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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.

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Mbeko Simaleko, M., Camengo Police, S. M., Longo, J. de D., Diemer, H. S. C., Piette, D., Gresenguet, G., & Perrine, H. (2020). Efficacité de la Combinaison d’Interventions de Prévention chez les Hommes Ayant des Rapports Sexuels avec des Hommes à Bangui (République Centrafricaine). HEALTH SCIENCES AND DISEASE, 21(7). https://doi.org/10.5281/hsd.v21i7.2168
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