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Characterizing the relationship between same sex policies and HIV testing history among gay men and other men who have sex with men across 10 countries in sub-Saharan Africa

Title
Characterizing the relationship between same sex policies and HIV testing history among gay men and other men who have sex with men across 10 countries in sub-Saharan Africa
Presenter
Carrie Lyons
Authors
C. Lyons * (1), J.O. Twahirwa Rwema (1), K. Makofane (2), D. Diouf (3), I. Ba (3), S. Kouanda (4), A. Simplice (5), A. Kouame (6), Z. Mnisi (7), U. Tamoufe (8), B. Cham (9), M. Aliu Djaló (10), R. Nowak (11), T. Crowell (12), E. Karita (13), C. Beyrer (1), S. Baral (1), E.-P. Obodou (14)
Institutions
(1) Johns Hopkins School of Public Health, Department of Epidemiology, Baltimore, United States, (2) Harvard School of Public Health, Boston, United States, (3) Enda Santé, Dakar, Senegal, (4) Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso, (5) ONG Arc-en-Ciel, Lome, Togo, (6) Ministère de la Sante et de l'Hygiène Publique, Abidjan, Cote D''Ivoire, (7) Ministry of Health, Health Research Department, Mbabane, Eswatini, (8) Metabiota, Yaounde, Cameroon, (9) Actionaid, Banjul, Gambia, (10) Enda Santé, Bissau, Guinea-Bissau, (11) University of Maryland School of Medicine, Institute of Human Virology, Baltimore, United States, (12) Walter Reed Army Institute of Research, U.S. Military HIV Research Program, Silver Spring, United States, (13) Projet San Francisco, Kigali, Rwanda, (14) Enda Santé, Abidjan, Cote D''Ivoire

BACKGROUND: Gay men other men who have sex with men (GMSM) are disproportionately affected by HIV across epidemic settings in Sub-Saharan Africa. Systematic reviews have evaluated the association of legislation and engagement in HIV testing services, however, there have been limited opportunities to assess these relationships using individual-level data across settings. In response, this study uses individual-data from GMSM in 10 countries across Sub-Saharan Africa to examine the relationship between HIV testing and the legal environment.
METHODS: Respondent driven sampling was used to recruit 8049 GMSM between 2011-2018 in Burkina Faso, Cameroon, Côte d'Ivoire, Gambia, Guinea-Bissau, Nigeria, Senegal, eSwatini, Rwanda, and Togo. Interviewer-administered socio-behavioral questionnaires and biological testing for HIV were conducted. Same-sex policy categorization was based on ILGA defined legal approach: Not criminalized and not protected; criminalized (< 8 years imprisonment); and severely criminalized (>10 years imprisonment). Poisson regression with robust variance was used to measure the association between legal barriers and HIV testing history and awareness of HIV status among individuals living with HIV. Models adjusted for demographic characteristics and were clustered by country, site, and recruitment seed.
RESULTS: Overall, 39.3% of individuals recruited were living in non-criminalized settings, 38.0% in criminalized settings, and 22.7% in severely criminalized settings. Individuals in criminalized (aPR:0.88:95%CI:0.82-0.95) and severely criminalized (aPR:0.63;95%CI:0.52-0.76) settings showed decreased history of HIV testing compared to non-criminalized settings (Table 1). GMSM in criminalized (aPR:0.68; 95%CI:0.48-0.96) and severely criminalized (aPR:0.16;95%CI:0.06-0.64) settings showed decreased awareness of HIV positive status compared to non-criminalized settings.
CONCLUSIONS: Consistently, legal barriers were associated with limited history of HIV testing, and limited awareness of HIV status among GMSM. The magnitude of these relationships was strongest in the most punitive settings. These results provide empiric data of how legal barriers impede HIV outcomes among GMSM across Sub-Saharan Africa.