Objectives Whether regular HIV testing and counselling reduce risky sexual behaviours in African men who have sex with men (MSM) is still a matter for debate. We aimed to identify behavioural trajectories based on HIV risk exposure (HRE) and factors affecting their evolution.
Methods Data were collected from 621 HIV-negative West African MSM (Mali, Cote d'Ivoire, Burkina Faso and Togo) included in a community-based cohort providing quarterly HIV testing and counselling. Sociobehavioural data were collected every 6 months. HRE was defined as reporting inconsistent condom use during receptive anal sex with male partners of unknown HIV status in the previous 6 months. Using 18-month follow-up data, group-based trajectory modelling helped identify behavioural trajectories and determine the factors associated with their evolution. HIV seroconversions (n=67) were specified in each group trajectory.
Results Two distinct group trajectories were identified: medium-risk exposure MSM (ME-MSM) (61%, 6.4% of whom having seroconverted) and high-risk exposure MSM (HE-MSM) (39%, 17.5% of whom having seroconverted). A significant declining trend in the probability of reporting HRE over time ((95% CI)) was observed for HE-MSM (from 0.59 (0.48 to 0.70) at M0 to 0.31 (0.22 to 0.41) at M18), while it remained constant for ME-MSM (0.034 (0.0 to 0.079)). This can be explained by a progressive use of risk reduction strategies (less receptive anal sex, better knowledge of their partners’ status and increasing condom use). Being younger, living in Burkina Faso, self-considering both a man and a woman and reporting a higher level of depression were all associated with HE membership. Among HE-MSM, HRE was higher in those practising transactional or group sex and those experiencing psychological harassment.
Conclusions Quarterly HIV testing and counselling seem to reduce risky sexual behaviours in HIV-negative MSM at greatest risk of infection. Specific support for young MSM, focusing on identity and mental health, is needed to strengthen HIV prevention in West African MSM.
- West Africa
- sexual behaviour
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Handling editor Henry John Christiaan de Vries
Collaborators The CohMSM Study Group: Clotilde Couders, Bruno Granouillac, Suzanne Izard, Christian Laurent, Laura March, Martine Peeters, Laetitia Serrano (IRD, INSERM, Univ Montpellier, TransVIHMI, Montpellier, France); Cyril Berenger, Michel Bourrelly, Pierre-Julien Coulaud, Gwenaëlle Maradan, Bakri M’madi Mrenda, Marion Mora, Enzo Parisi, Luis Sagaon-Teyssier, Bruno Spire (INSERM, IRD, Univ Aix-Marseille, SESSTIM, Marseille, France); Adeline Bernier, Paméla Palvadeau, Daniela Rojas Castro (Coalition Internationale Sida, Pantin, France); Drissa Camara, Oumar Cisse, Alou Coulibaly, Bintou Dembele Keita, Fodié Diallo, Mahamadou Diarra, Mady Gadjigo, Abdoul Aziz Keita, Kader Maiga, Aly Ouologuem, Fodé TRAORE (ARCAD-SIDA, Bamako, Mali); Niamkey Thomas AKA, Camille Anoma, Stéphane-Alain BABO YORO, Noufo Hamed COULIBALY, Rachelle KOTCHI, Patrick KOUABENAN, Malan Jean-Baptiste KOUAME, Kpassou Julien LOKROU, Frédéric Dibi N’GUESSAN (Espace Confiance, Abidjan, Côte d’Ivoire); Xavier ANGLARET, Jean-Marie MASUMBUKO, Maxime OGA (PACCI, Abidjan, Côte d’Ivoire); Christian COULIBALY, Ter Tiero Elias DAH, Ousseni ILBOUDO, Joseph OUEDRAOGO, Mamadou OUEDRAOGO, Elisabeth THIO, Juste Rodrigue TOURE, Abdoulazziz TRAORE, Issa TRAORE (Association African Solidarité, Ouagadougou, Burkina Faso); Fiffou YOUGBARE (Centre National de Transfusion Sanguine, Ouagadougou, Burkina Faso); Nicolas MEDA (Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso); Kouakou Kokouvi Selom AGBOMADJI, Richard Mawuényégan Kouamivi AGBOYIBOR, Messan ATTIOGBE, Aléda Mawuli BADJASSIM, Agbégnigan Lorette EKON, Anouwarsadat KOKOUBA, Ephrem MENSAH, Diimiln Joseph Strauss TABLISSI, Kossi Jeff YAKA (Espoir Vie Togo, Lomé, Togo); Claver Anoumou Yaotsè DAGNRA (Laboratoire BIOLIM, Univ Lomé, Lomé, Togo).
Contributors PJC implemented this work under supervision of LST and BS. AAK, SABY, ETTD, ChC, EM and SA performed data collection under supervision of ClC, MaM and GM. PJC, MoM and LST led the analysis. The manuscript was written by PJC, with input from LST, BS and CL. BDK, CA, ETTD, EM, BS, MB and CL provided ongoing support throughout the cohort study. All authors approved the final manuscript.
Funding This study was funded by the ANRS (France Recherche Nord & Sud Sida-hiv Hépatites; ANRS 12324) and Expertise France (Initiative 5%). PJC was the recipient of doctoral fellowships from ANRS (B7-ANRS 12324) and Sidaction (17-2- FJC-11561).
Competing interests None declared.
Patient consent for publication Parental/Guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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