Abstract
Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18–21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.
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Acknowledgements
We sincerely thank the MSM participants and the staff of the community-based organizations (ARCAD-SIDA, Espace Confiance, Association African Solidarité, Espoir Vie Togo) who participated in the CohMSM study. 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). Our thanks also to Jude Sweeney for the English revision.
The CohMSM Study Group: Clotilde Couderc, 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).
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Appendix: Multivariate Models
Appendix: Multivariate Models
Multivariate (n = 1465) | Multivariate (n = 1465) | Multivariate (n = 1465) | Multivariate (n = 1465) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Model I | Model II | Model III | Model IV | |||||||||
aOR | [95% CI] | p | aOR | [95% CI] | p | aOR | [95% CI] | p | aOR | [95% CI] | p | |
City | ||||||||||||
Bamako | Ref | Ref | Ref | Ref | ||||||||
Ouagadougou | 1.24 | [0.71–2.16] | .45 | 1.23 | [0.71–2.13] | .45 | 1.21 | [0.71–2.09] | .48 | 1.38 | [0.81–2.38] | .24 |
Lomé | 0.80 | [0.48–1.32] | .38 | 1.20 | [0.74–1.94] | .47 | 0.80 | [0.48–1.32] | .37 | 0.91 | [0.56–1.49] | .70 |
Abidjan | 2.28 | [1.29–4.02] | .005 | 2.16 | [1.21–3.87] | .009 | 1.93 | [1.09–3.43] | .03 | 2.53 | [1.44–4.45] | .001 |
Age (in years) | ||||||||||||
18–21 years | 3.02 | [1.85–4.93] | < .0001 | 2.79 | [1.69–4.58] | < .0001 | 3.15 | [1.93–5.13] | < .0001 | 3.01 | [1.85–4.91] | < .0001 |
21–24 years | 1.44 | [0.92–2.24] | .11 | 1.34 | [0.87–2.07] | .19 | 1.47 | [0.95–2.29] | .09 | 1.44 | [0.93–2.24] | .10 |
> 24 years | Ref | Ref | Ref | Ref | ||||||||
Sexual identity | ||||||||||||
Homosexual/gay | 2.03 | [1.46–2.82] | < .0001 | |||||||||
Bisexual | Ref | |||||||||||
Missing data | 1.58 | [0.56–4.40] | .39 | |||||||||
Gender identity | ||||||||||||
Both a man and a woman | 7.91 | [5.49–11.4] | < .0001 | |||||||||
Only a man | Ref | |||||||||||
Missing data | 4.70 | [1.30–17.0] | .02 | |||||||||
Experienced stigma | 1.19 | [1.07–1.33] | .002 | 1.13 | [1.00–1.27] | .049 | 1.19 | [1.06–1.32] | .002 | 1.18 | [1.06–1.32] | .003 |
Female sex partner | ||||||||||||
No | 2.16 | [1.60–2.92] | < .0001 | |||||||||
Yes | Ref | |||||||||||
Sexual attraction | ||||||||||||
Only attracted to men | 1.94 | [1.43–2.64] | < .0001 | |||||||||
Attracted both to men and women | Ref | |||||||||||
STI symptoms during life | ||||||||||||
Yes | 0.61 | [0.40–0.91] | .02 | 0.63 | [0.42–0.95] | .03 | 0.62 | [0.42–0.94] | .02 | 0.65 | [0.43–0.98] | .04 |
No | Ref | Ref | Ref | |||||||||
Missing data | 0.96 | [0.20–4.54] | .96 | 0.59 | [0.13–2.73] | .50 | 0.90 | [0.19–4.18] | .89 | 1.21 | [0.25–5.75] | .81 |
BIC | 6094.90 | 6460.94 | 6092.67 | 6103.45 | ||||||||
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Coulaud, Pj., Sagaon-Teyssier, L., Mimi, M. et al. Combined Sexual Behavioral Profiles in HIV-Seronegative Men Who have Sex with Men in West Africa (CohMSM ANRS 12324-Expertise France). Arch Sex Behav 49, 331–345 (2020). https://doi.org/10.1007/s10508-019-01513-z
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DOI: https://doi.org/10.1007/s10508-019-01513-z