A decade of research involving men who have sex with men in sub-Saharan Africa: Current knowledge and future directions

Figures & data

Table 1. MSM research in Africa: study characteristics, participant information, and biological and behavioral measurements.

	Study characteristics					Participant information		Biological measurements			Behavioral measurements
Location	Year(s) of study	Source	Type of study	Number of surveys	Recruitment method	Number of participants	Median age	HIV prevalence % (95% CI)	HIV incidence % (95% CI)	STI tests performed	Reported multiple male sex partners % (time period)	Reported consistent condom use % (time period)	Reported payment for sex or sex work % (time period)
Botswana
Gaborone	2008	Baral et al. (2009)	Bio-behavioral, cross-sectional	1	Snowball	117	24	19.7 (12.5–26.9)	–	–	13 (≥5, past 6 months)	NR	NR
Cameroon
Douala	2008	Henry, Marcellin, Yomb, Fugon, Nemande, Gueboguo, et al. (2010)	Behavioral, cross-sectional	1	Snowball	168	26	–	–	–	65 (past 6 months)	43 (past 6 months)	NR
Cote D'Ivoire
Abidjan	2007–2008	Vuylsteke et al. (2012)	Bio-behavioral, cross-sectional	1	Snowball	96	27	50.0 (39.6–60.4)	–	CT,NG,TV	NR	69 (‘always’)^a	100 (NR)
Kenya
Nairobi	2004	Onyango-Ouma, Birungi and Geibel (2005)	Behavioral, cross-sectional	1	Snowball	500	26	–	–	–	79 (past 12 months)	58 (past 12 months)	52 (past 12 months)
Mombasa, Nairobi	2005–2008	Price et al. (2012)	Cohort, vaccine preparedness	NA	Volunteer cohort	327	NR	–	6.8 (5.0–9.3)	TP	NR	NR	NR
Mombasa	2006	Sanders et al. (2007)	Cohort, vaccine preparedness	NA	Volunteer cohort	285	27 to 28^b	24.5 (19.7–30.7)	–	TP	NR	18 (past 3 months)	74 (past 3 months)
Mombasa	2006–2008	Geibel et al. (2012)	Intervention, cross-sectional	2	Time-location	425/442	26/23	–	–	–	74/63 (past 7 days)	36/50 (past month)	87/81 (past 7 days)
Nairobi	2010	Geibel et al. (2011)	Bio-behavioral, cross-sectional	1	RDS	563	28	18.2 (13.1–23.6)	–	TP,CT, NG	60 (past 12 months)^c	25 (past 1 month)	40 (past 2 months)
Kisumu	2010	Plenty et al. (2011)	Bio-behavioral, cross-sectional	1	RDS	415	21	11.1 (7.5–15.9)	–	TP, CT, NG, HSV,TV	92 (past 12 months)	40 (past 1 month)	67 (past 2 months)
Lesotho
NR	2009	Baral, Adams, Lebona, Kaibe, Letsie, Tshehlo, et al. (2011)^a	Bio-behavioral, cross-sectional	1	Snowball	252	26.3 (mean)	–	–	–	28 (≥5, past 12 months)	NR	NR
Malawi
Blantyre, Lilongwe	2008	Baral et al. (2009)	Bio-behavioral, cross-sectional	1	Snowball	201	25	21.4 (15.7–27.1)	–	–	18 (≥5, past 6 months)	NR	NR
Nambia
Windhoek	2008	Baral et al. (2009)	Bio-behavioral, cross-sectional	1	Snowball	218	23	12.4 (8.1–16.8)	–	–	15 (≥5, past 6 months)	NR	NR
Nigeria
Lagos	2007	Merrigan et al. (2011)	Bio-behavioral, cross-sectional	1	RDS	293	22	17.4 (12.3–23.2)	–	TP	NR	46 (past 6 months)^d	24 (past 6 months)
Kano	2007	Merrigan et al. (2011)	Bio-behavioral, cross-sectional	1	RDS	293	22	9.3 (5.7–15.4)	–	TP	NR	24 (past 6 months)^d	36 (past 6 months)
Cross River	2007	Merrigan et al. (2011)	Bio-behavioral, cross-sectional	1	RDS	293	22	1.1 (0.1–2.2)	–	TP	NR	30 (past 6 months)^d	35 (past 6 months)
Abuja	2008	Strömdahl, Onigbanjo Williams, Eziefule, Emmanuel, Iwuagwu, Anene, et al. (2012)	Behavioral, cross-sectional	1	Snowball	297	26	–	–	–	28 (≥5, past 6 months)^e	53 (past 6 months)	NR
Lagos	2010	FMOH (2011)	Bio-behavioral, cross-sectional	1	RDS	215	NR	15.8 (NR)	–	–	79 (past 6 months)^f	43 (past 6 months)^g	37 (past 6 months)
Kano	2010	FMOH (2011)	Bio-behavioral, cross-sectional	1	RDS	299	NR	8.3 (NR)	–	–	86 (past 6 months)^f	7 (past 6 months)^g	64 (past 6 months)
Cross River	2010	FMOH (2011)	Bio-behavioral, cross-sectional	1	RDS	313	NR	2.4 (NR)	–	–	82 (past 6 months)^f	16 (past 6 months)^g	18 (past 6 months)
Federal Capital Territory	2010	FMOH (2011)	Bio-behavioral, cross-sectional	1	RDS	199	NR	37.6 (NR)	–	–	78 (past 6 months)^f	49 (past 6 months)^g	39 (past 6 months)
Kaduna	2010	FMOH (2011)	Bio-behavioral, cross-sectional	1	RDS	286	NR	16.2 (NR)	–	–	84 (past 6 months)^f	40 (past 6 months)^g	32 (past 6 months)
Oyo	2010	FMOH (2011)	Bio-behavioral, cross-sectional	1	RDS	233	NR	3.3 (NR)	–	–	70 (past 6 months)^f	48 (past 6 months)^g	26 (past 6 months)
Rwanda
Kigali	2008–2009	Binagwaho, Chapman, Koleros, Utazirubanda and Pegurri (2009)	Behavioral, cross-sectional	1	Snowball	99	24	–	–	–	65 (past 12 months)	37 (past 12 months)	10 (past 12 months)
Senegal
Dakar	2001	Niang et al. (2003)	Behavioral, cross-sectional	1	Snowball	250	25	–	–	–	21 (past month)	27 (past month)	9 (last sex)
Dakar	2003/2005	Geibel et al. (2010)	Intervention, cross-sectional	2	Snowball	258/290	27/26	–	–	–	26/27 (past month)	52/58 (past 12 months)	26/17 (past month)
Dakar, Theis, Mbour, Kaolack, Saint-Louis	2004	Wade et al. (2005)	Bio-behavioral, cross-sectional	1	Snowball	463	24	21.5 (17.8–25.6)	–	TP, CT, NG, HSV	59 (≥3, past 12 months)	58 (past 12 months)^f	23 (past month)
Dakar, Theis, Mbour, Saint-Louis	2007	Wade et al. (2010)	Bio-behavioral, cross-sectional	1	Snowball	501	NR	21.8 (18.3–25.7)	–	TP, CT, NG, HSV	NR	75 (past month)^f	27 (past month)
South Africa
Gauteng, Kwazulu-Natal, Western Cape	2003-2005	Sandfort, Nel, Rich, Reddy and Yi  (2008)	Behavioral, cross-sectional	1	Snowball	1045	29.9 (mean)	–	–	–	NR	NR	NR
Gauteng province	2004–2005	Lane et al. (2008)	Behavioral, cross-sectional	1	Snowball	199	NR	–	–	–	NR	41 (past 6 months)	NR
Pretoria	2008	Knox, Sandfort, Yi, Reddy and Maimane (2011)	Behavioral, cross-sectional	1	Snowball	300	26.1 (mean)	–	–	–	NR	NR	NR
Soweto	2008	Lane et al. (2009)	Bio-behavioral, cross-sectional	1	RDS	363	23	13.2 (12.4–13.9)	–	–	NR	28 (past 6 months)	49 (ever)^h
Johannesburg, Durban^c	2008	Rispel et al. (2011)	Bio-behavioral, cross-sectional	1	RDS^i	204	22	49.5 (42.5–56.5),
								27.5 (17.0–38.1)	–	–	NR	49 (past 12 months)	NR
Cape Town	2008	Burrell, Mark, Grant, Wood and Bekker (2010)	Bio-behavioral, cross-sectional	1	Snowball	542	27	10.4 (NR)	–	–	NR	54 (past 12 months)	6 (past 12 months)
Cape Town peri-urban area	2009	Baral, Burrell, Sheibe, Brown, Beyrer and Bekker (2011)^b	Bio-behavioral, cross-sectional	1	Snowball	200	24	25.5 (NR)	–	–	18 (>5, past 6 months)	52 (‘always’)	12 (NR)
Pretoria	2009	Tun et al. (2012)	Behavioral, cross-sectional	1	RDS	307	24	–	–	–	39 (past 2 months)	80 (past 2 months)	18 (past 6 months)
Swaziland
NR	2011	Baral (2011)	Behavioral, cross-sectional	1	RDS	328	23	–	–	–	67 (past 12 months)	51 (NR ‘always’)	26 (past 12 months)
Tanzania
Ugunja (Zanzibar)	2007	Dahoma et al. (2011)	Bio-behavioral, cross-sectional	1	RDS	509	28	12.3 (8.7–16.3)	–	TP,HBV,HCV	33 (past month) (f,g)	9 (past month) (f,g)	59 (ever)
Uganda
Kampala	2004	Kajubi, Kamya, Raymond, Chen, Rutherford and Mandel (2008)	Behavioral, cross-sectional	1	RDS	224	NR	–	–	–	82 (lifetime)	63 (past 6 months)	27 (ever)
Kampala	2009	Hladik et al. (2012)	Bio-behavioral, cross-sectional	1	RDS	295	25	13.7 (7.9–20.1)	–	TP,CT, NG	47 (>10, past 6 months)	NR	NR
CI, confidence interval; NR, not reported; TP, Treponema pallidum; CT, Chlamydia trachomatis; NG, Nesseriah gonnorhea; HSV, herpes simplex virus type 2; HBV, hepatitis B virus; HCV, hepatitis C virus; FMOH, Federal Ministry of Health; RDS, respondent-driven sampling.
^aWith paying clients.
^bResults were disaggregated by MSM only and MSM who have sex with both men and women.
^cRegular male partners only.
^dNon-commercial anal sex only.
^eReported both male and female partners.
^fWith insertive male partners only.
^gNon-paying partners only.
^hReported as transactional and not necessarily formal sex work.
^iAuthors did not adjust analysis for RDS; HIV results were disaggregated by city, other results were combined.

Fig. 1. MSM HIV prevalence rates reported by city or area-specific bio-behavioral surveys in sub-Saharan Africa. *Source: UNAIDS (2010).

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