Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.
Technical Support Unit, Partners for Health and Development in Africa, Nairobi, Kenya.
J Int AIDS Soc. 2020 Jun;23 Suppl 2(Suppl 2):e25516. doi: 10.1002/jia2.25516.
INTRODUCTION: In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM)). METHODS: We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status. RESULTS: 177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040). CONCLUSIONS: Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions.
简介：在肯尼亚，男男性行为者（MSM）越来越多地使用虚拟场所，包括基于网络的应用程序，来寻找性伴侣。我们比较了仅通过实体场所（PMSM）和虚拟场所（VMSM）或实体和虚拟场所（DMSM）同时接触性伴侣的 HIV 阳性 MSM 人群的 HIV 检测、HIV 流行率、HIV 阳性状态的知晓率和抗逆转录病毒治疗（ART）的关联。
方法：我们在 2019 年 5 月至 7 月期间，在肯尼亚的三个县使用实体和虚拟场所的随机抽样方法，对 1200 名 15 岁及以上的 MSM 进行了横断面生物行为调查。我们根据他们在哪里接触性伴侣，将参与者分为 PMSM、DMSM 和 VMSM，并使用卡方检验比较组间差异：（i）检测比例；（ii）HIV 流行率和（iii）HIV 阳性 MSM 接受 HIV 护理的连续体。然后，我们进行了多变量逻辑回归，以衡量网络参与与 HIV 状态之间的独立关联。
结果：177（14.7%）、768（64.0%）和 255（21.2%）名参与者分别被归类为 PMSM、DMSM 和 VMSM。分别有 68.4%、70.4%和 78.5%的 PMSM、DMSM 和 VMSM 在过去六个月接受过 HIV 检测。HIV 流行率分别为 8.5%（PMSM）、15.4%（DMSM）和 26.7%（VMSM），p<0.001。在 HIV 阳性者中，分别有 46.7%（PMSM）、41.5%（DMSM）和 29.4%（VMSM）被诊断并知晓自己的状况；分别有 40.0%、35.6%和 26.5%接受了抗逆转录病毒治疗。在调整其他预测因素后，使用虚拟网络的 MSM 仍处于 HIV 流行的两到三倍高风险中：VMSM 与 PMSM（调整后的优势比 3.88（95%置信区间（CI）1.84 至 8.17），p<0.001）；DMSM 与 PMSM（2.00（95%CI 1.03 至 3.87），p=0.040）。
结论：参与虚拟网络与 HIV 风险升高有关，而与个体层面的风险因素无关。了解在不同场所寻找性伴侣的 MSM 的特征差异，将有助于 HIV 项目制定针对特定亚群的干预措施。
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