Factors associated with HIV transmission risk from men who have sex with men to women in West Africa (CohMSM ANRS 12324-Expertise France)

Title

Factors associated with HIV transmission risk from men who have sex with men to women in West Africa (CohMSM ANRS 12324-Expertise France)

Presenter

Marion Fiorentino

Authors

M. Fiorentino * (1), B. Coulibaly (2), C. Couderc (3), B. Dembele Keita (2), C. Anoma (4), E. Dah (5), E. Mensah (6), T. Niamkey Aka (4), F.R. Ouedraogo (5), N. Sangaré (2), A.R. Kokouba (6), G. Maradan (1,7), M. Mora (1), M. Bourrelly (1), L. Riegel (8), D. Rojas Castro (8,1), B. Spire (1), C. Laurent (3), L. Sagaon-Teyssier (1)

Institutions

(1) Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France, (2) ARCAD Santé PLUS, Centre Intégré de Recherche, de Soins et d'Action Communautaire (CIRSAC), Bamako, Mali, (3) TransVIHMI, Univ Montpellier, IRD, INSERM, Montpellier, France, (4) Espace Confiance, Abidjan, Cote D''Ivoire, (5) Association African Solidarité, Ouagadougou, Burkina Faso, (6) Espoir Vie Togo, Lomé, Togo, (7) ORS PACA, Marseille, France, (8) Coalition PLUS, Laboratoire de Recherche Communautaire, Pantin, France

BACKGROUND: The HIV epidemic in West Africa is highly prevalent in men who have sex with men (MSM). Accordingly, MSM who also have sex with women (MSMW), that is frequent in this region, are a potential bridge subpopulation for HIV transmission to women. We aimed to evaluate the proportions and characteristics of MSMW at 'high behavioral risk of acquiring HIV from male partner(s) and transmitting it to female partner(s)' (HBRMF).
METHODS: The community-based prospective cohort study CohMSM included 630 HIV-negative MSM in Burkina Faso, Cote d'Ivoire, Mali, and Togo. Among MSMW (ie.'¥1 female partner), HBRMF was defined using trajectory models based on seven at-risk sexual practices with male and with female partners, involving inconsistent condom use, multiple partnerships and receptive same-sex anal sex. To assess the relevance of trajectory models, we compared the proportion of HIV-seroconverted participants according to HBRMF. Factors associated with HBRMF were identified using a generalized estimation equation logistic regression model accounting for longitudinal data.
RESULTS: 45% of the 304 MSMW (22% of all CohMSM participants) were at HBRMF. This group accounted for 72% of the 28 HIV-seroconversions observed during the follow-up (p=0.001). HBRMF was positively associated with being aged 18-24 years (adjusted odds-ratio [95% confidence interval] 1.67[1.23-2.27], compared to '¥25 years), being sexually attracted to men only (1.94[1.38-2.75]), feelings of loneliness (1.92 [1.39-2.67]), experience of homonegative violence (1.22[1.05-1.41] per unit score). HRMW was negatively associated with having had both steady and occasional female partners (0.34[0.19-0.57], compared to a steady female partner only), and tended to be associated (0.05<p<0.1) with '¥4 sexual intercourses with female partner(s) in the previous four weeks (0.55[0.28-1.07], compared to 0-3 intercourses).
CONCLUSIONS: Establishing official relationships with women might be a strategy for young and/or stigmatized MSMW to comply with social pressure to display a heterosexual lifestyle; this increases at-risk sexual behaviors with both male and female partners. Although associated with little sexual activity with female partner(s), HBRMF concerned almost half of MSMW (one fifth of MSM included in CohMSM). This result stresses the need to adapt HIV research and prevention to MSMW and their female partners.

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