Efficacité de la Combinaison d’Interventions de Prévention chez les Hommes Ayant des Rapports Sexuels avec des Hommes à Bangui (République Centrafricaine)

Marcel Mbeko Simaleko, Serges Magloire Camengo Police, Jean de Dieu Longo, Henri Saint Calver Diemer, Danielle Piette, Gérard Gresenguet, Humblet Perrine

Abstract


RÉSUMÉ
Introduction. Les hommes ayant des rapports sexuels avec les hommes (HSH) constituent une population à haut risque des IST/VIH en RCA. Notre étude visait à tester l’efficacité de la combinaison d’interventions comportementale, biomédicale et structurelle de prévention du VIH chez les HSH, dans un contexte de crise sécuritaire. Matériels et méthodes. Les interventions ont eu lieu de juin 2014 à octobre 2016. Deux cent quinze (215)  HSH formés sur les IST/VIH ont été enrôlés au Centre National de Référence des IST et de la Thérapie Antirétrovirale (CNRIST/TAR), à Bangui. Le groupe d’intervention (n= 40) a été obtenu après randomisation. Le reste (n=175) constituait le groupe contrôle. Les interventions 1) biomédicales (traitement antirétroviral comme prévention/diagnostic –traitement des IST/conseil dépistage du VIH) ; 2) psycho-socio-éducatives (causeries éducatives, aides sociales et envoi de messages par SMS) et 3) structurelles (rendre disponibles et gratuits les préservatifs) ont été retenues. Résultats. Dans le groupe d’intervention, la médiane des partenaires sexuels occasionnels des trois derniers mois a été réduite de manière significative (p < 0.001). Le pourcentage de HSH ayant eu 100% de rapports sexuels protégés a augmenté de manière significative (p <0.001). Seul un HSH a été infecté contre neuf dans le groupe témoin. Aucune séroconversion au test de l’hépatite B n’a été relevée dans le groupe intervention. Il n’y a pas eu d’augmentation significative de nouvelles infections syphilitiques (p<0,001). Conclusion. La combinaison d’interventions a des effets sur le changement de comportement des HSH et probablement sur la réduction des cas d’IST/VIH, même en période de crise humanitaire. Au vu de l’effectif réduit de l’échantillon, il est nécessaire de réaliser une étude plus poussée sur un échantillon de HSH plus important, afin de conforter ces résultats.
ABSTRACT
Introduction. Men who have sex with men (MSM) are a high-risk population for STIs/HIV in the Central African Republic (CAR). Our study aimed to test the effectiveness of the combination of behavioral, biomedical and structural interventions in MSM in the context of a security crisis. Materials and methods. The interventions were conducted from June 2014 to October 2016. Participants (n=215) were enrolled in the National Reference Centre for STIs and Antiretroviral Therapy in Bangui, the capital city of CAR. The intervention group (n=40) was randomly selected. The remaining subjects (n= 175) was the control group. Both groups participated in a series of STI/HIV upgrading training sessions at the beginning of the study. Then, intervention group received 1) biomedical interventions (antiretroviral treatment as prevention, STI diagnosis and treatment, and HIV counseling), 2) psychosocio-educational interventions (interactive training, educative talks, social assistance and text messages) and 3) Structural interventions: (condoms available and free of charge). Results. In the intervention group, the median of casual sexual partners in the previous three months was significantly reduced (p < 0.001) ; the percentage of MSM having 100% of protected intercourse increased significantly (p<0.001). Only one MSM out of 40 was infected with HIV versus nine out of 76 in the control group. No negative subjects in the intervention group became positive for hepatitis B. There was no significant increase in the number of new cases of syphilis infection (p<0,001). Conclusion. The combination of interventions has an alleviating impact on risk behaviors and probably reduces the incidence of STI/HIV among MSM, even in times of humanitarian crisis. In view of the small sample size, it would be necessary to carry out a more in-depth study with a larger sample of MSM, in order to confirm these results.

Keywords


HSH, VIH, Interventions, RCA.Keywords: MSM, HIV, Interventions, CAR.

Full Text:

PDF (Français)

References


United Nations Development Programme, 2005. HIV/AIDS and Human Development thematic Guidance Note, U.N.D. Programme, Editor 2005.

Baral, S., et al., Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000-2006: a systematic review. PLoS medicine, 2007. 4(12): p. e339.

Longo, J.d.D., Groupes à Haut Risque du VIH en République Centrafricaine: Classification et interventions précoces. Health sciences and diseases, 2016. Available on https://tel.archives-ouvertes.fr/tel-01591492

van Griensven, F., et al., The global epidemic of HIV infection among men who have sex with men. Current opinion in HIV and AIDS, 2009. 4(4): p. 300-7.

Loukabou Mbongolo, N.C, Mayengue P.I, Bayonne Kombo, E.S,et al. Infections à VIH, Syphilis, Hépatites B et C chez les Hommes ayant des Rapports Sexuels avec d’autres Hommes en République du Congo. Health sciences and diseases, 2019. 20(6): p. 49-54 available on www.hsd-fmsb.org.

Williams, B.G., V. Lima, and E. Gouws, Modelling the impact of antiretroviral therapy on the epidemic of HIV. Current HIV research, 2011. 9(6): p. 367-82.

Sanders, E.J., et al., HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS, 2007. 21(18): p. 2513-20.

Baral, S., et al., HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PloS one, 2009. 4(3): p. e4997.

Wade, A.S., et al., HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS, 2005. 19(18): p. 2133-40.

UNAIDS Data 2018.

M.B.Simaleko, Caractéristiques sociodémographiques et pratiques sexuelles à risque des hommes ayant des rapports sexuels avec des hommes à Bangui, République centrafricaine. Médecine d'Afrique Noire, 2013. 60: p. 109-114.

Ouedraogo, H.G., et al., Hepatitis B, C, and D virus and human T-cell leukemia virus types 1 and 2 infections and correlates among men who have sex with men in Ouagadougou, Burkina Faso. Virology journal, 2018. 15(1): p. 194.

Schaalma, H.P., et al., Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects. Health education quarterly, 1996. 23(4): p. 469-87.

Teng, Y. and W.W. Mak, The role of planning and self-efficacy in condom use among men who have sex with men: an application of the Health Action Process Approach model. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 2011. 30(1): p. 119-28.

Herbst, J.H., et al., A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men. Journal of acquired immune deficiency syndromes, 2005. 39(2): p. 228-41.

Mbeko Simaleko M., L.J.D.D., Camengo Police S.M., Piette D., Attitude of men who have sex with men toward condom use in Bangui,Central African Republic (CAR). Medecine et Sante´ Tropicales, 2018. 28: p. 424-429.

Klein, H., Condom use self-efficacy and HIV risk practices among men who use the internet to find male partners for unprotected sex. American journal of men's health, 2014. 8(3): p. 190-204.

Morales, A., et al., Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016. PloS one, 2018. 13(6): p. e0199421.

Kesler, M.A., et al., Actual sexual risk and perceived risk of HIV acquisition among HIV-negative men who have sex with men in Toronto, Canada. BMC public health, 2016. 16: p. 254.

Eyong, E.M., et al., The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka Health Districts of the South West region of Cameroon: a three-year retrospective study. The Pan African medical journal, 2019. 32: p. 122.

Chesson, H.W., et al., The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV Infection. Sexually transmitted diseases, 2013. 40(5): p. 366-71.

Luo, S., et al., Evaluating the Impact of Test-and-Treat on the HIV Epidemic among MSM in China Using a Mathematical Model. PloS one, 2015. 10(6): p. e0126893.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

********************************************************************************************