A cross-sectional evaluation of the HIV prevalence and HIV-related risk factors of men who have sex with men (MSM) in Malawi
Background: Malawi has a generalized HIV epidemic with an estimated population prevalence of 14.1%. The dominant risk factors for HIV in Malawi have been heterosexual and vertical transmission. HIV prevention expenditures have nearly exclusively targeted decreasing these two modes of transmission. Recent studies from within Africa have suggested that MSM are also at risk for HIV infection, and that these epidemics may be propagated by a lack of targeted prevention programming and social marginalization. This study was conducted to evaluate the HIV risk status of MSM in Malawi.
Methods: A 2008 cross-sectional anonymous probe of 200 men who report ever having sex with another man in Malawi using a structured survey instrument. HIV-1/2 was assessed with oral fluid samples with the OraQuick© rapid test kit.
Results: Preliminary analyses revealed a HIV prevalence of 21.0% (95%CI 15.9-27.2, 42/200). 75% (150/200) had multiple male sexual partners within the last 6 months, with a mean of 14.09 male partners. 56% (112/200) had multiple female partners during this same time frame, with a mean of 12.42 female partners. Self-identifying as being homosexual compared to self-identifying as heterosexual was significantly associated with being HIV-positive (p=0.04), and there was a similar trend for those who self-identify as bisexual (p=0.07). Self-reporting as always using condoms during anal intercourse compared to never wearing condoms during was not associated with HIV serostatus (p=0.15). Univariate analysis demonstrated that those MSM less than 25 years old were at higher risk for being HIV infected (OR 4.24,95%CI1.95-9.21).
Conclusions: This is the first study to evaluate HIV risk status of MSM in Malawi and it demonstrated that MSM are a high-risk group for HIV infection. Further epidemiologic and evaluative research is needed to assess the contribution of MSM to the Malawian HIV epidemic and how best to mitigate this. Malawi should begin to adopt and appropriately fund evidence-based and targeted HIV prevention programs for MSM.
-Abstract available at link below-