title: HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya.
abstract: 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.
authors.affiliation: Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI) - Kilifi, Kilifi, Kenya.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Haile S
authors.initials: HS
authors.lastname: Okuku
authors.forename: Elise M
authors.initials: EM
authors.lastname: van der Elst
authors.forename: Allan
authors.initials: A
authors.lastname: Muhaari
authors.forename: Alun
authors.initials: A
authors.lastname: Davies
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: Matthew
authors.initials: M
authors.lastname: Price
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Smith
mesh_terms: 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