title: High HIV risk in a cohort of male sex workers from Nairobi, Kenya.
abstract: OBJECTIVE
  Men who have sex with men (MSM) are at high risk of HIV-1 acquisition and transmission, yet there remains limited data in the African context, and for men who sell sex to men (MSM SW) in particular.
  
  
  METHODS
  We enrolled 507 male sex workers in a Nairobi-based prospective cohort study during 2009-2012. All participants were offered HIV/STI screening, counselling and completed a baseline questionnaire.
  
  
  RESULTS
  Baseline HIV prevalence was 40.0% (95% CI 35.8% to 44.3%). Prevalent HIV infection was associated with age, less postsecondary education, marijuana use, fewer female partners and lower rates of prior HIV testing. Most participants (73%) reported at least two of insertive anal, receptive anal and insertive vaginal sex in the past 3 months. Vaginal sex was reported by 37% of participants, and exclusive MSM status was associated with higher HIV rates. Condom use was infrequent, with approximately one-third reporting 100% condom use during anal sex. HIV incidence was 10.9 per 100 person-years (95% CI 7.4 to 15.6). Predictors of HIV risk included history of urethral discharge (aHR 0.29, 95% CI 0.08 to 0.98, p=0.046), condom use during receptive anal sex (aHR 0.05, 95% CI 0.01 to 0.41, p=0.006) and frequency of sex with male partners (aHR 1.33/sex act, 95% CI 1.01 to 1.75, p=0.04).
  
  
  CONCLUSIONS
  HIV prevalence and incidence were extremely high in Nairobi MSM SW; a combination of interventions including increasing condom use, pre-exposure prophylaxis and access to effective treatment is urgently needed to decrease HIV transmission in this key population.
authors: Department of Medical Microbiology, University of Nairobi, , Nairobi, Kenya.
authors: Lyle R
authors: LR
authors: McKinnon
authors: Gloria
authors: G
authors: Gakii
authors: Jennifer A
authors: JA
authors: Juno
authors: Preston
authors: P
authors: Izulla
authors: Julius
authors: J
authors: Munyao
authors: Naomi
authors: N
authors: Ireri
authors: Cecilia W
authors: CW
authors: Kariuki
authors: Souradet Y
authors: SY
authors: Shaw
authors: Nico J D
authors: NJ
authors: Nagelkerke
authors: Lawrence
authors: L
authors: Gelmon
authors: Helgar
authors: H
authors: Musyoki
authors: Nicholas
authors: N
authors: Muraguri
authors: Rupert
authors: R
authors: Kaul
authors: Rob
authors: R
authors: Lorway
authors: Joshua
authors: J
authors: Kimani
mesh_terms: D000328:Adult; D017677:Age Distribution; D017280:Condoms / Q000706:statistics & numerical data*; D004522:Educational Status; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D011634:Public Health; D012309:Risk-Taking; D060386:Sex Workers; D012725:Sexual Behavior; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Africa; HIV; Males