HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya.
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.
Sanders
Eduard J
EJ
Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI) - Kilifi, Kilifi, Kenya.
Graham
Susan M
SM
Okuku
Haile S
HS
van der Elst
Elise M
EM
Muhaari
Allan
A
Davies
Alun
A
Peshu
Norbert
N
Price
Matthew
M
McClelland
R Scott
RS
Smith
Adrian D
AD
D000293:Adolescent; D000328:Adult; D001003:Anal Canal; D017280:Condoms / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications; D047568:Unsafe Sex / Q000706:statistics & numerical data