Abstract
ABSTRACTThe UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08–0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03–1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area.
Highlights
Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by the HIV epidemic in sub-Saharan Africa (Geibel, Tun, Tapsoba, & Kellerman, 2010; Sanders et al, 2007; van Griensven & Sanders, 2008)
Among 537 MSM recruited from Botswana, Malawi, and Namibia, men enrolled for HIV care and treatment, compared to men who were not, had higher odds of fear of seeking health care services and of ever being denied health care services on the basis of sexuality (Fay et al, 2011)
Among 711 GBMSM enrolled in the Anza Mapema study, 75 men were HIV-positive at baseline (Figure 1)
Summary
Bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by the HIV epidemic in sub-Saharan Africa (Geibel, Tun, Tapsoba, & Kellerman, 2010; Sanders et al, 2007; van Griensven & Sanders, 2008). In South Africa, 47 MSM who were interviewed or participated in focus group discussions explained that homophobic verbal harassment from healthcare workers had a negative influence on the appropriate use of health care services and resulted in delays or avoidance of treatment for STI or HIV (Lane, Shade, McIntyre, & Morin, 2008) While these data suggest that GBMSM experience strong barriers to utilization of healthcare and HIV treatment services, expanding access to antiretroviral therapy (ART) represents a priority throughout sub-Saharan Africa (amFAR, 2008; Holland et al, 2015; UNAIDS, 2013). We launched a longitudinal cohort study called “Anza Mapema” (Kiswahili for “Start Early”) in order to implement a program of HIV prevention and care designed for GBMSM in Kisumu, Kenya The purpose of this analysis was to identify factors associated with viral suppression among HIV-positive GBMSM who were offered treatment in a GBMSM supportive program and followed for 12 months
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