Fiorentino Marion, Dos Santos Marie, Eubanks August, Yanwou Nathan, Laurent Christian, Roux Perrine, Spire Bruno
Aix Marseille Univ, IRD, Inserm, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
J Int AIDS Soc. 2024 Dec;27(12):e26402. doi: 10.1002/jia2.26402.
In sub-Saharan Africa (SSA), men who have sex with men (MSM) often have female sexual partners. Their overall risk of acquiring HIV is higher with male partners. Risk perception is associated with HIV knowledge, sexual risk and preventive behaviours. This synthesis aimed to summarize existing data about HIV knowledge and perceived HIV acquisition risk regarding sex with men and with women in MSM in SSA.
We conducted a systematic literature review of MSM's relationships with women in SSA (PROSPERO-CRD42021237836). Quantitative and qualitative data related to MSM's perceived risk from sex with men and with women and HIV knowledge (published up to 2021) were selected and synthesized.
Twenty studies were selected. More MSM perceived that the greatest risk of HIV acquisition came from heterosexual/vaginal sex than from homosexual/anal sex (53% vs. 15%; 51% vs. 39%; 42% vs. 8%; 27% vs. 25%; 43% vs. 11%; 23% vs. 13%; 35% vs. 16%, cumulative sample n = 4396, six countries). A higher proportion of MSM received preventive information on heterosexual HIV transmission than on homosexual transmission (79% vs. 22%; 94% vs. 67%; 54% vs. 19%; cumulative sample n = 1199, four countries). The qualitative synthesis (eight studies) highlighted biology- and behaviour-based misconceptions leading MSM to perceive lower or negligible HIV risk from sex with men, compared to sex with women. These misconceptions were partly fuelled by the predominant focus on heterosexual and vaginal HIV transmission in HIV prevention information.
Common misconceptions regarding sexual risk between men remain unaddressed by the heteronormative messaging of HIV prevention. Underestimation by MSM of their HIV acquisition risk with male partners can pose significant barriers to effective HIV preventive behaviours and strengthen the transmission risk from MSM to their female partners.
Improving access of MSM to tailored HIV prevention information and tools that address their practices with male and female partners is crucial. Integrating messages about anal sex into broader public health initiatives, including sexual health programmes targeting the general population, is essential. Further research in diverse settings in SSA is necessary to gain a greater understanding of the drivers and implications of HIV risk perception in MSM.
在撒哈拉以南非洲地区（SSA），与男性发生性关系的男性（MSM）通常有女性性伴侣。他们与男性伴侣发生性行为时感染艾滋病毒的总体风险更高。风险认知与艾滋病毒知识、性风险及预防行为相关。本综述旨在总结关于SSA地区MSM与男性及女性发生性行为时的艾滋病毒知识和感知到的感染艾滋病毒风险的现有数据。
我们对SSA地区MSM与女性的关系进行了系统的文献综述（PROSPERO-CRD42021237836）。选取并综合了与MSM与男性及女性发生性行为时感知到的风险以及艾滋病毒知识（截至2021年发表）相关的定量和定性数据。
共选取了20项研究。更多的MSM认为感染艾滋病毒的最大风险来自异性性行为/阴道性交而非同性性行为/肛交（53%对15%；51%对39%；42%对8%；27%对25%；43%对11%；23%对13%；35%对16%，累计样本量n = 4396，六个国家）。接受异性传播艾滋病毒预防信息的MSM比例高于接受同性传播预防信息的比例（79%对22%；94%对67%；54%对19%；累计样本量n = 1199，四个国家）。定性综合分析（八项研究）突出了基于生物学和行为的误解，导致MSM认为与男性发生性行为感染艾滋病毒的风险低于或可忽略不计，与和女性发生性行为相比。这些误解部分是由于艾滋病毒预防信息主要关注异性和阴道传播艾滋病毒所致。
艾滋病毒预防的异性规范信息未解决关于男性之间性风险的常见误解。MSM对与男性伴侣感染艾滋病毒风险的低估可能对有效的艾滋病毒预防行为构成重大障碍，并增加MSM将病毒传播给其女性伴侣的风险。
改善MSM获取针对其与男性及女性伴侣性行为的定制艾滋病毒预防信息和工具的机会至关重要。将关于肛交的信息纳入更广泛的公共卫生举措，包括针对普通人群的性健康项目，至关重要。有必要在SSA的不同环境中进行进一步研究，以更深入了解MSM中艾滋病毒风险认知的驱动因素及其影响。
