Main Article Content
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.
Article Details
References
- REFERENCES
- ONUSIDA. Rapport mondial sur l’épidémie mondiale de Sida 2012. Genève, 2012 ; 212p.
- de Gruchy J, Lewin S. Ethics that exclude: the role of ethics committees in lesbian and gay health research in South Africa. Am J Public Health 2001; 91:865-868.
- Gelfand M. Apparent absence of homosexuality and lesbianism in traditional Zimbabweans. Cent Afr J Med 1985; 31:137-138.
- Orubuloye IO, Omoniyi OP, Shokunbi WA. Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria. Health Transition Review 1995; 5 (suppl.):123-129.
- Ehlers VJ, Zuyderduin A, Oosthuizen MJ. The well-being of gays, lesbians and bisexuals in Botswana. J Adv Nurs 2001; 35:848-856.
- Teunis N. Same-Sex Sexuality in Africa: A Case Study from Senegal. AIDS and Behavior 2001; 5:173-182.
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- Malekinejad M, Johnston LG, Kendall C, Kerr L, Rifkin M, Rutherford G. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS and Behavior. 2008; 12(1):105-130.
- Billong SC, Fokam J, Essi MJ, Nguefack-Tsague G, Billong E J, Papworth E, Nfetam Elat JB. Prévalence de l’Infection à VIH et comportements sexuels chez les Hommes Homosexuels dans la Ville de Yaoundé au Cameroun. Health Sci. Dis: Vol 14 (2) June 2013.
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- UNFPA/Bangui et ICF International. Atlas de la République Centrafricaine sur les indicateurs du VIH et du SIDA : basé sur les résultats de l’Enquête à indicateurs multiples couplée avec la sérologie en RCA de 2010. Available at: http://dhsprogram.com/pubs/pdf/ATR10/ATR10.pdf (1st May 2014).
- Merrigan M, Azeez A, Afolabi B et al. HIV prevalence and risk behaviours among men having sex with men in Nigeria. Sex Transm Infect. 2011; 87:65-70.
- Scott KC, Philip S, Ahrens K, Kent CK, Klausner JD. High prevalence of gonococcal and chlamydial infection in men who have sex with men with newly diagnosed HIV infection: an opportunity for same day presumptive treatment. J Acquir Immune Defic Syndr 2008; 48:109–112.
- Hall HI, Byers RH, Ling Q, Espinoza L. Racial/ethnic and age disparities in HIV prevalence and disease progression among men who have sex with men in the United States. Am J Public Health 2007; 97:1060–1066.
- O’Leary A, Fisher HH, Purcell DW, Spikes PS, Gomez CA. Correlates of risk patterns and race/ethnicity among HIV-positive men who have sex with men. AIDS Behav 2007; 11:706–715.
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- Kajubi P, Kamya, MR, Raymond HF, Chen S, Rutherford GW, et al. Gay and bisexual men in Kampala, Uganda. AIDS Behav 2008; 12: 492–504.
- Kenneth H. Mayer. Sexually Transmitted Diseases in Men Who Have Sex With Men. Downloaded from http://cid.oxfordjournals.org/ by guest on October 14, 2013.
- Programme National de Lutte contre le SIDA. Plan National Stratégique du VIH-SIDA. 2011. Togo. Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, McIntyre J. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men's Study. AIDS Behav. 2011 ;15(3):626-634.
- MacKellar DA, Valleroy LA, Secura GM, et al. Two decades after vaccine license: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health. 2001; 91: 965–71.
- Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe HW. Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Lancet 2009, 374, 416-422.
References
REFERENCES
ONUSIDA. Rapport mondial sur l’épidémie mondiale de Sida 2012. Genève, 2012 ; 212p.
de Gruchy J, Lewin S. Ethics that exclude: the role of ethics committees in lesbian and gay health research in South Africa. Am J Public Health 2001; 91:865-868.
Gelfand M. Apparent absence of homosexuality and lesbianism in traditional Zimbabweans. Cent Afr J Med 1985; 31:137-138.
Orubuloye IO, Omoniyi OP, Shokunbi WA. Sexual networking, STDs and HIV/AIDS in four urban gaols in Nigeria. Health Transition Review 1995; 5 (suppl.):123-129.
Ehlers VJ, Zuyderduin A, Oosthuizen MJ. The well-being of gays, lesbians and bisexuals in Botswana. J Adv Nurs 2001; 35:848-856.
Teunis N. Same-Sex Sexuality in Africa: A Case Study from Senegal. AIDS and Behavior 2001; 5:173-182.
Henry E, Marcellin F, Yomb Y, Fugon L, Nemande S, Gueboguo C, Larmarange J, Trenado E, Eboko F. Factors associated with unprotected anal intercourse among men who have sex with men in Douala, Cameroon. Sex Transm Infect 2010; 86:136-140.
Wade AS, Larmarange J, Diop AK, Diop O, Gueye K, Marra A, Ndawinz J, Sene A, Enel C, Ba S, Niang Diallo P, Toure Kane NC, Mboup S, Desgrées du Loû A. Diminution des prises de risque chez les HSH au Sénégal entre 2004 et 2007. Projet ELIHoS, ANRS 12139. Communication orale – CISMA, 3-7 décembre 2008, Dakar, Sénégal. Prix Aides-ANRS.
Salganik MJ. Variance estimation, design effects and sample size calculations for respondent driven sampling. Journal of Urban Health. 2006; 83(7):98–112.
Malekinejad M, Johnston LG, Kendall C, Kerr L, Rifkin M, Rutherford G. Using respondent-driven sampling methodology for HIV biological and behavioral surveillance in international settings: a systematic review. AIDS and Behavior. 2008; 12(1):105-130.
Billong SC, Fokam J, Essi MJ, Nguefack-Tsague G, Billong E J, Papworth E, Nfetam Elat JB. Prévalence de l’Infection à VIH et comportements sexuels chez les Hommes Homosexuels dans la Ville de Yaoundé au Cameroun. Health Sci. Dis: Vol 14 (2) June 2013.
Grésenguet G,Séhounou J,Bassirou B, Longo JD, Malkin JE, Brogan T, Belec L. Voluntery HIV counselling and testing :experience among the sexually active population in Bangui, Central African Republic. J Acquir Immune Defic Syndr. 2002 Sep 1 ; 3 (1) :106-14.
UNFPA/Bangui et ICF International. Atlas de la République Centrafricaine sur les indicateurs du VIH et du SIDA : basé sur les résultats de l’Enquête à indicateurs multiples couplée avec la sérologie en RCA de 2010. Available at: http://dhsprogram.com/pubs/pdf/ATR10/ATR10.pdf (1st May 2014).
Merrigan M, Azeez A, Afolabi B et al. HIV prevalence and risk behaviours among men having sex with men in Nigeria. Sex Transm Infect. 2011; 87:65-70.
Scott KC, Philip S, Ahrens K, Kent CK, Klausner JD. High prevalence of gonococcal and chlamydial infection in men who have sex with men with newly diagnosed HIV infection: an opportunity for same day presumptive treatment. J Acquir Immune Defic Syndr 2008; 48:109–112.
Hall HI, Byers RH, Ling Q, Espinoza L. Racial/ethnic and age disparities in HIV prevalence and disease progression among men who have sex with men in the United States. Am J Public Health 2007; 97:1060–1066.
O’Leary A, Fisher HH, Purcell DW, Spikes PS, Gomez CA. Correlates of risk patterns and race/ethnicity among HIV-positive men who have sex with men. AIDS Behav 2007; 11:706–715.
Kassegne S, Vu L, Koumagnanou K, Koevie-Koudam NA. A profile of men who have sex with men (MSM) in Lome and Aneho cities, Togo: Challenges and opportunities for programming. 2012. Poster, IAC .
Wade AS, Larmarange J, Diop AK, Diop O, Gueye K, et al. Reduction in risk-taking behaviours among MSM in Senegal between 2004 and 2007 and prevalence of HIV and other STIs. ELIHoS Project, ANRS 12139. AIDS Care 2010 ; 22: 409–414.
Sanders EJ, Graham SM, Okuku HS, van der Elst EM, Muhaari A, et al. HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS 2007, 21: 2513–20.
Eduard- Sanders EJ, Graham S, Okuku HS, van der Elst EM, Muhaari A,Davies A, et al. Risk factors for HIV-1 infection and high HIV-1 incidence of men who have sex with men, in and around Mombasa, Kenya. Trop Med Int Health 2007; 12(suppl. 1):88 [Abstract O26-59].
Kajubi P, Kamya, MR, Raymond HF, Chen S, Rutherford GW, et al. Gay and bisexual men in Kampala, Uganda. AIDS Behav 2008; 12: 492–504.
Kenneth H. Mayer. Sexually Transmitted Diseases in Men Who Have Sex With Men. Downloaded from http://cid.oxfordjournals.org/ by guest on October 14, 2013.
Programme National de Lutte contre le SIDA. Plan National Stratégique du VIH-SIDA. 2011. Togo. Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, McIntyre J. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men's Study. AIDS Behav. 2011 ;15(3):626-634.
MacKellar DA, Valleroy LA, Secura GM, et al. Two decades after vaccine license: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health. 2001; 91: 965–71.
Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe HW. Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Lancet 2009, 374, 416-422.