Knowledge, behaviors and HIV prevention coverage among men who have sex with men (MSM) in low and middle income countries: lessons from the 2005 UNGASS reporting round
Background: While recent reviews provide estimates of MSM population size and HIV-prevalence in low-and-middle-income countries (LMIC), appraisals of HIV-knowledge, behaviors and prevention coverage are lacking. This gap is adressed by drawing on data from country progress reports on implementation of the UNGASS Declaration of Committment on HIV/AIDS.
Methods: Analyses were conducted on pooled UNGASS 2005 epidemiological and prevention indicator data concerning MSM.
Results: Only 37 out of 145 LMIC reported at least one indicator of HIV-knowledge, condom use, HIV-prevalence or prevention coverage in MSM. Reporting was associated with larger population size (p<.05), higher country level of education (p<.05), and absence of laws penalizing homosexuality (p<.01). Mean HIV-prevalence was 7.7% (sd=8.4). Compared to estimates reported by Baral et al. (2007), mean HIV-prevalence in the same subset of countries (n=19), was one point lower in UNGASS data. Mean percentage of correct HIV-knowledge was low (41.8%; sd=21.8), but varied widely over countries, as did condom use (M=52.8%; sd=23.5). Most reporting countries (n=25) had prevention policies for most-at-risk-populations. Of these, 20 countries had prevention policies for MSM. Countries without prevention policies for MSM had lower economic development (p<.05), and more often had laws penalizing homosexuality (p<.10). A third of countries reporting on prevention coverage estimated proportions of MSM reached as lower than 10%.
Conclusions: Increased understanding of the global response to the HIV-epidemic in MSM resulted from the 2005 UNGASS reporting round. Results indicate that MSM are at high risk for HIV-infection in (most) LMIC. Countries aware of this situation have started to implement HIV-prevention policies for MSM, but HIV-knowledge and condom use in MSM on average remain low. Prevention interventions remain weak and do not reach sufficient numbers of those most at risk. Increasing coverage, intensity and quality of HIV-prevention for MSM in LMIC is needed to influence behaviors and adjust epidemic trends.
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