2017.1280122. Epub 2017 Jan 29.
In the mixed and concentrated HIV epidemics of West Africa, the relative disproportionate burden of HIV among men who have sex with men (MSM) compared to other reproductive-age men is higher than that observed in Southern and Eastern Africa. Our aim is to describe the correlates of HIV infection among MSM living in Lomé, Togo, using the Modified Social Ecological Model (MSEM). A total of 354 MSM ≥18 years of age were recruited using respondent driven sampling (RDS) for a cross-sectional survey in Lomé, Togo. Participants completed a structured questionnaire and were tested for HIV and syphilis. Statistical analyses included RDS-weighted proportions, bootstrapped confidence intervals (CI), and logistic regression models. Mean age of participants was 22 years; 71.5% were between 18 and 24 years. RDS-weighted HIV prevalence was 9.2% (95% CI=5.4-13.2). In RDS-adjusted (RDSa) bivariate analysis, HIV infection was associated with disclosure of sexual orientation to a family member, discriminatory remarks made by family members, forced sex, ever being blackmailed because of being MSM, community and social stigma and discrimination, and health service stigma and discrimination. In the multivariable model, HIV infection was associated with being 25 years or older (RDSa adjusted OR (aOR)=4.3, 95% CI=1.5-12.2), and having sex with a man before age 18 (RDSa aOR=0.3, 95% CI=0.1-0.9). HIV prevalence was more than seven times higher than that estimated among adults aged 15-49 living in Togo. Using the MSEM, network, community, and policy-level factors were associated with HIV infection among MSM in Lomé, Togo. Through the use of this flexible risk framework, a structured assessment of the multiple levels of HIV risk was characterized, highlighting the need for evidence-based and human-rights affirming combination HIV prevention and treatment programs that address these various risk levels for MSM in Lomé.
在西非混合性和集中性的艾滋病毒流行情况中,与其他育龄男性相比,男男性行为者(MSM)中艾滋病毒负担相对不成比例的情况比在南部和东部非洲观察到的更为严重。我们的目标是使用改良社会生态模型(MSEM)描述多哥洛美市男男性行为者中艾滋病毒感染的相关因素。通过应答驱动抽样(RDS),在多哥洛美市招募了总共354名年龄≥18岁的男男性行为者进行横断面调查。参与者完成了一份结构化问卷,并接受了艾滋病毒和梅毒检测。统计分析包括RDS加权比例、自展置信区间(CI)和逻辑回归模型。参与者的平均年龄为22岁;71.5%的人年龄在18至24岁之间。RDS加权艾滋病毒流行率为9.2%(95%CI=5.4-13.2)。在RDS调整(RDSa)的双变量分析中,艾滋病毒感染与向家庭成员披露性取向、家庭成员的歧视性言论、强迫性行为、曾因身为男男性行为者而被敲诈、社区和社会耻辱与歧视以及卫生服务耻辱与歧视有关。在多变量模型中,艾滋病毒感染与年龄在25岁及以上(RDSa调整后的比值比(aOR)=4.3,95%CI=1.5-12.2)以及在18岁之前与男性发生性行为(RDSa aOR=0.3,95%CI=0.1-0.9)有关。艾滋病毒流行率比多哥15至49岁成年人中的估计流行率高出七倍多。使用MSEM,网络、社区和政策层面的因素与多哥洛美市男男性行为者中的艾滋病毒感染有关。通过使用这种灵活的风险框架,对艾滋病毒风险的多个层面进行了结构化评估,突出表明需要有基于证据且维护人权的艾滋病毒综合预防和治疗方案,以应对洛美市男男性行为者的这些不同风险层面。
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