Giovenco Danielle, Mabuto Tonderai, Manyuchi Albert, Savva Helen, McIntyre Anne, Puren Adrian, Kubeka Griffiths, Pienaar Jacqueline, Dietrich Cheryl, Struthers Helen, Operario Don, Sanders Eduard J
Rollins School of Public Health, Emory University, Atlanta, GeorgiaUnited States of America.
The Aurum Institute, Johannesburg, South Africa.
PLOS Glob Public Health. 2025 Sep 2;5(9):e0004874. doi: 10.1371/journal.pgph.0004874. eCollection 2025.
The HIV continuum of care for men who have sex with men (MSM) in South Africa remains inadequately characterised, hindering the tracking of progress towards ending the HIV epidemic. We estimated HIV prevalence and care continuum indicators for MSM in three South African cities.
MSM were recruited via respondent-driven sampling (RDS) methods in Cape Town, Johannesburg, and Mahikeng. Eligibility criteria included age ≥ 18 years, assigned male sex at birth, recent oral or anal sex with a man, and living, working, or socialising in one of the selected cities within the past six months. Participants completed a survey, and dried blood spots were collected to test for HIV antibodies, antiretrovirals, and HIV viral load. RDS weights were used to estimate HIV prevalence and 95-95-95 care continuum indicators. From May to October 2019, 1,790 cisgender MSM were sampled. HIV prevalence was highest in Johannesburg (weighted prevalence = 40.7%, 95% confidence interval 34.4-47.3), followed by Cape Town (25.2%, 20.9-30.1) and Mahikeng (14.7%, 12.0-17.8). Among MSM living with HIV, awareness of status was 67.0% (56.8-75.8) in Cape Town, 67.8% (56.7-77.1) in Johannesburg, and 60.2% (49.9-69.8) in Mahikeng. ART coverage among those aware of their status was 65.1% (53.4-75.2) in Cape Town, 77.9% (67.2-85.8) in Johannesburg, and 72.5% (58.6-83.0) in Mahikeng. Viral suppression among those on ART was 79.3% (59.5-90.9) in Cape Town, 88.7% (77.8-94.6) in Johannesburg, and 90.7% (78.1-96.4) in Mahikeng.
Achievements towards HIV care indicators were sub-optimal for MSM in three South African sites, revealing potential gaps in the reach and uptake of HIV testing and treatment services. Research identifying multi-level determinants of these gaps is needed to guide the development of contextually appropriate and effective interventions.
南非男男性行为者（MSM）的艾滋病病毒连续护理情况仍未得到充分描述，这阻碍了对终结艾滋病流行进展的追踪。我们估计了南非三个城市中男男性行为者的艾滋病病毒感染率和护理连续指标。
通过应答驱动抽样（RDS）方法在开普敦、约翰内斯堡和马希肯招募男男性行为者。纳入标准包括年龄≥18岁、出生时被指定为男性、近期与男性有口交或肛交行为，以及在过去六个月内在选定城市之一生活、工作或社交。参与者完成一项调查，并采集干血斑以检测艾滋病病毒抗体、抗逆转录病毒药物和艾滋病病毒载量。使用RDS权重来估计艾滋病病毒感染率和95-95-95护理连续指标。2019年5月至10月，对1790名顺性别男男性行为者进行了抽样。艾滋病病毒感染率在约翰内斯堡最高（加权感染率=40.7%，95%置信区间34.4-47.3），其次是开普敦（25.2%，20.9-30.1）和马希肯（14.7%，12.0-17.8）。在感染艾滋病病毒的男男性行为者中，开普敦对自身感染状况的知晓率为67.0%（56.8-75.8），约翰内斯堡为67.8%（56.7-77.1），马希肯为60.2%（49.9-69.8）。知晓自身感染状况者的抗逆转录病毒治疗覆盖率在开普敦为65.1%（53.4-75.2），约翰内斯堡为77.9%（67.2-85.8），马希肯为72.5%（58.6-83.0）。接受抗逆转录病毒治疗者的病毒抑制率在开普敦为79.3%（59.5-90.9），约翰内斯堡为88.7%（77.8-94.6），马希肯为90.7%（78.1-96.4）。
在南非的三个地区，男男性行为者在艾滋病病毒护理指标方面的成就未达最优，这揭示了艾滋病病毒检测和治疗服务在覆盖范围和接受程度上的潜在差距。需要开展研究以确定这些差距的多层次决定因素，从而指导制定因地制宜且有效的干预措施。
