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1. Male clients of male sex workers in West Africa: A neglected high-risk population.

Author

Cheick Haïballa Kounta, Luis Sagaon-Teyssier, Pierre-Julien Coulaud, Marion Mora, Gwenaelle Maradan, Michel Bourrelly, Abdoul Aziz Keita, Stéphane-Alain Babo Yoro, Camille Anoma, Christian Coulibaly, Elias Ter Tiero Dah, Selom Agbomadji, Ephrem Mensah, Adeline Bernier, Clotilde Couderc, Bintou Dembélé Keita, Christian Laurent, Bruno Spire, and CohMSM Study Group

Subjects
Medicine, Science
Abstract

Research on male clients of male sex workers (MCMSW) has been neglected for a long time globally. We aimed to characterize MCMSW and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Our study focused on HIV-negative men who have sex with other men (MSM), recruited between 06/2015 and 01/2018 by a team of trained peer educators. Scheduled study visits at 6, 12 and 18 months included medical examinations, HIV screening, risk-reduction counselling and face-to-face interviews to collect information on their sociodemographic characteristics, sexual behaviours, and HIV risk-reduction strategies (HIV-RRS). Three stigmatization sub-scores were constructed (experienced, perceived and internalized). Mixed-effects logistic regression was used for data analysis. Of the 280 participants recruited at baseline, 238, 211 and 118, respectively, had a follow-up visit at 6, 12 and 18 months. Over a total of 847 visits, 47 transactional sex (TS) encounters were reported by 38 MCMSW (13.6%). Of the latter, only one participant reported systematic TS (2.6%), 18 (47.4%) stopped reporting TS after baseline, while 6 (15.8%) reported TS after baseline. Thirteen participants (34.2%) reported occasional TS. After adjusting for country of study and age, the following self-reported factors were associated with a greater likelihood of being MCMSW: protected anal sex, exclusively insertive anal sex with male sexual partners, avoidance of sex after consuming psychoactive products and experiencing stigmatization (all during the previous 6 months). The majority of MCMSW in this study practiced HIV-RRS with male sexual partners, including engaging in protected anal sex, avoidance of sex when consuming psychoactive products, and practising exclusively insertive anal sex.

Published
2019
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2. Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa.

Author

Cheick Haïballa Kounta, Luis Sagaon-Teyssier, Pierre-Julien Coulaud, Marion Mora, Gwenaelle Maradan, Michel Bourrelly, Abdoul Aziz Keita, Stéphane-Alain Babo Yoro, Camille Anoma, Christian Coulibaly, Elias Ter Tiero Dah, Selom Agbomadji, Ephrem Mensah, Adeline Bernier, Clotilde Couderc, Bintou Dembélé Keita, Christian Laurent, Bruno Spire, and CohMSM Study Group

Subjects
Medicine, Science
Abstract

Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39-2.50]), less educated (aOR[95%CI]:1.49[1.09-2.03]), unmarried status (aOR[95%CI]:1.79[1.10-2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06-1.88]), group sex with men (aOR[95%CI]:2.07[1.46-2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40-2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12-1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97-3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08-1.93]) and drug use (aOR[95%CI]:1.82[1.24-2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07-1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53-0.99]) was negatively associated with TS.

Published
2019
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3. Changes in risky sexual behaviours among West African MSM enrolled in a quarterly HIV testing and counselling prevention programme (CohMSM ANRS 12324 - Expertise France)

Author

Camille Anoma, Marion Mora, Abdoul Aziz Keita, Bintou Dembélé Keita, Mohamed Mimi, Stéphane-Alain Babo Yoro, Daniela Rojas Castro, Pierre-Julien Coulaud, Michel Bourrelly, Paméla Palvadeau, Adeline Bernier, Ephrem Mensah, Bruno Spire, Selom Agbomadji, Christian Coulibaly, Clotilde Couderc, Elias Ter Tiero Dah, Christian Laurent, Gwenaëlle Maradan, Luis Sagaon-Teyssier, Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS, Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Institut de Recherche pour le Développement (IRD [France-Sud]), Université de Montpellier (UM), and Aiello, Mélisande

Subjects
Counseling, Male, [SDV]Life Sciences [q-bio], Social Stigma, Intimate Partner Violence, HIV Infections, hiv, 030312 virology, Mali, Men who have sex with men, law.invention, Cohort Studies, Condoms, Health Risk Behaviors, Sexual and Gender Minorities, 0302 clinical medicine, prevention, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, 030212 general & internal medicine, Depression (differential diagnoses), 0303 health sciences, Depression, Risk of infection, Age Factors, sexual behaviour, Gender Identity, virus diseases, 3. Good health, Infectious Diseases, Togo, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Bisexuality, Adult, Sexual Behavior, Sexually Transmitted Diseases, Dermatology, Hiv testing, Young Adult, 03 medical and health sciences, Condom, Burkina Faso, West Africa, Humans, MSM, Unsafe Sex, business.industry, Sex Work, Mental health, Self Concept, Cote d'Ivoire, Logistic Models, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Harassment, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Risk Reduction Behavior, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Demography
Abstract

ObjectivesWhether regular HIV testing and counselling reduce risky sexual behaviours in African men who have sex with men (MSM) is still a matter for debate. We aimed to identify behavioural trajectories based on HIV risk exposure (HRE) and factors affecting their evolution.MethodsData were collected from 621 HIV-negative West African MSM (Mali, Cote d'Ivoire, Burkina Faso and Togo) included in a community-based cohort providing quarterly HIV testing and counselling. Sociobehavioural data were collected every 6 months. HRE was defined as reporting inconsistent condom use during receptive anal sex with male partners of unknown HIV status in the previous 6 months. Using 18-month follow-up data, group-based trajectory modelling helped identify behavioural trajectories and determine the factors associated with their evolution. HIV seroconversions (n=67) were specified in each group trajectory.ResultsTwo distinct group trajectories were identified: medium-risk exposure MSM (ME-MSM) (61%, 6.4% of whom having seroconverted) and high-risk exposure MSM (HE-MSM) (39%, 17.5% of whom having seroconverted). A significant declining trend in the probability of reporting HRE over time ((95% CI)) was observed for HE-MSM (from 0.59 (0.48 to 0.70) at M0 to 0.31 (0.22 to 0.41) at M18), while it remained constant for ME-MSM (0.034 (0.0 to 0.079)). This can be explained by a progressive use of risk reduction strategies (less receptive anal sex, better knowledge of their partners’ status and increasing condom use). Being younger, living in Burkina Faso, self-considering both a man and a woman and reporting a higher level of depression were all associated with HE membership. Among HE-MSM, HRE was higher in those practising transactional or group sex and those experiencing psychological harassment.ConclusionsQuarterly HIV testing and counselling seem to reduce risky sexual behaviours in HIV-negative MSM at greatest risk of infection. Specific support for young MSM, focusing on identity and mental health, is needed to strengthen HIV prevention in West African MSM.

Published
2020
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4. Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa

Author

Michel Bourrelly, Bintou Dembélé Keita, Ephrem Mensah, Camille Anoma, Abdoul Aziz Keita, Pierre-Julien Coulaud, Elias Ter Tiero Dah, Bruno Spire, Cheick Haïballa Kounta, Stéphane-Alain Babo Yoro, Gwenaëlle Maradan, Luis Sagaon-Teyssier, Selom Agbomadji, Clotilde Couderc, Marion Mora, Christian Laurent, Christian Coulibaly, Adeline Bernier, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut de Recherche pour le Développement (IRD [France-Sud]), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Aiello, Mélisande

Subjects
RNA viruses, Male, Safe Sex, Epidemiology, Economics, Physiology, [SDV]Life Sciences [q-bio], Social Sciences, HIV Infections, Human sexuality, Pathology and Laboratory Medicine, Men who have sex with men, West africa, Geographical Locations, Cohort Studies, 0302 clinical medicine, Immunodeficiency Viruses, Reproductive Physiology, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Copulation, Medicine and Health Sciences, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Generalized estimating equation, Alcohol Consumption, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, 3. Good health, [SDV] Life Sciences [q-bio], Africa, Western, Sexual Partners, Medical Microbiology, HIV epidemiology, Viral Pathogens, Sex life, Viruses, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pathogens, 0305 other medical science, Research Article, Adult, Sexual Behavior, HIV prevention, Men WHO Have Sex with Men, Transactional sex, Microbiology, Young Adult, 03 medical and health sciences, Retroviruses, Humans, Homosexuality, Male, Microbial Pathogens, Socioeconomic status, Nutrition, Preventive medicine, Sex Workers, 030505 public health, business.industry, Lentivirus, Organisms, Biology and Life Sciences, HIV, Diet, Public and occupational health, People and Places, Africa, Population Groupings, business, Finance, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Sexuality Groupings, Demography
Abstract

International audience; Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39-2.50]), less educated (aOR[95%CI]:1.49[1.09-2.03]), unmarried status (aOR[95%CI]:1.79[1.10-2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06-1.88]), group sex with men (aOR[95%CI]:2.07[1.46-2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40-2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12-1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97-3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08-1.93]) and drug use (aOR[95%CI]:1.82[1.24-2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07-1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53-0.99]) was negatively associated with TS.

Published
2019
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5. Interest in HIV pre-exposure prophylaxis in men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France)

Author

Pierre-Julien, Coulaud, Luis, Sagaon-Teyssier, Bakridine, M'madi Mrenda, Gwenaëlle, Maradan, Marion, Mora, Michel, Bourrelly, Bintou, Dembélé Keita, Abdoul Aziz, Keita, Camille, Anoma, Stéphane-Alain, Babo Yoro, Ter Tiero Elias, Dah, Christian, Coulibaly, Ephrem, Mensah, Selom, Agbomadji, Adeline, Bernier, Clotilde, Couderc, Christian, Laurent, Bruno, Spire, Claver Anoumou Yaotsè, Dagnra, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), This study was funded by the ANRS (France Recherche Nord & Sud Sida-hiv Hépatites, ANRS 12324) and Expertise France (Initiative 5%). PJC was the recipient of a doctoral fellowship from ANRS (B7-ANRS 12324)., The CohMSM Study Group : Granouillac B, Izard S, March L, Peeters M, Serrano L, Berenger C, Parisi E, Palvadeau P, Rojas Castro D, Trenado E, Camara D, Cisse O, Coulibaly A, Diallo F, Diarra M, Gadjigo M, Maiga K, Ouologuem A, Traore F, Aka NT, Coulibaly NH, Kotchi R, Kouabenan P, Kouame MJ, Lokrou KJ, N'Guessan FD, Anglaret X, Masumbuko JM, Oga M, Ilboudo O, Ouedraogo J, Ouedraogo M, Thio E, Toure JR, Traore A, Traore I, Yougbare F, Meda N, Agboyibor RMK, Attiogbe M, Badjassim AM, Ekon AL, Kokouba A, Tablissi DJS, Yaka KJ, Dagnra CAY., Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Dupuis, Christine, and Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI)

Subjects
Adult, Male, Health Knowledge, Attitudes, Practice, Anti-HIV Agents, Human immunodeficiency virus (HIV), men who have sex with men, HIV Infections, Transactional sex, Mali, medicine.disease_cause, Logistic regression, Men who have sex with men, Sexual and Gender Minorities, Young Adult, 03 medical and health sciences, Pre-exposure prophylaxis, 0302 clinical medicine, prevention, Burkina Faso, medicine, Humans, 030212 general & internal medicine, Homosexuality, Male, pre-exposure prophylaxis, 030505 public health, Unsafe Sex, business.industry, Public Health, Environmental and Occupational Health, HIV, Odds ratio, Patient Acceptance of Health Care, Confidence interval, 3. Good health, Cote d'Ivoire, Cross-Sectional Studies, Infectious Diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Togo, Africa, Parasitology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, prophylaxis, 0305 other medical science, business, Demography, Cohort study
Abstract

International audience; OBJECTIVE:To explore the interest in taking PrEP among Western African men who have sex with men (MSM).METHODS:A cross-sectional survey was implemented at enrolment of HIV-negative MSM in a multiple centre community-based cohort study in four West African countries (Mali, Côte d'Ivoire, Burkina Faso, Togo). A standardised face-to-face questionnaire collected data on socio-demographic and behavioural characteristics over the previous 6 months. Descriptive analysis and multivariate logistic regression helped identify factors associated with the interest in taking PrEP.RESULTS:Of 564 participants, 87% were interested in taking PrEP. Interest in PrEP was associated with inconsistent condom use for anal sex (adjusted odds ratio (aOR): 2.11; 95% confidence interval (CI) 1.21-3.67), transactional sex (aOR: 2.02; 95% CI 1.11-3.71), searching for male sexual partners on the Internet in the previous month (aOR: 1.86; 95% CI 1.01-3.43), having a high level of self-esteem (aOR: 1.20; 95% CI 1.06-1.36), having at least one sexually transmitted infections at enrolment (aOR: 5.08; 95% CI 1.40-18.4) and not being aware of PrEP (aOR: 2.03; 95% CI 1.04-3.96). Participants having sex with HIV-positive male partners (aOR: 0.28; 95% CI 0.11-0.74), those being more sexually attracted to women than to men (aOR: 0.20; 95% CI 0.07-0.89) and those reporting psychological and material support from close friends (aOR: 0.33; 95% CI 0.15-0.73) were less interested in taking PreP.CONCLUSIONS:Western African HIV-negative MSM appear very interested in taking PrEP, especially those most at risk of HIV infection. PrEP implementation in a comprehensive prevention package should be considered urgently.

Published
2018
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