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New HIV Rate Remains "Alarmingly High" in MSM and TGW of Sub-Saharan Africa
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HIV Research for Prevention (HIVR4P), October 21-25, 2018, Madrid
Mark Mascolini
HIV incidence (the new-infection rate) remains "alarmingly high" in sub-Saharan men who have sex with men (MSM) and transgender women (TGW), according to results of a 329-person HPTN 075 cohort analysis [1]. The main risk factor for incident HIV was having a rectal sexually transmitted infection (STI) when entering the cohort.
Many African countries continue to criminalize same-sex behavior, which remains largely socially unacceptable throughout the continent. As a result, many gays, lesbians, and transgender people hide their sexuality and avoid HIV testing and medical care. A 56-study meta-analysis presented at HIVR4P found that only two thirds of African MSM ever had an HIV test, though testing rates are improving [2].
HPTN 075 researchers who conducted the new study noted that prior work confirms disproportionately high HIV prevalence among sub-Saharan MSM. But because little is known about HIV incidence in MSM and TGW, they aimed to analyze incidence in these groups and to identify risk factors for incident HIV infection.
To assess the feasibility of recruiting and retaining MSM in a multicountry prospective cohort with an eye toward HIV prevention studies, HPTN 075 investigators sought participants in Cape Town and Soweto, South Africa, and in Kisumu, Kenya and Blantyre, Malawi. Participants had to be 18 to 44 years old, biologically male at birth, willing to be tested for HIV throughout the study, and having anal sex with a man in the previous 3 months. Twenty of a targeted 100 participants per site could have HIV infection when entering the cohort.
Among people enrolled in the cohort, 18% already had HIV infection. This analysis focused on 329 people who initially tested negative for HIV. This group averaged 23.8 years in age and 52.9% had a job. Most participants, 60.9%, ever had sex with women, 55.8% were attracted to both men and women, 39.8% did not identify themselves as gay, and 16.4% called themselves transgender. About 1 in 6 participants (16.1%) had a rectal STI at enrollment.
During 301.8 person-years of follow-up, 21 of 329 HIV-negative participants tested positive for HIV to yield an incidence of 6.98 per 100 person-years (95% confidence interval [CI] 4.31 to 10.64). That rate means 7 of every 100 people would get infected every year. Incidence varied substantially by study site: 1.34 per 100 person-years in Blantyre, 3.75 in Kisumu, 8.97 in Soweto, and 14.44 in Cape Town.
Univariate analysis determined that the Cape Town group had more than a 3-fold higher risk of incident HIV infection (hazard ratio 3.65, 95% CI 1.01 to 13.29, P = 0.049), while having a rectal STI at study enrollment boosted infection risk almost 4-fold (hazard ratio 3.95, 95% CI 1.66 to 9.38, P = 0.002). In multivariate analysis only initial rectal STI independently predicted incident HIV (adjusted hazard ratio 2.68, 95% CI 1.06 to 6.80, P = 0.038).
While overall HIV incidence across sub-Saharan Africa is falling, the HPTN 075 team observed, incidence in MSM and TGW remains "alarmingly high." They called for "intensified and optimized" prevention initiatives for MSM and TGW in the region. And they underlined the need to remove structural barriers to preventive behavior, including access to medical care.
References
1. Sandfort TGM, Guo X, Hamilton EL, et al. HIV incidence among men who have sex with men and transgender women in sub-Saharan Africa: findings from the multi-country HPTN 075 cohort study. HIV Research for Prevention (HIVR4P), October 21-25, 2018, Madrid. Abstract OA10.04LB.
2. Dale E, Stannah J, Elmes J, Staunton R, Mitchell KN, Boily MC. Increases over time in HIV testing among MSM in Africa: a systematic review and meta-analysis. HIV Research for Prevention (HIVR4P), October 21-25, 2018, Madrid. Abstract P29.06.
WEBCAST: http://webcasts.hivr4p.org/console/player/40388?mediaType=slideVideo&&crd_fl=1&ssmsrq=1541599955608&ctms=5000&csmsrq=1210
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