Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
School of Nursing, University of Rochester, Rochester, New York, United States of America.
PLoS One. 2024 Sep 25;19(9):e0310909. doi: 10.1371/journal.pone.0310909. eCollection 2024.
Apart from HIV acquisition, men who have sex with men are at a higher risk of sexually transmitted infections, especially syphilis. Although the intersection between syphilis and HIV poses a formidable challenge among key populations who are known to be vulnerable to many health threats, there is little known about syphilis infection among MSM living with HIV in Ghana. This study seeks to investigate the burden of syphilis and address the existing knowledge gap by exploring behavioral, healthcare access, and structural factors influencing the syphilis burden within the HIV-positive MSM population.
This study was conducted in 2023 as part of the bio-behavioral survey (BBS) among men who have sex with men (MSM) in Ghana. A cross-sectional survey that used a respondent-driven sampling (RDS) approach was conducted in the old ten regions of Ghana. Data was collected on 3,420 participants, however, 857 HIV-positive MSM were included in this study since it focused on syphilis among HIV-positive MSM in Ghana. The study estimated the prevalence of syphilis among MSM living with HIV and provided a 95% confidence interval across different categories of explanatory variables. Bivariate and multivariable logistic regression models were used to identify factors associated with overall syphilis prevalence. All other analyses were weighted due to the complex design of the study.
The overall prevalence of syphilis was 23.83% (95% CI: 20.44, 27.58). HIV-positive men who only had sex with men had a 29.77% (95% CI: 23.90, 36.40) prevalence of syphilis compared to a prevalence of 9.50% (95% CI: 2.56, 29.53) recorded by HIV-positive MSM who were attracted to mostly females. Participants who ever had receptive anal sex recorded a higher prevalence 26.79% (95% CI: 22.78, 31.23) than those who never had receptive anal sex 12.86% (95% CI: 8.02, 19.99). The odds of syphilis among HIV-positive MSM who never used condoms with regular sex partners in the last 6 months were 41.08 (aOR: 41.08 at 95% CI 1.24-136.42; p = 0.038).
There is a high prevalence of syphilis among HIV-positive men who have sex with men in Ghana, especially among those who engage in unprotected anal sex and have multiple sexual partners. Our findings underscore the dire need for targeted interventions to address the dual brunt of HIV and syphilis among the MSM population in Ghana.
除了 HIV 感染，男男性行为者（MSM）面临更高的性传播感染风险，尤其是梅毒。尽管梅毒和 HIV 之间的交集给已知易受多种健康威胁影响的关键人群带来了严峻挑战，但在加纳，HIV 阳性的 MSM 中梅毒感染的情况鲜为人知。本研究旨在通过探讨影响 HIV 阳性 MSM 梅毒负担的行为、医疗保健获取和结构性因素，调查梅毒负担并弥补现有知识空白。
本研究于 2023 年在加纳男男性行为者（MSM）的生物行为调查（BBS）中进行。采用了一种基于应答驱动抽样（RDS）方法的横断面调查，在加纳的旧十个地区进行。研究共收集了 3420 名参与者的数据，但由于本研究重点关注加纳 HIV 阳性 MSM 中的梅毒，因此仅纳入了 857 名 HIV 阳性 MSM。该研究估计了 HIV 阳性 MSM 中梅毒的流行率，并在不同解释变量类别中提供了 95%置信区间。采用单变量和多变量逻辑回归模型来确定与总梅毒流行率相关的因素。由于研究设计复杂，所有其他分析均进行了加权。
梅毒的总流行率为 23.83%（95%CI：20.44，27.58）。与仅与男性发生性关系的 HIV 阳性男性相比，主要对女性有吸引力的 HIV 阳性 MSM 的梅毒流行率为 9.50%（95%CI：2.56，29.53），HIV 阳性男性中梅毒的流行率为 29.77%（95%CI：23.90，36.40）。曾有过接受性肛交的参与者的流行率为 26.79%（95%CI：22.78，31.23），高于从未有过接受性肛交的参与者的流行率 12.86%（95%CI：8.02，19.99）。在过去 6 个月中与固定性伴侣从不使用安全套进行性行为的 HIV 阳性 MSM 中，梅毒的患病几率为 41.08（优势比[aOR]：41.08，95%CI 1.24-136.42；p = 0.038）。
加纳 HIV 阳性 MSM 中梅毒的流行率很高，尤其是那些进行无保护肛交和有多个性伴侣的人群。我们的研究结果强调了迫切需要针对加纳 MSM 人群中的 HIV 和梅毒双重负担开展有针对性的干预措施。
