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High HIV risk in a cohort of male sex workers from Nairobi, Kenya
  1. Lyle R McKinnon1,2,
  2. Gloria Gakii1,
  3. Jennifer A Juno3,
  4. Preston Izulla1,
  5. Julius Munyao1,
  6. Naomi Ireri1,
  7. Cecilia W Kariuki1,
  8. Souradet Y Shaw4,
  9. Nico J D Nagelkerke3,5,
  10. Lawrence Gelmon1,3,
  11. Helgar Musyoki6,
  12. Nicholas Muraguri6,
  13. Rupert Kaul1,2,
  14. Rob Lorway4,
  15. Joshua Kimani1,3
  1. 1Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
  2. 2Department of Medicine, University of Toronto, Toronto, Canada
  3. 3Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
  4. 4Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
  5. 5Community Medicine, United Arab Emirates University, Al Ain, United Arab Emirates
  6. 6National AIDS & STI Control Programme (NASCOP), Ministry of Public Health and Sanitation, Nairobi, Kenya
  1. Correspondence to Dr Lyle McKinnon, Center for the AIDS Programme of Research in South Africa (CAPRISA), 2nd floor DDMRI, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 719 Umbilo Road, Private Bag X7, Congella, Durban 4013, South Africa; sijuisijali{at}gmail.com

Abstract

Objectives Men who have sex with men (MSM) are at high risk of HIV-1 acquisition and transmission, yet there remains limited data in the African context, and for men who sell sex to men (MSM SW) in particular.

Methods We enrolled 507 male sex workers in a Nairobi-based prospective cohort study during 2009–2012. All participants were offered HIV/STI screening, counselling and completed a baseline questionnaire.

Results Baseline HIV prevalence was 40.0% (95% CI 35.8% to 44.3%). Prevalent HIV infection was associated with age, less postsecondary education, marijuana use, fewer female partners and lower rates of prior HIV testing. Most participants (73%) reported at least two of insertive anal, receptive anal and insertive vaginal sex in the past 3 months. Vaginal sex was reported by 37% of participants, and exclusive MSM status was associated with higher HIV rates. Condom use was infrequent, with approximately one-third reporting 100% condom use during anal sex. HIV incidence was 10.9 per 100 person-years (95% CI 7.4 to 15.6). Predictors of HIV risk included history of urethral discharge (aHR 0.29, 95% CI 0.08 to 0.98, p=0.046), condom use during receptive anal sex (aHR 0.05, 95% CI 0.01 to 0.41, p=0.006) and frequency of sex with male partners (aHR 1.33/sex act, 95% CI 1.01 to 1.75, p=0.04).

Conclusions HIV prevalence and incidence were extremely high in Nairobi MSM SW; a combination of interventions including increasing condom use, pre-exposure prophylaxis and access to effective treatment is urgently needed to decrease HIV transmission in this key population.

  • Africa
  • HIV
  • Males

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