Author: Mark Mascolini
26 April 2014

HIV prevalence stood at 40% among men who have sex with men (MSM) sex workers
studied in Nairobi, Kenya. HIV incidence was also exceedingly high, and inconsistent
condom use was associated with both rates.

Across the world, HIV rates are high among sexually active MSM with multiple
partners. Because little is known about HIV rates and risks in MSM sex workers in
Africa, researchers conducted this prospective analysis.

The 2009-2012 study involved 507 MSM sex workers in Nairobi. All participants
completed a baseline questionnaire and were offered HIV and sexually transmitted
infection screening and counseling.

At the baseline visit, 40% of participants had HIV infection (95% confidence
interval [CI] 35.8% to 44.3%). Older age, less postsecondary education, marijuana
use, fewer female sex partners, and lower rates of previous HIV testing raised
chances of prevalent HIV infection.

Three quarters of study participants (73%) had at least two insertive anal,
receptive anal, and insertive vaginal sex acts in the past 3 months. More than one
third of participants (37%) reported vaginal sex. Only one third of men reported
100% condom use during anal sex.

Over the study period, HIV incidence measured 10.9 per 100 person-years (95% CI 7.4
to 15.6), meaning about 11 of 100 men became infected with HIV every year.

Condom use during receptive anal sex lowered the risk of HIV infection 95% (adjusted
hazard ratio [aHR] 0.05, 95% CI 0.01 to 0.41, P = 0.006). A history of urethral
discharge cut HIV risk about 70% (aHR 0.29, 95% CI 0.08 to 0.98). Every additional
sex act with another man raised the risk of HIV infection 33% (aHR 1.33, 95% CI 1.01
to 1.75, P = 0.04).

The researchers see an urgent need for “a combination of interventions including
increasing condom use, pre-exposure prophylaxis and access to effective treatment .
. . to decrease HIV transmission in this key population.”

Source: Lyle R. McKinnon, Gloria Gakii, Jennifer A. Juno, Preston Izulla, Julius
Munyao, Naomi Ireri, Cecilia W. Kariuki, Souradet Y. Shaw, Nico J.D. Nagelkerke,
Lawrence Gelmon, Helgar Musyoki, Nicholas Muraguri, Rupert Kaul, Rob Lorway, Joshua
Kimani. High HIV risk in a cohort of male sex workers from Nairobi, Kenya. Sexually
Transmitted Infections. 2014; 90: 237-242.

Semugoma Paul MD

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