Changes in condom use among males who have sex with males (MSM): Measuring the effect of HIV prevention programme in Dhaka city.

Md Masud Reza,Sharful Islam Khan,Akm Masud Rana,Ezazul Islam Chowdhury,Md Sha Al Imran,Tasnim Azim,Md Aminul Islam,Gorkey Gourab,Tendesayi Kufa

doi:10.1371/journal.pone.0236557

Abstract

BackgroundA systematic assessment was done to examine the effect of HIV interventions among MSM in Dhaka, Bangladesh. MSM were defined as males having sex with males but did not sell sex in the last year. MSM are hidden, marginalized and stigmatized population groups not only in Bangladesh but also globally. In 2010, HIV interventions for MSM were expanded in 40 districts of Bangladesh through 65 drop-in-centres (DICs) and peer outreach workers.MethodsData from two surveys on MSM in Dhaka in 2010 (baseline) and 2013 (midline) were used to analyse the effect of ongoing HIV prevention services. Both surveys used time location sampling to randomly select MSM for risk behaviour interviews. Two outcome variables were considered; condom use in the last anal sex act and consistent condom use during anal sex in the last month. Univariate and multivariate logistic regression methods were used to determine factors associated with condom use.ResultsCondom use significantly increased at the midline than baseline (p<0.001 for both). Multivariate analysis showed that having comprehensive knowledge of HIV and participation in HIV prevention programme were positively associated with both last time and consistent condom use. MSM who had comprehensive knowledge of HIV were 1.9 times (95% CI: 1.3–2.8, p = 0.002) and 2.1 times (95% CI: 1.4–3.2, p<0.001) more likely to use condoms than those who did not have comprehensive knowledge of HIV. The likelihood of using condoms among MSM was more than double at the midline than the baseline (p<0.01 for both). However, odds of condom use was significantly lower among those who perceived themselves to be at risk or were not able to assess their own risk of HIV.ConclusionTo sustain positive changes in HIV risk behaviours, HIV prevention programmes for MSM need to be continued and strengthened.

Highlights

Males having Sex with Males (MSM) are at elevated risk of HIV infection in most countries around the world [1]
Multivariate analysis showed that having comprehensive knowledge of HIV and participation in HIV prevention programme were positively associated with both last time and consistent condom use
The analysis presented here shows that condom use increased following three years of programming suggesting that the prevention programme for MSM in Dhaka had a positive effect in promoting safer sexual behaviours

Summary

Introduction

Males having Sex with Males (MSM) are at elevated risk of HIV infection in most countries around the world [1]. Police can arrest persons without any warrant based on information provided by a third party who are involved with such offences [16] Bail for this offence is at the discretion of the courts and can take up to two years to obtain [15]. 13.5% of MSM reported that they were beaten and/or raped in the last year, only 10.6% ever accessed HIV testing services (HTS) and 35.5% had comprehensive knowledge of HIV [17]. Given these data there is concern that HIV may rise among MSM if prevention efforts are not strengthened. In 2010, HIV interventions for MSM were expanded in 40 districts of Bangladesh through 65 drop-in-centres (DICs) and peer outreach workers

Methods

Results

Discussion

Conclusion