Abstract
Background: In Uganda, female sex workers (FSWs) and their male partners are estimated to contribute 16% to new HIV infections. We assessed HIV prevalence and associated sexual behaviour risk among male regular partners of FSWs attending a peri-urban clinic in Kampala, Uganda.Methods: Between June 2012 - June 2017, we conducted a mixed methods cross-sectional study among male regular partners (aged ≥18 years old) of FSWs. The men were enrolled through FSWs attending a routine three monthly visit at a research clinic. Eligible and interested men were consented and counselled for parallel rapid HIV testing (Determine, Statpak, Unigold) on a serum sample. HIV-positive men were assessed and enrolled into HIV care and 3 monthly follow up. Data on socio-demographic, sexual behaviour (sexual relationships, condom and alcohol use), and clinical characteristics were collected. Multivariable logistic regression was used to identify factors associated with HIV sero-positivity. In-depth interviews were conducted to elicit information on participants’ knowledge of HIV and its prevention as well as sexual risk practices. Qualitative data was analysed using NVIVO 12.0 following thematic approach.Results: One hundred and sixty-two men were included in the analysis; mean age was 35 years old (SD± 8.43). The overall HIV sero-positivity was 65/162 (40%), of these 57/65 (88%) men were initiated on ART from the clinic. Ninety percent had no signs of sexually transmitted infections (STI), 119/162 (73%) reported not using a condom during last sexual intercourse. At adjusted analysis, HIV sero-positivity was less likely among men with no STI (aOR= 0.21; 95% CI: 0.06-0.70) and using a condom during last sexual intercourse (aOR = 0.39 (95% CI: 0.18-0.85). HIV sero-positivity was more likely among uncircumcised men (aOR=3.10; 95%CI: 1.49-6.45), those with multiple sexual relationships (two or more sexual partners] (aOR= 3.45; 95% CI: 1.59-7.51). Qualitative findings highlight that most participants were not consistently using condoms with FSWs; the main reason given was that they “trusted” their steady FSWs.Conclusions: HIV prevalence among male regular partners was associated with high risk sexual behaviour. Interventions targeting FSWs should be extended to their male regular partners, to enable their access to HIV care and support.
A study of patient attitudes towards decentralisation of HIV care in an urban clinic in South Africa