title: Using a social ecological framework to characterize the correlates of HIV among men who have sex with men in Lomé, Togo.
abstract: In the mixed and concentrated HIV epidemics of West Africa, the relative disproportionate burden of HIV among men who have sex with men (MSM) compared to other reproductive-age men is higher than that observed in Southern and Eastern Africa. Our aim is to describe the correlates of HIV infection among MSM living in Lomé, Togo, using the Modified Social Ecological Model (MSEM). A total of 354 MSM ≥18 years of age were recruited using respondent driven sampling (RDS) for a cross-sectional survey in Lomé, Togo. Participants completed a structured questionnaire and were tested for HIV and syphilis. Statistical analyses included RDS-weighted proportions, bootstrapped confidence intervals (CI), and logistic regression models. Mean age of participants was 22 years; 71.5% were between 18 and 24 years. RDS-weighted HIV prevalence was 9.2% (95% CI=5.4-13.2). In RDS-adjusted (RDSa) bivariate analysis, HIV infection was associated with disclosure of sexual orientation to a family member, discriminatory remarks made by family members, forced sex, ever being blackmailed because of being MSM, community and social stigma and discrimination, and health service stigma and discrimination. In the multivariable model, HIV infection was associated with being 25 years or older (RDSa adjusted OR (aOR)=4.3, 95% CI=1.5-12.2), and having sex with a man before age 18 (RDSa aOR=0.3, 95% CI=0.1-0.9). HIV prevalence was more than seven times higher than that estimated among adults aged 15-49 living in Togo. Using the MSEM, network, community, and policy-level factors were associated with HIV infection among MSM in Lomé, Togo. Through the use of this flexible risk framework, a structured assessment of the multiple levels of HIV risk was characterized, highlighting the need for evidence-based and human-rights affirming combination HIV prevention and treatment programs that address these various risk levels for MSM in Lomé.
authors.affiliation: a Department of Psychiatry , Michigan State University , East Lansing , MI , USA.|b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Horacio
authors.identifier: 0000-0002-0367-6976
authors.initials: H
authors.lastname: Ruiseñor-Escudero
authors.affiliation: b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Grosso
authors.affiliation: b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Sosthenes
authors.initials: S
authors.lastname: Ketende
authors.affiliation: c Consell National de Lutte contre le SIDA (National AIDS Council), Service de Dermatologie, CHU Sylvanus Olympio, Faculté de sciences de la santé , Université de Lomé , Lomé , Togo.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pitche
authors.affiliation: d Arc-en-Ciel , Lomé , Togo.
authors.forename: Anato
authors.initials: A
authors.lastname: Simplice
authors.affiliation: e Espoir Vie , Lomé , Togo.
authors.forename: Jules
authors.initials: J
authors.lastname: Tchalla
authors.affiliation: f FAMME , Lomé , Togo.
authors.forename: Dometo
authors.initials: D
authors.lastname: Sodji
authors.affiliation: b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Liestman
authors.affiliation: g United States Agency for International Development West Africa Regional Office , Accra , Ghana.
authors.forename: Laurent
authors.initials: L
authors.lastname: Kapesa
authors.affiliation: b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004192:Discrimination, Psychological; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D018451:Homosexuality, Male; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012650:Self Disclosure; D012922:Social Change; D057545:Social Stigma; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology; D014037:Togo / Q000453:epidemiology; D055815:Young Adult
keywords: HIV; Togo; epidemiology; men who have sex with men; respondent driven sampling