Background: The role of homosexuality and anal sex practices in the African HIV -1 epidemic is not well described. We aimed to assess the risk factors for prevalent HIV-1 infection among men who have sex with men (MSM) to guide HIV-1 prevention efforts.
Methods: Socio-behavioural characteristics, signs and symptoms of sexually transmitted diseases (STD), and serological evidence of HIV-1 were determined for 285 MSM at enrolment into a vaccine preparedness cohort study. We used multivariate logistic regression to assess risk factors for prevalent HIV-1 infection.
Results: HIV-1 prevalence was 43.0% [49/114, 95% confidence interval (CI), 34–52%] for men who reported sex with men exclusively (MSME), and 12.3% (21/171, 95% CI, 7–17%) for men who reported sex with both men and women (MSMW). Eighty-six (75%) MSME and 69 (40%) MSMW reported recent receptive anal sex. Among 174 MSM sexually active in the last week, 44% reported no use of condoms with casual partners. In the previous 3 months, 210 MSM (74%) reported payment for sex, and most clients (93%) were local residents. Prevalent HIV-1 infection was associated with recent receptive anal sex [odds ratio (OR), 6.1; 95% CI, 2.4–16], exclusive sex with men (OR, 6.3; 95% CI, 2.3–17), and increasing age (OR, 1.1 per year; 95% CI, 1.04–1.12). Only four MSM reported injecting drug use.
Conclusions: The high prevalence of HIV-1 in Kenyan MSM is probably attributable to unprotected receptive anal sex. There is an urgent need for HIV-1 prevention programmes to deliver targeted risk-reduction interventions and STD services to MSM in Kenya.
From the aCentre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI) – Kilifi, Kilifi, Kenya
bCentre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, UK
cUniversity of Washington, Seattle, Washington, USA
dInternational AIDS Vaccine Initiative, New York, USA
eDepartment of Public Health & Primary Care, University of Oxford, Headington, UK.
Received 19 June, 2007
Revised 11 September, 2007
Accepted 19 September, 2007
Correspondence to E.J. Sanders, MD, PhD, Box 230, Kilifi, Kenya. E-mail: ESanders@kilifi.kemri-wellcome.org