Forte Prévalence de l'Infection à VIH dans la Population des Hommes ayant des Rapports Sexuels Avec d'Autres Hommes Vivant À Bangui, En République Centrafricaine

Jean de Dieu Longo, Marcel Mbeko Simaleko, Serges Police Camego, Henri Saint-Calvaire Diemer, Gilles Brücker, Laurent Bélec, Gérard Grésenguet

Abstract


RÉSUMÉ
OBJECTIF. La population des Hommes ayant des rapports sexuels avec des Hommes (HSH) est très peu documentée en Centrafricaine. Le but de cette étude était de mieux caractériser la population HSH à Bangui.
MÉTHODES : Les HSH ont été recrutés sur une base de volontariat. Les HSH inclus venaient au centre pour les conseils et le dépistage du VIH, des IST et/ou soins médicaux. Les données collectées et analysées étaient les données cliniques et sérologiques, ainsi que les caractéristiques sociodémographiques, les connaissances et attitudes face au VIH et les facteurs comportementaux.
RÉSULTATS : 131 HSH ont été consécutivement inclus entre 2010 et 2013. L’âge au premier rapport sexuel homosexuel était compris dans 50 % des cas dans la tranche d’âge de 15 – 20 ans et dans 35% avant l’âge de 15 ans. 70 % avaient concomitamment deux ou plus de partenaires sexuels masculins ou féminins et 50% sont bisexuels. 60% n'avaient pas utilisé le condom lors de leur premier rapport sexuel ; 73 % n’avaient pas utilisé de préservatif lors des derniers rapports sexuels occasionnels. 46 % avaient eu des rapports sexuels avec un partenaire sexuel masculin plus âgés qu'eux. Les pratiques sexuelles comprenaient : sexe-anal (99%) ; fellation (97%) ; pénis-bouche (93%), doigt-anus (87%) et bouche anus (5%). 24 % étaient séropositifs pour le VIH-1 ; 20 % étaient infectés par le virus de l'hépatite B, dont 8 cas étaient co-infectés par le VIH et le VHB. 21% avaient une sérologie positive vis à vis du HSV-2 et 4 % cas une sérologie positive pour la syphilis.
CONCLUSION. Les HSH à Bangui constituent un groupe à haut risque, avec 24% de prévalence du VIH, ont donc besoin d'interventions spécifiques en toute urgence.

ABSTRACT

BACKGROUND.
The core group of men who have sex with men (MSM) constitutes a yet poorly documented high-risk group for HIV in Central Africa. The aim of the study was to evidence and characterize the MSM population in Bangui (Central African Republic).
METHODS. MSM were recruited on a voluntary basis by the way of local network of nonprofit organizations working in the field of HIV infection. Included MSM were referred to the National STI center of Bangui for social, behavioral and medical evaluation. Clinical and biological data were collected and analyzed as well as sociodemographic, knowledge, attitudes and practice towards HIV.
RESULTS. A total of 131 MSM were prospectively included between 2010 to 2013. The first sexual intercourse occurred in 50% between 15-20 years and in 35% before the age of 15 years. 70% had two or more concomitant sexual male or female partners; 50% defined themselves as bisexual. 60% did not used condom at first sexual intercourse. 73% never used condom at occasional sexual intercourse. 46% had sexual intercourse with a male sexual partner older than them. Sexual practices included anal sex (99%); fellatio (97%); French kiss (93%), anal fisting (87%), and oro-anal practices (5%). 24% were HIV-1-infected; 17% were infected by hepatitis B virus (HBV) (Ag HBs) including 8 cases of co-infection by HIV and HBV; 21% were HSV-2 seropositive; 4% were seropositive for syphilis.
CONCLUSIONS The population of MSM in Bangui is clearly identified as a high-risk group for HIV, being 5-fold higher HIV-infected than the general adult heterosexual population, thus needing urgently specific interventions for prevention and heath care.


Keywords


HSH; Comportements sexuels ; VIH-1; Centrafrique

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