A systematic review of HIV epidemiology and risk factors among MSM in Sub-Saharan Africa
Background: The epidemic of HIV in Sub-Saharan Africa is driven by multiple factors, yet the role of male same-sex behaviors has been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in Africa are among the sparsest globally, but there is evidence that male to male sexual contact is a risk for men on this continent as on all others. Grassroots efforts are underway to characterize HIV risks of MSM beyond calling for recognition of their existence. A greater understanding of the drivers of infectious disease epidemics among these men is needed to design prevention and surveillance strategies and advocate for funding for these efforts.
Methods: A systematic review using the QUORUM protocol.
Results: As of January, 2008, there is published HIV prevalence data available for MSM in Kenya, Senegal, and Sudan. Prevalence rates in these studies ranged from 9.3% in Sudan, 21.5% in Senegal, and to 43% in Kenya which are all higher than the general population prevalence in these countries. Studies of prevalence of HIV risk factors were available from other countries including Zambia and Nigeria suggesting high rates of unprotected anal intercourse and low levels of HIV related knowledge among African MSM.
Conclusions: African MSM are underserviced and marginalized. HIV rates are higher than among other men, and there is limited knowledge of the health related risks of anal intercourse. Efforts at increasing access of MSM to health and social services have largely been driven by community based organizations rather than nationally funded HIV programs. These efforts have been hampered by the systemic stigmatization targeting MSM in much of Africa manifesting in violence, anti-sodomy laws, and exclusion from AIDS strategies. To comprehensively address the HIV epidemic, African national AIDS strategies should allocate funds based on evidence, ensuring that the right to healthcare is respected for all those at risk.
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