Anal cancer and male sex workers who have sex with men (MSM-SW): marginalized, high risk and not accessing comprehensive care in Nairobi, Kenya
J. Nyamu1, J. Munyao1, F. Muriuki1, J. Kimani1,2
1Kenya AIDS Control Project, Clinical Research, Nairobi, Kenya, 2University of Manitoba, Medical Microbiology, Winnipeg, Canada
Background: MSM sex workers are not only marginalized and at high risk of STIs in our settings, they’re also an extremely vulnerable group for anal cancer. The risk doubles among those who are HIV positive and unlike other conditions that have declined in incidence since the advent of HAART, anal cancer has continued to increase since 1996. Anal cancer rates in the general population are 1/100,000 people, however among MSMs they’re 35/100,000 people and twice that number if the individual is HIV+. These rates are comparable to those of cervical cancer in the pre-screening era.
Methods: A cross-sectional study was conducted using enrollment data for 160 MSM sex workers currently registered at a Sex Workers Outreach Program clinic in Nairobi. The database was explored to illustrate the magnitude of risk of anal cancer in this cohort.
Results: 77 (47.2%) of those enrolled are HIV+, while 86 (52.8%) were HIV-.Those who smoke were 57 (35%) and the median casual client number /day was 1.4 with a range of 1- 6. A total of 98 (64.5%) reported having receptive anal sex in the last 3 months and only 42 (42.9%) use condoms always when having receptive anal sex. However, no data was available on pre-existing abnormal anal lesions and HPV infection due to inadequate screening procedures.
Conclusions: Anal cancer, a difficult to treat condition with a poor outcome and is totally being ignored in a high risk population. Are we handing MSMs a pending death sentence with the gaps in the existing care packages? There is need to expand existing interventions to incorporate annual anal pap smear screening programs as well as educating them on anal cancer.