HIV testing, care and viral suppression among men who have sex with men and transgender individuals in Johannesburg, South Africa

• Published in: PloS one Vol. 15; no. 6; p. e0234384
• Main Authors: Fearon, Elizabeth, Tenza, Siyanda, Mokoena, Cecilia, Moodley, Kerushini, Smith, Adrian D, Bourne, Adam, Weatherburn, Peter, Palanee-Phillips, Thesla
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 17.06.2020; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; AIDS Serodiagnosis - statistics & numerical data; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Biology and Life Sciences; Care and treatment; Diagnosis; Female; Forecasts and trends; Gays & lesbians; Gender identity; Health aspects; Health Behavior; HIV; HIV infections; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - virology; Homosexuality, Male; Human immunodeficiency virus; Humans; Male; Medical care utilization; Medical tests; Medicine and Health Sciences; Men; Mens health; MSM (Men who have sex with men); People and Places; Polls & surveys; Population; Prevalence; Public health administration; Reproductive health; Robustness (mathematics); Sex; Sex ratio; Sexually transmitted diseases; Social Sciences; Socioeconomic Factors; South Africa - epidemiology; STD; Stigma; Surveys and Questionnaires; Transgender people; Transgender Persons; Viral Load; Young Adult; South Africa; Johannesburg South Africa; United Kingdom > UK; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0234384

Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes. We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017. Participants gave blood samples for HIV testing and viral load. Participants self-completed a survey including sociodemographics, HIV testing history, and engagement in care. We calculated RDS-II weighted estimates of the percentage of HIV-negative MSM/TG reporting HIV testing in the previous 6 months, their testing experience and preferences. Among those HIV-positive, we estimated the percentage status-aware, on ART, and virally suppressed (<50 viral copies/ml plasma). We conducted RDS-weighted robust Poisson regression to obtain weighted prevalence ratios of factors associated with 1) HIV testing among those HIV-negative; and 2) viral suppression among those HIV-positive. There were 118/300 HIV-positive MSM/TG, (37.5%). Of the HIV-negative MSM/TG, 61.5% reported that they had tested for HIV in the previous 6 months, which was associated with selling sex to men (Prevalence Ratio = 1.67, 95% CI 1.36-2.05). There were 76/118 HIV-positive MSM/TG (56.5%) who reported having previously tested positive for HIV and 39/118 (30.0%) who reported current ART. There were 58/118 HIV-positive MSM/TG with viral loads <50 copies/ml plasma (46.9%). Viral suppression was associated with older age (adjusted PR = 1.03, 95% CI 1.00-1.06 for each year), neighbourhood, and having bought sex from men (adjusted PR = 1.53, 95% CI 1.12-2.08). HIV prevalence was very high. Viral suppression among those HIV-positive was similar to the general male population in South Africa, but remains far short of national and international targets. A majority of HIV-negative MSM/TG had HIV tested in the previous 6 months, though there is room for improvement.