Kalu Ngozi, Ross Michael W, Taegtmeyer Miriam, Lamontagne Erik, Howell Sean, Neuman Melissa
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Sex Transm Infect. 2024 Feb 8;100(3):150-7. doi: 10.1136/sextrans-2023-055964.
HIV incidence among men who have sex with men (MSM) in sub-Saharan Africa (SSA) remains high compared with the general population. Many countries in the region still criminalise consensual homosexual relationships, and some are yet to adopt WHO-recommended interventions for MSM into national HIV policies. This study examines how HIV testing of adult MSM in SSA varies according to the legal climate and presence of targeted HIV policy using data from the cross-sectional 2019 Global LGBTI Internet Survey study.
Using data from 3191 MSM in 44 SSA countries, we assessed associations of legal climate and HIV policy with ever and recent HIV testing using linear ecological and logistic multilevel analyses. From the single-level analysis, we can compare our findings to previously reported data, then, extending to a two-level multilevel analysis, we account for the hierarchical structure of the population and simultaneously adjust for differences in context and composition in each country. We then test the sensitivity of our analyses to excluding countries from the model.
We find evidence that legalised same-sex relationships were associated with increased odds of ever testing (OR=2.00, 95% CI 1.04, 3.82) in multilevel analyses. We also find evidence of an association of targeted HIV policies with increased odds of ever testing (OR=2.49, 95% CI 1.12, 5.52). We did not find evidence of an association of the legal climate (OR=1.01, 95% CI 0.69, 1.46) and targeted HIV policies (OR=1.26, 95% CI 0.78, 2.04) with recent testing.
This study suggests elimination of discriminatory laws and policies might be important for increasing HIV status awareness of MSM, an important first step in epidemic control. Additionally, we highlight heterogeneity between South Africa and other SSA countries, which has implications for studying SSA countries as a homogeneous group.
与撒哈拉以南非洲地区（SSA）的普通人群相比，男男性行为者（MSM）中的艾滋病毒感染率仍然很高。该地区许多国家仍将双方自愿的同性恋关系定为犯罪行为，一些国家尚未将世界卫生组织推荐的针对男男性行为者的干预措施纳入国家艾滋病毒政策。本研究利用2019年全球LGBTI互联网横断面调查研究的数据，探讨撒哈拉以南非洲地区成年男男性行为者的艾滋病毒检测如何因法律环境和针对性艾滋病毒政策的存在而有所不同。
利用来自撒哈拉以南非洲44个国家3191名男男性行为者的数据，我们使用线性生态和逻辑多级分析评估了法律环境和艾滋病毒政策与既往及近期艾滋病毒检测之间的关联。从单级分析中，我们可以将我们的研究结果与先前报告的数据进行比较，然后，扩展到两级多级分析，我们考虑了人群的层次结构，并同时调整了每个国家在背景和构成方面的差异。然后，我们测试了我们的分析对从模型中排除国家的敏感性。
我们发现有证据表明，在多级分析中，同性关系合法化与既往检测几率增加有关（比值比=2.00，95%置信区间1.04，3.82）。我们还发现有证据表明针对性艾滋病毒政策与既往检测几率增加有关（比值比=2.49，95%置信区间1.12，5.52）。我们没有发现法律环境（比值比=1.01，95%置信区间0.69，1.46）和针对性艾滋病毒政策（比值比=1.26，95%置信区间0.78，2.04）与近期检测有关的证据。
本研究表明，消除歧视性法律和政策可能对提高男男性行为者对艾滋病毒感染状况的认识很重要，这是疫情控制的重要第一步。此外，我们强调了南非与撒哈拉以南非洲其他国家之间的异质性，这对将撒哈拉以南非洲国家作为一个同质群体进行研究具有启示意义。
