Queering the evidence: remaking homosexuality and HIV risk to ‘end AIDS’ in Kenya

Until recently, HIV in Africa was presumed to be driven by poverty, gender inequality and poor governance. The last decade has seen a shift in global and national public health discourses, especially in eastern Africa where new statistical evidence is used to justify prevention efforts to target Key Populations, i.e. men who have sex with men (MSM), injecting drug users, and sex workers. In this article, we focus on Kenya to examine state, NGO and community HIV treatment and prevention efforts targeting MSM, specifically male sex workers. We combine ethnographic fieldwork with a critical analysis of policy(making) and implementation practices to sketch the contours of the global, national and local forces that have combined to (re)make male homosexual sex to be understood as a practice that contributes to HIV incidence in Kenya. We also show that HIV-related MSM programmes in Kenya primarily enrol male sex workers in HIV treatment programmes, which focus on mainly on treatment adherence and pay insufficient attention to the economic and psycho-social problems experienced by male sex workers. Although upper and middle class MSM are involved in running LGTBI rights-based interventions and in mobilising male sex workers for HIV interventions, they are rarely targeted by those interventions.     

Men who have sex with men inadequately addressed in African AIDS National Strategic Plans

Abstract

Through an analysis of AIDS National Strategic Plans (NSPs), this study investigated the responses of African governments to the HIV epidemics faced by men who have sex with men (MSM). NSPs from 46 African countries were systematically analysed, with attention focused on (1) the representation of MSM and their HIV risk, (2) the inclusion of epidemiologic information on the HIV epidemic among MSM and (3) government-led interventions addressing MSM. Out of 46 NSPs, 34 mentioned MSM. While two-thirds of these NSPs acknowledged the vulnerability of MSM to HIV infection, fewer than half acknowledged the role of stigma or criminalisation. Four NSPs showed estimated HIV prevalence among MSM, and one included incidence. Two-thirds of the NSPs proposed government-led HIV interventions that address MSM. Those that did plan to intervene planned to do so through policy interventions, social interventions, HIV-prevention interventions, HIV-treatment interventions and monitoring activities. Overall, the governments of the countries included in the study exhibited little knowledge of HIV disease dynamics among MSM and little knowledge of the social dynamics behind MSM's HIV risk. Concerted action is needed to integrate MSM into NSPs and governmental health policies in a way that acknowledges this population and its specific HIV/AIDS-related needs.     

Barriers to uptake of hepatitis C virus (HCV) health intervention among men who have sex with men in Southwest China: A qualitative study

Men who have sex with men (MSM) are at risk of contracting the hepatitis C virus (HCV). Previous studies have documented low uptake of sexually transmitted disease (STD) prevention and health services among Chinese MSM. We carried out qualitative research among MSM in Southwest China. By taking the Health Brief Model (HBM) as a framework, we aimed to determine the underlying factors related to use of HCV health intervention services among MSM. From May to July 2018, we conducted in-depth interviews in Southwest China with 20 participants. Our research revealed that a lack of knowledge about HCV prevention was the main reason why MSM failed to perceive their susceptibility to HCV and had low motivation to seek preventive services. Poor service accessibility and unpleasant experiences seeing doctors also exerted negative influences on health care-seeking behaviour in MSM. More trust and understanding needs to be built between health providers and MSM. Protection of privacy for MSM should be guaranteed in the delivery of health interventions. In addition, the interviewees showed refusal to engage with health interventions being specifically targeted at MSM, which would create a sense of being ‘labelled’. Tailored health interventions may overemphasise their sexuality, segregate them from heterosexuals, and make them feel alienated. Therefore, we speculate that differential treatment may be an obstacle for MSM to become involved in health interventions.     

Social geographies of African American men who have sex with men (MSM): A qualitative exploration of the social,spatial and temporal context of HIV risk in Baltimore,Maryland

This qualitative study utilized a time-geography framework to explore the daily routines and daily paths of African American men who have sex with men (AA MSM) and how these shape HIV risk. Twenty AA MSM aged 18 years and older completed an in-depth interview. Findings revealed (1) paths and routines were differentiated by indicators of socio-economic status, namely employment and addiction, and (2) risk was situated within social and spatial processes that included dimensions of MSM disclosure and substance use. This study highlights the critical need for future research and interventions that incorporate the social and spatial dimensions of behavior to advance our ability to explain racial disparities in HIV and develop effective public health responses.     

Overcoming HIV Stigma? A Qualitative Analysis of HIV Cure Research and Stigma Among Men Who Have Sex with Men Living with HIV

Despite global progress in HIV stigma reduction, persistent HIV stigma thwarts effective HIV service delivery. Advances in HIV biomedical research toward a cure may shift perceptions of people living with HIV and HIV stigma. The purpose of this study was to examine how men who have sex with men (MSM) living with HIV in Guangzhou, China perceive HIV cure research and its potential impact on MSM and HIV stigma. We conducted in-depth interviews with 26 MSM living with HIV about their perceptions of HIV cure research and the potential impact of an HIV cure on their lives. Thematic coding was used to identify themes and structure the analysis. Two overarching themes emerged. First, participants stated that an HIV cure may have a limited impact on MSM-related stigma. Men noted that most stigma toward MSM was linked to stereotypes of promiscuity and high rates of sexual transmitted diseases in the MSM community and might persist even after a cure. Second, participants believed that an HIV cure could substantially reduce enacted, anticipated, and internalized stigma associated with HIV. These findings suggest that a biomedical cure alone would not remove the layered stigma facing MSM living with HIV. Comprehensive measures to reduce stigma are needed.     

Geographical Disparities in HIV Seroprevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria: Exploratory Spatial Data Analysis

BackgroundThe assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies.ObjectiveWe aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria.MethodsWe included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases.ResultsMSM and PWID had HIV seroprevalence rates of 12.14% (3209/26,423) and 11.88% (1126/9474), respectively. Global spatial autocorrelation Moran I statistics revealed a clustered distribution of HIV infection among MSM and PWID with a <5% and <1% likelihood that this clustered pattern could be due to chance, respectively. Significant clusters of HIV infection (Getis-Ord-Gi* statistics) confined to the North Central and South South regions were identified among MSM and PWID. Compared to the 2014 integrated biological and behavioural surveillance survey, our results suggest an increased HIV seroprevalence among PWID and a substantial decrease among MSM.ConclusionsThis study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection.     

成都市艾滋病自愿咨询检测门诊男男性行为者人群特征及HIV感染状况

目的 了解成都市艾滋病自愿咨询检测(VCT)门诊男男性行为者(MSM)人群特征、 HIV感染状况,以便有效地在VCT门诊中开展男男性行为者人群的咨询检测及干预。 方法 对2014年成都市VCT门诊中接受咨询检测服务的MSM人群登记资料进行分析,描述性分析MSM人群特征,采用非条件logistic回归分析不同人口学特征的HIV感染风险。 结果 接受VCT服务的1 459名MSM中30岁以下占67.77%,未婚者占66.88%,大专及以上占51.66%;检出HIV抗体阳性率12.16%。多因素分析显示,相对于婚姻状况已婚者,离异或丧偶感染HIV风险更高(OR=9.088),其次为未婚者(OR=2.104);年龄组和婚姻状况存在感染HIV交互作用,30岁及以上且未婚者感染HIV风险更高(OR=2.106);既往接受检测者感染率高于未接受过检测者(OR=1.539);梅毒感染者感染HIV风险高于未感染梅毒者(OR=5.818)。 结论 成都市VCT门诊的MSM人群HIV阳性检出率相对较高;不同特征的MSM的感染风险不同,应有针对性地开展咨询检测及干预服务。     

Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney

Objectives: Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. Methods: A retrospective, cross‐sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. Results: Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01‐AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). Conclusions: Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health: HIV testing and preventative interventions supporting international students are required.     

男男性行为者中流动人口艾滋病高危行为研究

目的 探讨男男性行为者(MSM)中流动人口艾滋病高危行为状况.方法 采用定向抽样法开展横断而调查,对9个城市2250名MSM的匿名调查问卷进行分析,比较其中流动人口与常住人口两亚人群的高危行为发生状况.结果 MSM流动人口组近6个月性伴数(平均9.61个)、口交(平均8.61个)和肛交(平均7.52个)性伴数,近1个月口交(平均2.89个)和肛交(平均3.69个)性伴数,近6个月女性性伴数(平均1.17个)均明显高于常住人口组(P<0.05或P<0.01).MSM中近6个月内流动人口组与男性肛交时以及同非妻子女性性交时每次使用安全套的百分率(分别为37.15%、23.28%)均低于常住人口组(P<0.05或P<0.01).MSM流动人口组从事男性性工作、与gay网友性交过、近1年在男性间参加群交、近1年与男性性交时出血、近1年在外地与男性性交、目前有固定女性性伴(分别为17.89%、12.56%、22.13%、31.38%、32.36%、31.86%)均明显高于常住人口组(P<0.05或P<0.01).结论 MSM流动人口具有比常住人口更多的HIV高危行为;该亚人群具有将HIV传播到其他地区的条件,应加强对MSM流动人口的行为干预,以阻断其在HIV传播过程中的"桥梁"作用.     

男男性行为者中流动人口艾滋病高危行为研究

目的 探讨男男性行为者(MSM)中流动人口艾滋病高危行为状况.方法 采用定向抽样法开展横断而调查,对9个城市2250名MSM的匿名调查问卷进行分析,比较其中流动人口与常住人口两亚人群的高危行为发生状况.结果 MSM流动人口组近6个月性伴数(平均9.61个)、口交(平均8.61个)和肛交(平均7.52个)性伴数,近1个月口交(平均2.89个)和肛交(平均3.69个)性伴数,近6个月女性性伴数(平均1.17个)均明显高于常住人口组(P<0.05或P<0.01).MSM中近6个月内流动人口组与男性肛交时以及同非妻子女性性交时每次使用安全套的百分率(分别为37.15%、23.28%)均低于常住人口组(P<0.05或P<0.01).MSM流动人口组从事男性性工作、与gay网友性交过、近1年在男性间参加群交、近1年与男性性交时出血、近1年在外地与男性性交、目前有固定女性性伴(分别为17.89%、12.56%、22.13%、31.38%、32.36%、31.86%)均明显高于常住人口组(P<0.05或P<0.01).结论 MSM流动人口具有比常住人口更多的HIV高危行为;该亚人群具有将HIV传播到其他地区的条件,应加强对MSM流动人口的行为干预,以阻断其在HIV传播过程中的"桥梁"作用.