Factors associated with viral suppression among HIV-positive Kenyan gay and bisexual men who have sex with men

ABSTRACT

The UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08–0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03–1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area.

KEYWORDS:

• Gay and bisexual men who have sex with men
• GBMSM
• MSM
• HIV
• viral suppression
• Kenya

Acknowledgments

The authors would like to thank the men who participated in the Anza Mapema study. Special thanks also go to all research and staff members of the Anza Mapema study and the Nyanza Reproductive Health Society including Leah Osula, Beatrice Achieng, George N’gety, Caroline Oketch, Violet Apondi, Evans Kottonya, Caroline Agwanda, Ted Aloo, George Oloo, Caroline Obare, and Edmon Obat, as well as the Community Advisory Board of the Anza Mapema study, the Men Against AIDS Youth Group Organization (MAAYGO), and the Nyanza, Rift Valley and Western Kenya LGBTI Network (NYARWEK). We thank the Centers for Disease Control and Prevention (U01GH000762) and the Evidence for HIV Prevention in Southern Africa (MM/EHPSA/NRHS/0515008) for providing financial support for the Anza Mapema study. Finally, we thank Dr. Ross Slotten and the Slotten Scholarship in Global Health at the University of Illinois at Chicago for supporting this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data sharing statement

Researchers requesting access to data/resources will be asked to submit a request in writing describing their qualifications including their certification by their local IRB, analytic plans and other uses of the data/resources, and plans to secure the confidentiality and safety of the data. They will be required to agree in writing that they will not share the data with others, will use it only for the research purpose(s) delineated and will return or destroy the data on completion.

In order to maintain protection of our participants’ privacy, no directly identifying information will be shared with outside investigators. Given the sensitive nature of the data we are collecting, including HIV diagnosis and same-sex behaviors, no public access file is available.

ORCID

Susan M. Graham http://orcid.org/0000-0001-7847-8686

Additional information

Funding

The Anza Mapema study was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of grant number U01GH000762; and by Evidence for HIV Prevention in Southern Africa (MM/EHPSA/NRHS/0515008).