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Introduction: Despite the knowledge that men who have sex with men (MSM) are more likely to be infected with HIV across settings, there has been little investigation of the experiences of MSM who are living with HIV in sub-Saharan Africa. Using the framework of positive health, dignity and prevention, we explored the experiences and HIV prevention, care and treatment needs of MSM who are living with HIV in Swaziland. Methods: We conducted 40 in-depth interviews with 20 HIV-positive MSM, 16 interviews with key informants and three focus groups with MSM community members. Qualitative analysis was iterative and included debriefing sessions with a study staff, a stakeholders’ workshop and coding for key themes using Atlas.ti. Results: The predominant theme was the significant and multiple forms of stigma and discrimination faced by MSM living with HIV in this setting due to both their sexual identity and HIV status. Dual stigma led to selective disclosure or lack of disclosure of both identities, and consequently a lack of social support for care-seeking and medication adherence. Perceived and experienced stigma from healthcare settings, particularly around sexual identity, also led to delayed care-seeking, travel to more distant clinics and missed opportunities for appropriate services. Participants described experiences of violence and lack of police protection as well as mental health challenges. Key informants, however, reflected on their duty to provide non-discriminatory services to all Swazis regardless of personal beliefs. Conclusions: Intersectionality provides a framework for understanding the experiences of dual stigma and discrimination faced by MSM living with HIV in Swaziland and highlights how programmes and policies should consider the specific needs of this population when designing HIV prevention, care and treatment services. In Swaziland, the health sector should consider providing specialized training for healthcare providers, distributing condoms and lubricants and engaging MSM as peer outreach workers or expert clients. Interventions to reduce stigma, discrimination and violence against MSM and people living with HIV are also needed for both healthcare workers and the general population. Finally, research on experiences and needs of MSM living with HIV globally can help inform comprehensive HIV services for this population. Keywords: men who have sex with men; positive health dignity and prevention; people living with HIV; qualitative research; Swaziland. (Published: 2 December 2013) Citation: Kennedy CE et al. Journal of the International AIDS Society 2013, 16 (Suppl 3):18749 http://www.jiasociety.org/index.php/jias/article/view/18749 | http://dx.doi.org/10.7448/IAS.16.4.18749

OBJECTIVES: Nonbarrier modern contraceptive users often are less likely to use condoms particularly with more intimate sex partners. We examine whether female sex workers (FSWs) in Swaziland who use nonbarrier contraception use condoms less consistently and whether this inverse association varies by relationship type. METHODS: In 2011 we conducted a survey among 325 Swazi FSWs using respondent-driven sampling. Each woman reported on condom use during sexual activity in the past month with up to 3 partner types (new clients regular clients noncommercial partners). We used a generalized estimating equation model to conduct a relationship-level multivariate logistic regression analysis of correlates of consistent condom use in the past month. We tested whether relationship type modified the effect of nonbarrier modern contraception on condom use. RESULTS: Each participant reported up to 3 observations for a total of 892 measures of condom use in the past month. Compared with sexual activity with new clients sex with regular clients and noncommercial partners was less likely to be protected by consistent condom use (adjusted odds ratio 0.30 [95% confidence interval 0.19-0.47] for regular clients; adjusted odds ratio 0.15 [95% confidence interval 0.09-0.24] for noncommercial partners). There was no significant association between condom use and nonbarrier modern contraceptive use. CONCLUSIONS: These data highlight the need to provide condoms and condom-compatible lubricants and targeted education programs for FSWs and their male sex partners to encourage the consistent use of these commodities with all sex partners irrespective of the use of other contraceptive methods.