Using a social ecological framework to characterize the correlates of HIV among men who have sex with men in Lomé, Togo

ABSTRACT

In the mixed and concentrated HIV epidemics of West Africa, the relative disproportionate burden of HIV among men who have sex with men (MSM) compared to other reproductive-age men is higher than that observed in Southern and Eastern Africa. Our aim is to describe the correlates of HIV infection among MSM living in Lomé, Togo, using the Modified Social Ecological Model (MSEM). A total of 354 MSM ≥18 years of age were recruited using respondent driven sampling (RDS) for a cross-sectional survey in Lomé, Togo. Participants completed a structured questionnaire and were tested for HIV and syphilis. Statistical analyses included RDS-weighted proportions, bootstrapped confidence intervals (CI), and logistic regression models. Mean age of participants was 22 years; 71.5% were between 18 and 24 years. RDS-weighted HIV prevalence was 9.2% (95% CI=5.4–13.2). In RDS-adjusted (RDSa) bivariate analysis, HIV infection was associated with disclosure of sexual orientation to a family member, discriminatory remarks made by family members, forced sex, ever being blackmailed because of being MSM, community and social stigma and discrimination, and health service stigma and discrimination. In the multivariable model, HIV infection was associated with being 25 years or older (RDSa adjusted OR (aOR)=4.3, 95% CI=1.5–12.2), and having sex with a man before age 18 (RDSa aOR=0.3, 95% CI=0.1–0.9). HIV prevalence was more than seven times higher than that estimated among adults aged 15–49 living in Togo. Using the MSEM, network, community, and policy-level factors were associated with HIV infection among MSM in Lomé, Togo. Through the use of this flexible risk framework, a structured assessment of the multiple levels of HIV risk was characterized, highlighting the need for evidence-based and human-rights affirming combination HIV prevention and treatment programs that address these various risk levels for MSM in Lomé.

KEYWORDS:

• HIV
• Togo
• men who have sex with men
• epidemiology
• respondent driven sampling

Acknowledgements

The authors thank the men who participated in the study for their engagement and making this analysis possible. The authors concurrently thank the Togo Ministry of Health for approving and collaborating on this study as well as Erin Papworth and Ping-An Chen for their support in implementing the study. The authors also acknowledge the team at USAID and USAID West Africa, for their continued dedication and important role in the success of this study and similar studies across the region. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP).

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Horacio Ruiseñor-Escudero http://orcid.org/0000-0002-0367-6976

Additional information

Funding

The USAID and Project SEARCH, Task Order No.2, is funded by the US Agency for International Development under Contract No. GHH-I-00-0700,032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief.