A rapid assessment of HIV risks and human rights status of men who have sex with men (MSM) in Lesotho
S. Baral1, B. Kaibe2, J. Lebona2, D. Adams3, P. Letsie4, R. Tshehlo5, J. Miletti1, A. Wirtz1, B. Cheluget6, C. Beyrer1
1Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Epidemiology, Baltimore, United States, 2The Matrix Discussion Group, Maseru, Lesotho, 3United States Peace Corps, Maseru, Lesotho, 4UNDP, HIV/AIDS Practice, Maseru, Lesotho, 5National AIDS Commission, Policy, Strategy and Communications Directorate, Maseru, Lesotho, 6UNAIDS, Maseru, Lesotho
Background: Evidence is increasing of high HIV risks among Southern African MSM. This is the first study of HIV risks among MSM in Lesotho.
Methods: 252 men who reported ever having anal sex with another man were accrued with network-referral and administered a structured quantitative instrument from October-November, 2009.
Results: 96.4%(240/249) of participants were ethnic Basotho, mean age was 26.3 (range 18-56); 49.6%(124/250) were currently employed, and 95.2%(238/250) had at least a secondary-level education. Self-reported HIV prevalence was 11.6%(22/190); 54.5%(128/235) reported being tested for HIV in the last year.
HIV knowledge was low; only 3.7%(8/212)of MSM knew that both receptive anal intercourse was the highest risk for HIV, and that water-based lubricant(WBL) is most appropriate to use with condoms. 75.1%(172/229) reported having a regular male partner; 28.6%(58/203) concurrent regular male and female partners; and 41%(71/173) both male and female sexual partners in the last year. 40%(40/100) reported wearing condoms with their last female partner, and 21%(39/286) reported safe sex with men as defined by wearing condoms with last partner and using WBL.
Self-reported HIV infection was significantly associated with wearing condoms with men(OR 0.37,95%CI0.12-1.08,p=0.07); reporting transactional sex(OR 3.1,95%CI1.2-7.7), more than 5 male partners in last year(OR2.6,95%CI1.0-6.7,p< 0.5), having had symptoms of an STI in the last year (OR8.2,95%CI2.9-23.6,p< 0.01),having been raped (OR3.4,95%CI1.1-10.7,p< 0.05), and injecting-drug use in the last year (OR 5.1,95%CI1.1-22.5,p< 0.03).
Human rights abuses were common; 76.2%(170/223) reporting at least one abuse including rape(9.8%,22/225), blackmail(21.3%,47/221), fear of seeking health care(22.2%,49/221), police discrimination (16.4%,36/219),verbal or physical harassment(59.8%/140/234), or having been beaten (18.9%,43/228). Blackmail was associated with having disclosed sexual orientation to a health care worker(OR3.6,95%CI1.8-7.3,p< 0.05) or family member(OR 2.7,95%CI1.4-5.3,p< 0.05).
Conclusions: MSM in Lesotho are at high risk for HIV infection and human rights abuses. Evidence-based and rights affirming HIV prevention programs supporting the needs of MSM should be developed and implemented.