Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
PLoS One. 2019 Nov 6;14(11):e0217115. doi: 10.1371/journal.pone.0217115. eCollection 2019.
Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39-2.50]), less educated (aOR[95%CI]:1.49[1.09-2.03]), unmarried status (aOR[95%CI]:1.79[1.10-2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06-1.88]), group sex with men (aOR[95%CI]:2.07[1.46-2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40-2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12-1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97-3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08-1.93]) and drug use (aOR[95%CI]:1.82[1.24-2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07-1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53-0.99]) was negatively associated with TS.
尽管艾滋病毒在西非呈普遍流行态势，但一些人群群体，如男男性行为者（MSM），特别是从事商业性行为的人，被认为比其他人更容易受到艾滋病毒的影响。然而，目前几乎没有数据可以帮助确定他们的与健康相关的需求，以便实施有针对性的预防干预措施。为了填补这一知识空白，我们旨在描述报告商业性行为的男男性行为者（MSM-TS），并利用前瞻性队列研究 CohMSM 的数据确定与他们的性行为相关的因素，该研究在布基纳法索、科特迪瓦、马里和多哥进行。构建了三个耻辱感亚评分（经历、感知和内化）。使用广义估计方程方法进行数据分析。在 CohMSM 中招募的 630 名 HIV 阴性 MSM 中，463、410 和 244 名分别在 6、12 和 18 个月时进行了随访。在总共 1747 次随访中，289 名 MSM-TS 报告了 478 次商业性行为（45.9%）。其中，91 人定期报告商业性行为（31.5%），55 人（19.0%）在基线后停止报告商业性行为，53 人（18.3%）在基线后报告商业性行为，90 人（31.1%）偶尔报告商业性行为。以下变量与商业性行为呈正相关：年龄较小（aOR[95%CI]：1.86[1.39-2.50]）、受教育程度较低（aOR[95%CI]：1.49[1.09-2.03]）、未婚状态（aOR[95%CI]：1.79[1.10-2.93]）、对当前性生活满意（aOR[95%CI]：1.41[1.06-1.88]）、与男性发生群交（aOR[95%CI]：2.07[1.46-2.94]）、与多个男性发生性关系（aOR[95%CI]：1.85[1.40-2.44]）、接受或通用的肛交（aOR[95%CI]：1.48[1.12-1.96]）、与男性发生性行为时给予好处（aOR[95%CI]：2.80[1.97-3.98]）、饮酒（aOR[95%CI]：1.44[1.08-1.93]）和吸毒（aOR[95%CI]：1.82[1.24-2.68]），最后是经历耻辱感（aOR[95%CI]：1.15[1.07-1.25]）。肛交时使用安全套（aOR[95%CI]：0.73[0.53-0.99]）与商业性行为呈负相关。
