High HIV risk behavior among men who have sex with men in Kigali, Rwanda: making the case for supportive prevention policy
A. Binagwaho1, J. Chapman2, A. Koleros3, Y. Delmont4, E. Pegurri5
1Ministry of Health, Kigali, Rwanda, 2Futures Group, Washington, United States, 3Futures Group, Kigali, Rwanda, 4MEASURE Evaluation, Kigali, Rwanda, 5UNAIDS, Kigali, Rwanda
Background: Rwanda has responded strongly to HIV/AIDS, but prevention among men who have sex with men (MSM) has not yet been addressed due to a strong cultural resistance to homosexuality and a lack of data showing the public health value of attending to the sexual health needs of this group. We conducted an exploratory study of HIV risk among MSM in Kigali to advocate for HIV programming. This was the first study of MSM in Rwanda.
Methods: This was a quantitative, cross-sectional study using a snowball sampling strategy, with a double-incentive structure, to recruit 100 MSM aged 18 or over to complete an interviewer-administered questionnaire. Basic summative and comparative statistics were applied. This study was designed and overseen by a Management Committee including MSM. Ethics approval was gained from both Rwandan and US ethics review boards.
Results: Ninety-eight MSM aged 18-52 participated. Eighty-eight respondents reported anal sex with a man and one-quarter reported sex with a woman in the last 12 months. Thirty-four respondents reported no prior condom use with males or females. Selling and buying sex from men in the last 12 months was reported by 25 and 20 respondents respectively, and 14 men reported buying sex from women in the last 12 months. One in five respondents reported mistreatment due to their sexuality; 17 men reported a history of forced sex and eight within the last 12 months. Fifty-five respondents reported a previous HIV test for which they obtained their results.
Conclusions: Results suggest MSM in Kigali require specific HIV/STI prevention services/support. Specific recommendations include:
- Carry out HIV/STI awareness-raising campaigns in a manner that maximizes privacy and safety and avoids stigma and discrimination.
- Use HIV testing as a gateway into MSM-friendly care and support services.
- Distribute safe sex commodities, e.g. condoms and appropriate lubricants.