HIV infection among men who have sex with men in Kampala, Uganda--a respondent driven sampling survey

• Published in: PloS one Vol. 7; no. 5; p. e38143
• Main Authors: Hladik, Wolfgang, Barker, Joseph, Ssenkusu, John M, Opio, Alex, Tappero, Jordan W, Hakim, Avi, Serwadda, David
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.05.2012; Public Library of Science (PLoS)
• Subjects: Abuse; Acquired immune deficiency syndrome; Adult; AIDS; Anal sex; Audio data; Biomarkers; Confidence intervals; Demographics; Disease control; Disease transmission; Epidemics; Female; Gays & lesbians; Health risks; Health Surveys; HIV; HIV infections; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV tests; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; Infections; Laboratory tests; Male; Medicine; Men; Multivariate analysis; Population statistics; Prevalence; Random sampling; Risk analysis; Risk Assessment; Risk factors; Sampling; Sex; Sexually transmitted diseases; STD; Surveys; Uganda - epidemiology; Young Adult; Uganda
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0038143

Uganda's generalized HIV epidemic is well described, including an estimated adult male HIV prevalence in Kampala of 4.5%, but no data are available on the prevalence of and risk factors for HIV infection among men who have sex with men (MSM). From May 2008 to February 2009, we used respondent-driven sampling to recruit MSM ≥18 years old in Kampala who reported anal sex with another man in the previous three months. We collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. Laboratory testing included biomarkers for HIV and other sexually transmitted infections. We obtained population estimates adjusted for the non-random sampling frame using RDSAT and STATA. 300 MSM were surveyed over 11 waves; median age was 25 years (interquartile range, 21-29 years). Overall HIV prevalence was 13.7% (95% confidence interval [CI] 7.9%-20.1%), and was higher among MSM ≥25 years (22.4%) than among MSM aged 18-24 years (3.9%, odds ratio [OR] 5.69, 95% CI 2.02-16.02). In multivariate analysis, MSM ≥25 years (adjusted OR [aOR] 4.32, 95% CI 1.33-13.98) and those reporting ever having been exposed to homophobic abuse (verbal, moral, sexual, or physical abuse; aOR 5.38, 95% CI 1.95-14.79) were significantly more likely to be HIV infected. MSM in Kampala are at substantially higher risk for HIV than the general adult male population. MSM reporting a lifetime history of homophobic abuse are at increased risk of being HIV infected. Legal challenges and stigma must be overcome to provide access to tailored HIV prevention and care services.