Prevalence of STI symptoms and high levels of stigma in STI healthcare among men who have sex with men in Dar es Salaam, Tanzania: a respondent-driven sampling study

Symptoms of sexually transmitted infections (STIs), whether they are presented for treatment or diagnosis, and how they are received by the clinician where they are presented, may be concomitants of stigma associated with homosexuality in homophobic climates. We analyzed respondent-driven sampling data from a study on 200 young men who have sex with men (MSM) in Dar es Salaam, Tanzania to examine sample prevalence, treatment and clinician response to 10 symptoms potentially associated with STIs. Survey measures included 10 self-reported STI symptoms, further specified according to location (genital, anal, oral), further specified according to place of diagnosis, place of, treatment whether there was pharmacy treatment or self-medication, healthcare worker (HCW) inquiries about source of infection and whether the HCW was polite. Most common symptoms reported were genital pain, burning urination, genital itching/burning, penile discharge, and groin swelling. Anal symptoms had the lowest proportion of treatment at public clinics and among the highest proportion of pharmacy treatment; anal sores had the highest proportion of self-medication. HCWs were reported as not being polite in response to 71–90% of the symptoms, (median = 82%). The findings suggest that stigma and negative HCW response are barriers to public clinic treatment for MSM in Tanzania and that these may have implications for both STI treatment and the HIV cascade.

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Social networks of men who have sex with men: a study of recruitment chains using Respondent Driven Sampling in Salvador, Bahia State, Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00085614 ◽

2015 ◽

Vol 31 (suppl 1) ◽

pp. 170-181 ◽

Cited By ~ 5

Author(s):

Sandra Mara Silva Brignol ◽

Inês Dourado ◽

Leila Denise Amorim ◽

José Garcia Vivas Miranda ◽

Lígia R. F. S. Kerr

Keyword(s):

Hiv Transmission ◽

Sexual Contact ◽

Demographic Characteristics ◽

Respondent Driven Sampling ◽

Friendship Networks ◽

Sexually Transmitted ◽

Positive Attitudes ◽

Number Of Sexual Partners ◽

Sex With Men ◽

Networks Structure

Abstract Social and sexual contact networks between men who have sex with men (MSM) play an important role in understanding the transmission of HIV and other sexually transmitted infections (STIs). In Salvador (Bahia State, Brazil), one of the cities in the survey Behavior, Attitudes, Practices, and Prevalence of HIV and Syphilis among Men Who Have Sex with Men in 10 Brazilian Cities, data were collected in 2008/2009 from a sample of 383 MSM using Respondent Driven Sampling (RDS). Network analysis was used to study friendship networks and sexual partner networks. The study also focused on the association between the number of links (degree) and the number of sexual partners, in addition to socio-demographic characteristics. The networks’ structure potentially facilitates HIV transmission. However, the same networks can also be used to spread messages on STI/HIV prevention, since the proximity and similarity of MSM in these networks can encourage behavior change and positive attitudes towards prevention.

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HIV prevalence among men who have sex with men following the implementation of the HIV preventive guideline in Tanzania: respondent-driven sampling survey

BMJ Open ◽

10.1136/bmjopen-2019-036460 ◽

2020 ◽

Vol 10 (10) ◽

pp. e036460

Author(s):

Mwijage Alexander Ishungisa ◽

Kare Moen ◽

Germana Leyna ◽

Neema Makyao ◽

Angela Ramadhan ◽

...

Keyword(s):

Risk Factors ◽

Hiv Infection ◽

Primary Outcome ◽

Behavioural Change ◽

Dar Es Salaam ◽

Hiv Prevalence ◽

Respondent Driven Sampling ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Sex With Men

ObjectivesTo estimate HIV prevalence and associated risk factors among men who have sex with men (MSM) in Dar es Salaam, Tanzania following the implementation of the national comprehensive package of HIV interventions for key population (CHIP).DesignA cross-sectional survey using respondent-driven sampling.SettingDar es Salaam, Tanzania’s largest city.ParticipantsMen who occasionally or regularly have sex with another man, aged 18 years and above and living in Dar es Salaam city at least 6 months preceding the study.Primary outcome measureHIV prevalence was the primary outcome. Independent risk factors for HIV infection were examined using weighted logistics regression modelling.ResultsA total of 777 MSM with a mean age of 26 years took part in the study. The weighted HIV prevalence was 8.3% (95% CI: 6.3%–10.9%) as compared with 22.3% (95% CI: 18.7%–26.4%) observed in a similar survey in 2014. Half of the participants had had sex with more than two partners in the month preceding the survey. Among those who had engaged in transactional sex, 80% had used a condom during last anal sex with a paying partner. Participants aged 25 and above had four times higher odds of being infected than those aged 15–19 years. HIV infection was associated with multiple sexual partnerships (adjusted OR/AOR, 3.0; 95% CI: 1.8–12.0), not having used condom during last sex with non-paying partner (AOR, 4.1; 95% CI: 1.4–7.8) and ever having engaged in group sex (AOR, 3.4; 95% CI: 1.7–3.6).ConclusionHIV prevalence among MSM in Dar es Salaam has decreased by more than a half over the past 5 years, coinciding with implementation of the CHIP. It is nonetheless two times as high as that of men in the general population. To achieve the 2030 goal, behavioural change interventions and roll out of new intervention measures such as pre-exposure prophylaxis are urgently needed.

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Example A: Using online respondent-driven sampling among men who have sex with men in Vietnam

European Journal of Public Health ◽

10.1093/eurpub/ckz185.532 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A E Thorson ◽

L E C Rocha

Keyword(s):

Rural Areas ◽

Controlled Trial ◽

Risk Behaviour ◽

Incidence Rates ◽

Respondent Driven Sampling ◽

Sexually Transmitted ◽

Initial Intervention ◽

Sex With Men ◽

Randomised Controlled ◽

Double Blinded

Abstract Men who have sex with men (MSM) represent a key population at enhanced risk of sexually transmitted infections including HIV. HIV incidence rates are increasing amongst MSM in Vietnam. The last prevalence rates estimates range between 4% and 12% in major cities (2014). High rates of syphilis, chlamydia and gonorrhoea have also been reported, including drug resistant gonorrhoea. MSM face a strong cultural stigma, especially predominant in rural areas, which make them hard-to-reach in relation to preventive activities. In this context, respondent-driven sampling (RDS) becomes an efficient solution for sampling as well as for testing health promotive interventions. The high Internet penetration rate makes web-based RDS to enable sampling as well as testing risk reduction interventions, an appealing alternative to reduce costs, increase data reliability and to facilitate project management of complex study designs. In this talk, we will present and discuss the implementation of a nation-wide webRDS study of MSM in Vietnam aiming to collect self-reported sexual health and risk behaviour information. Using the same web-RDS system, we combine RDS with a double-blinded randomised controlled trial to implement an online intervention based on the participants own responses to encourage self-reflection. The system allows us to follow up respondents for several months after the initial intervention to check the consequences of the intervention on individual behaviour over time.

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"My friends would believe my word": appropriateness and acceptability of respondent-driven sampling in recruiting young tertiary student men who have sex with men for HIV/STI research in Nairobi, Kenya

10.1101/2021.10.21.21265250 ◽

2021 ◽

Author(s):

Samuel Waweru Mwaniki ◽

Peter Mwenda Kaberia ◽

Peter Mwangi Mugo ◽

Thesla Palanee-Phillips

Keyword(s):

Sampling Method ◽

Service Providers ◽

Qualitative Interviews ◽

Easy Access ◽

Sex Behavior ◽

Respondent Driven Sampling ◽

Sexually Transmitted ◽

Implementation Challenges ◽

Tertiary Student ◽

Sex With Men

Background: Tertiary student men who have sex with men (TSMSM) may engage in behaviors that increase their risk of infection with human immunodeficiency virus (HIV) and sexually transmitted infections (STI). Respondent-driven sampling (RDS) has become a popular method for discretely recruiting marginalized populations into HIV/STI research. We conducted formative research to assess appropriateness and acceptability of RDS in recruiting TSMSM into a prospective HIV/STI bio-behavioral survey in Nairobi, Kenya. Methods: Between September and October 2020, semi-structured qualitative interviews were held with service providers from organizations that serve MSM (n=3), and TSMSM (n=13). Interviews explored social networks of TSMSM, acceptability of using RDS as a sampling method, potential RDS implementation challenges, and proposed solutions to these challenges. Interviews were done in English, audio-recorded and transcribed then analyzed thematically using NVivo version 11. Results: Service providers reflected that TSMSM had large though concealed networks, thus making RDS an appropriate sampling method. Risk of ineligible persons attempting to participate due to the associated double incentive was noted, and using student identification documents as part of eligibility screening recommended. TSMSM also perceived RDS to be an acceptable strategy based on their large social network sizes (10-40), and the trust amongst themselves. TSMSM were concerned about participating due to the risk of being outed as MSM, seeing as same sex behavior is criminalized in Kenya, and hence emphasized that researchers needed to assure them of their confidentiality, and include MSM as part of the study team to encourage participation. TSMSM suggested coupons should indicate value of reimbursement, be pocket-sized and placed in an envelope to avoid loss, and provide directions to and contacts of the survey site for easy access. Conclusion: RDS was perceived as both an appropriate and acceptable sampling method. Anticipated challenges of RDS implementation were highlighted, and possible solutions to these challenges suggested.

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The New York State Department of Health is Making Awards to New York to Invest $1.88 Million to Prevent HIV and Other Sexually Transmitted Diseases in Gay and Other Men Who Have Sex with Men

PsycEXTRA Dataset ◽

10.1037/e590952010-001 ◽

2010 ◽

Keyword(s):

New York ◽

Sexually Transmitted Diseases ◽

New York State ◽

State Department ◽

York State Department ◽

York State ◽

Sexually Transmitted ◽

Department Of Health ◽

Sex With Men

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Faculty of 1000 evaluation for Beyond Anal Sex: Sexual Practices of Men Who Have Sex With Men and Associations With HIV and Other Sexually Transmitted Infections.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.726132536.793516027 ◽

2016 ◽

Author(s):

Chiara Simonelli ◽

Stefano Eleuteri ◽

Roberta Rossi

Keyword(s):

Sexually Transmitted Infections ◽

Sexual Practices ◽

Anal Sex ◽

Sexually Transmitted ◽

Sex With Men

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Prevalence and health care seeking behaviour for sexually transmitted infections among in-school adolescents in Ado-Ekiti, South-Western Nigeria

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0011 ◽

2016 ◽

Vol 29 (6) ◽

Author(s):

Patrick T. Adegun ◽

Eyitope O. Amu

Keyword(s):

Health Care ◽

Sexually Transmitted Infections ◽

Health Care Seeking ◽

Care Seeking ◽

Self Medication ◽

Cross Sectional ◽

Sexually Transmitted ◽

Stomach Pain ◽

Health Care Seeking Behaviour ◽

Care Seeking Behaviour

Abstract Background: In Nigeria, adolescents are highly vulnerable to sexually transmitted infections (STIs) which have the potential of jeopardising their future reproductive lives if poorly treated. Objective: To determine the prevalence and health care seeking behaviour for STIs among secondary school adolescents in Ado, South-Western Nigeria. Subjects: Male and female adolescents aged 10–19 years. Methods: The study employed a descriptive cross-sectional design. A pre-tested, self-administered, semi-structured questionnaire was used to elicit information from 560 adolescents selected from public and private secondary schools in Ado Local Government Area (LGA) of Ekiti State, using a multistage sampling technique. The data were analyzed using descriptive and inferential statistics. Analyzed data were presented in the form of tables and charts. Results: Two hundred and fifty-one (47.1%) respondents had previous symptoms of STIs. The commonest symptoms among the males were penile discharge (30.5%), painful micturition (30.5%) and stomach pain with swollen testes (25.4%). The commonest symptoms among the females were genital itching (27.6%), genital sores (14.1%) and painful micturition (13.1%). Only 26.7% sought treatment from a health facility; 37.0% did nothing; 15.9% went to patent medicine stores, 10.0% used herbs; the rest did self-medication or prayed. Conclusion: The prevalence of STI symptoms among adolescents in Ado-Ekiti is high but their health care seeking behaviour is poor. Health education about the dangers of untreated STI and the importance of seeking treatment early, targeted at adolescents, should be intensified.

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Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia

BMJ Open ◽

10.1136/bmjopen-2020-037608 ◽

2020 ◽

Vol 10 (11) ◽

pp. e037608

Author(s):

Mario Martín-Sánchez ◽

Richard Case ◽

Christopher Fairley ◽

Jane S Hocking ◽

Catriona Bradshaw ◽

...

Keyword(s):

Health Centre ◽

Cross Sectional Study ◽

Sexual Practices ◽

Sectional Study ◽

Anal Sex ◽

Cross Sectional ◽

Men And Women ◽

Sexually Transmitted ◽

Receptive Anal Sex ◽

Sex With Men

ObjectivesIn the 2010s, there has been an increase in sexually transmitted infections (STI) in men who have sex with men (MSM) in Australia, and since 2015 also in urban heterosexuals. Men who have sex with both men and women (MSMW) have characteristics that may differ from both men who have sex with men only (MSMO) and heterosexual men. We aimed to compare the sexual practices and the trends in HIV/STI positivity between MSMO and MSMW.DesignRepeated cross-sectional study.SettingA sexual health centre in Melbourne, Australia.ParticipantsMSM aged 18 years and above who attended the Melbourne Sexual Health Centre for the first time between 2011 and 2018. This includes 12 795 MSMO and 1979 MSMW.Primary outcome measuresDemographic characterics, sexual practices and HIV/STI positivity.ResultsCompared with MSMW, MSMO were more likely to practice anal sex and to have condomless receptive anal sex with casual male partners, and less likely to have a current regular relationship. Over the 8-year period, there was an increase in condomless receptive anal sex with casual male partners for both groups (MSMO: from 46.2% to 63.3%, ptrend <0.001; MSMW: from 41.3% to 57.9%, ptrend=0.011). Syphilis positivity increased in MSMO (from 5.5% to 7.9%, ptrend=0.012) and MSMW (from 0.9% to 6.4%, ptrend=0.004) and HIV remained stable. Gonorrhoea increased among MSMO from 2011 to 2014 (from 6.7% to 9.6%, ptrend=0.002), and remained stable from 2015 to 2018. MSMO had higher odds of testing positive for gonorrhoea (adjusted OR (aOR) 1.36, 95% CI 1.13 to 1.64), chlamydia (aOR 1.39, 95% CI 1.16 to 1.67), syphilis (aOR 1.74, 95% CI 1.37 to 2.22) and HIV (aOR 4.60, 95% CI 2.43 to 8.70) than MSMW.ConclusionsMSMW have overall lower condomless sex and lower HIV/STI positivity. In the last years, changes in sexual practices in MSM have affected both MSMW and MSMO leading to an increased STI risk.

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Testing as Prevention of Resistance in Bacteria Causing Sexually Transmitted Infections—A Population-Based Model for Germany

Antibiotics ◽

10.3390/antibiotics10080929 ◽

2021 ◽

Vol 10 (8) ◽

pp. 929

Author(s):

Andreas Hahn ◽

Hagen Frickmann ◽

Ulrike Loderstädt

Keyword(s):

Sexually Transmitted Infections ◽

False Negative ◽

Population Based ◽

Sexually Transmitted ◽

Test Characteristics ◽

Antibiotic Drugs ◽

False Positive Signal ◽

Antibiotic Drug ◽

Potential Applicability ◽

Sex With Men

Prescribed antibiotic treatments which do not match the therapeutic requirements of potentially co-existing undetected sexually transmitted infections (STIs) can facilitate the selection of antibiotic-drug-resistant clones. To reduce this risk, this modelling assessed the potential applicability of reliable rapid molecular test assays targeting bacterial STI prior to the prescription of antibiotic drugs. The modelling was based on the prevalence of three bacterial STIs in German heterosexual and men-having-sex-with-men (MSM) populations, as well as on reported test characteristics of respective assays. In the case of the application of rapid molecular STI assays for screening, the numbers needed to test in order to correctly identify any of the included bacterial STIs ranged from 103 to 104 for the heterosexual population and from 5 to 14 for the MSM population. The number needed to harm—defined as getting a false negative result for any of the STIs and a false positive signal for another one, potentially leading to an even more inappropriate adaptation of antibiotic therapy than without any STI screening—was at least 208,995 for the heterosexuals and 16,977 for the MSM. Therefore, the screening approach may indeed be suitable to avoid unnecessary selective pressure on bacterial causes of sexually transmitted infections.

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