Filling the Knowledge Gap: Measuring HIV Prevalence and Risk Factors among Men Who Have Sex with Men and Female Sex Workers in Tripoli, Libya

Joseph J Valadez,Joanna Thomson,Caroline Jeffery,Sima Berendes,Leon Danon,Rabea Saffialden,Abdullah A Turki,Lusine Mirzoyan,Hussain Ben Othman,Michael Alan Polis

doi:10.1371/journal.pone.0066701

Joseph J Valadez, Joanna Thomson + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0066701

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Abstract

BackgroundPublications on Libya’s HIV epidemic mostly examined the victims of the tragic nosocomial HIV outbreak in the 1990s and the related dispute about the detention of foreign medical workers. The dispute resolution in 2003 included an agreement with the European Union on humanitarian cooperation and the development of Libya’s first National HIV Strategy. As part of this we conducted Libya’s first bio-behavioural survey among men having sex with men (MSM) and female sex workers (FSW).MethodsUsing respondent-driven sampling, we conducted a cross-sectional study to estimate the prevalence of HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and related risk factors among 227 MSM and 69 FSW in Tripoli (FSW recruitment ended prematurely due to the political events in 2011).ResultsFor MSM we estimated an HIV prevalence of 3.1%, HBV prevalence of 2.9%, and HCV prevalence of 7.3%, and for FSW an HIV prevalence of 15.7%, HBV prevalence of 0%, and HCV prevalence of 5.2%. We detected high levels of risk behaviours, poor HIV-related knowledge, high stigma and lack of prevention programmes. These results must be interpreted in the context of the political situation which prohibited reaching an ideal sample size for FSW.ConclusionThere is urgent need to implement an effective National HIV Strategy informed by the results of this research. The risk of transmission within different risk groups and to the general population may be high given the recent military events that led to increased violence, migration, and the disruption of essential HIV-related services.

Highlights

An assessment of the HIV prevalence, related risk behaviour and knowledge among men who have sex with men (MSM) and female sex workers (FSW) in Libya is urgently needed to inform near-term policy making while the window of opportunity to act is still open [1,2]
This is important in Libya which has not had a National HIV Strategy, and may face an expansion of the HIV epidemic due to increased migration, violence, and the disruption of services and structures related to recent warfare and socio-political transition [3,4,5]
Given the interruption of the FSW study due to the political turmoil, the sample size was too small for equilibrium to be reached for some (11 of 54) indicators, including HIV status

Summary

Introduction

An assessment of the HIV prevalence, related risk behaviour and knowledge among men who have sex with men (MSM) and female sex workers (FSW) in Libya is urgently needed to inform near-term policy making while the window of opportunity to act is still open [1,2]. In Libya, both MSM and sex workers have been highly stigmatized, facing corporal punishment and sentences of up to several years in prison if arrested and sentenced [11] This behaviour creates incentives for these groups to remain hidden, resulting in an apparent lack of knowledge on HIV prevention and frequent inability to access HIV related services and tools. The dispute resolution in 2003 included an agreement with the European Union on humanitarian cooperation and the development of Libya’s first National HIV Strategy As part of this we conducted Libya’s first bio-behavioural survey among men having sex with men (MSM) and female sex workers (FSW)

Methods

Results

Conclusion