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      Uptake of HIV self‐testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM

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          Abstract

          Introduction

          HIV self‐testing ( HIVST) offers an alternative to facility‐based HIV testing services, particularly for populations such as men who have sex with men ( MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders ( KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment.

          Methods

          A cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick ® HIV antibody test) distribution to eligible MSM followed by a 3‐month follow‐up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits.

          Results

          The median age of the participants was 25 years, 88.7% were literate and 17.9% were first‐time testers. Of the 257 participants (80.7% retention) who completed the three‐month follow‐up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self‐reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three‐month survey.

          Conclusions

          HIVST distribution through KOLs was feasible and oral self‐testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self‐testing, this study showed that linkage to treatment can be achieved with active follow‐up and access to a trusted MSM‐friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.

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          Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana.

          Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.
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            Improved Inference for Respondent-Driven Sampling Data With Application to HIV Prevalence Estimation

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              Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland

              Introduction Same-sex practices and orientation are both stigmatized and criminalized in many countries across sub-Saharan Africa. This study aimed to assess the relationship of fear of seeking healthcare and disclosure of same-sex practices among a sample of men who have sex with men (MSM) in Swaziland with demographic, socio-economic and behavioural determinants. Methods Three hundred and twenty-three men who reported having had anal sex with a man in the past year were recruited using respondent-driven sampling and administered a structured survey instrument. Asymptotically unbiased estimates of prevalence of stigma and human rights abuses generated using the RDSII estimator are reported with bootstrapped confidence intervals (CIs). Weighted simple and multiple logistic regressions of fear of seeking healthcare and disclosure of same-sex practices to a healthcare provider with demographic, social and behavioural variables are reported. Results Stigma was common, including 61.7% (95% CI=54.0–69.0%) reporting fear of seeking healthcare, 44.1% (95% CI=36.2–51.3%) any enacted stigma and 73.9% (95% CI=67.7–80.1%) any perceived social stigma (family, friends). Ever disclosing sexual practices with other men to healthcare providers was low (25.6%, 95% CI=19.2–32.1%). In multiple logistic regression, fear of seeking healthcare was significantly associated with: having experienced legal discrimination as a result of sexual orientation or practice (aOR=1.9, 95% CI=1.1–3.4), having felt like you wanted to end your life (aOR=2.0, 95% CI=1.2–3.4), having been raped (aOR=11.0, 95% CI=1.4–84.4), finding it very difficult to insist on condom use when a male partner does not want to use a condom (aOR=2.1, 95% CI=1.0–4.1) and having a non-Swazi nationality at birth (aOR=0.18, 95% CI=0.05–0.68). In multiple logistic regression, disclosure of same-sex practices to a healthcare provider was significantly associated with: having completed secondary education or more (aOR=5.1, 95% CI=2.5–10.3), having used a condom with last casual male sexual partner (aOR=2.4, 95% CI=1.0–5.7) and having felt like you wanted to end your life (aOR=2.1, 95% CI=1.2–3.8). Conclusions MSM in Swaziland report high levels of stigma and discrimination. The observed associations can inform structural interventions to increase healthcare seeking and disclosure of sexual practices to healthcare workers, facilitating enhanced behavioural and biomedical HIV-prevention approaches among MSM in Swaziland.
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                Author and article information

                Contributors
                wtun@popcouncil.org
                Journal
                J Int AIDS Soc
                J Int AIDS Soc
                10.1002/(ISSN)1758-2652
                JIA2
                Journal of the International AIDS Society
                John Wiley and Sons Inc. (Hoboken )
                1758-2652
                22 July 2018
                July 2018
                : 21
                : Suppl Suppl 5 , Optimizing the impact of key population programming across the HIV cascade, Guest Editors: R. Cameron Wolf, Trista Bingham, Greg Millett, Rose Wilcher ( doiID: 10.1002/jia2.2018.21.issue-S5 )
                Affiliations
                [ 1 ] HIV and AIDS Program Population Council Washington DC USA
                [ 2 ] HIV and AIDS Program Population Council Abuja Nigeria
                [ 3 ] College of Medicine University of Lagos Lagos Nigeria
                [ 4 ] HIV and AIDS Program Population Council Lagos Nigeria
                Author notes
                [* ] Corresponding author: Waimar Tun, 4301 Connecticut Avenue, NW, Suite 280, Washington, DC 20008, USA. Tel: +1 202 237 9400. ( wtun@ 123456popcouncil.org )
                Article
                JIA225124
                10.1002/jia2.25124
                6055125
                30033680
                609f218c-5ebc-4136-9ec5-d93ccbbb07c3
                © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 4, Pages: 9, Words: 8520
                Product
                Funding
                Funded by: U.S. National Institutes of Health
                Award ID: 1R21AI124409‐01
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                jia225124
                July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.3 mode:remove_FC converted:22.07.2018

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