title: HIV prevalence and factors associated with HIV infection among men who have sex with men in Cameroon.
abstract: BACKGROUND
  Despite men who have sex with men (MSM) being a key population for HIV programming globally, HIV epidemiologic data on MSM in Central Africa are sparse. We measured HIV and syphilis prevalence and the factors associated with HIV infection among MSM in Cameroon.
  
  
  METHODS
  Two hundred and seventy-two and 239 MSM aged ≥ 18 from Douala and Yaoundé, respectively, were recruited using respondent-driven sampling (RDS) for this cross-sectional surveillance study in 2011. Participants completed a structured questionnaire and HIV and syphilis testing. Statistical analyses, including RDS-weighted proportions, bootstrapped confidence intervals and logistic regressions, were used.
  
  
  RESULTS
  Crude and RDS-weighted HIV prevalence were 28.6% (73/255) and 25.5% (95% CI 19.1-31.9) in Douala, and 47.3% (98/207) and 44.4% (95% CI 35.7-53.2) in Yaoundé. Active syphilis prevalence in total was 0.4% (2/511). Overall, median age was 24 years, 62% (317/511) of MSM identified as bisexual and 28.6% (144/511) identified as gay. Inconsistent condom use with regular male partners (64.1%; 273/426) and casual male and female partners (48.5%; 195/402) was common, as was the inconsistent use of condom-compatible lubricants (CCLs) (26.3%; 124/472). In Douala, preferring a receptive sexual role was associated with prevalent HIV infection [adjusted odds ratio (aOR) 2.33, 95% CI 1.02-5.32]. Compared to MSM without HIV infection, MSM living with HIV were more likely to have ever accessed a health service targeting MSM in Douala (aOR 4.88, 95% CI 1.63-14.63). In Yaoundé, MSM living with HIV were more likely to use CCLs (aOR 2.44, 95% CI 1.19-4.97).
  
  
  CONCLUSIONS
  High HIV prevalence were observed and condoms and CCLs were used inconsistently indicating that MSM are a priority population for HIV prevention, treatment and care services in Douala and Yaoundé. Building the capacity of MSM community organizations and improving the delivery and scale-up of multimodal interventions for MSM that are sensitive to concerns about confidentiality and the complex individual, social, community-level and policy challenges are needed to successfully engage young MSM in the continuum of HIV care. In addition to scaling up condom and CCL access, evaluating the feasibility of novel biomedical interventions, including antiretroviral pre-exposure prophylaxis and early antiretroviral therapy for MSM living with HIV in Cameroon, is also warranted.
authors: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Ju Nyeong
authors: JN
authors: Park
authors: Erin
authors: E
authors: Papworth
authors: Sethson
authors: S
authors: Kassegne
authors: Laure
authors: L
authors: Moukam
authors: Serge Clotaire
authors: SC
authors: Billong
authors: Issac
authors: I
authors: Macauley
authors: Yves Roger
authors: YR
authors: Yomb
authors: Nathalie
authors: N
authors: Nkoume
authors: Valentin
authors: V
authors: Mondoleba
authors: Jules
authors: J
authors: Eloundou
authors: Matthew
authors: M
authors: LeBreton
authors: Ubald
authors: U
authors: Tamoufe
authors: Ashley
authors: A
authors: Grosso
authors: Stefan D
authors: SD
authors: Baral
mesh_terms: D000293:Adolescent; D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine; D015658:HIV Infections / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D021841:Safe Sex / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology; D055815:Young Adult
keywords: Africa; HIV/AIDS; Men who have sex with men (MSM); epidemiology; homosexuality; prevalence; prevention; respondent-driven sampling (RDS); risk factors; sexual behaviour