AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #270 - A lack of proximity to HIV is associated with an absence of HIV testing among men who have sex with men living in Douala, Cameroon
Authors: Presenting Author: Mr Nicolas Lorente - INSERM U912
Additional Authors: Ms. Emilie Henry, Ms. Lionel Fugon, LLM Yves Yomb, Dr. Fred Eboko, Dr. Patrizia Carrieri, Dr. Bruno Spire,
Aim: In low- and middle-income countries, Men having Sex with Men (MSM) are 19 times more likely to be HIV positive compared with background general populations. Criminalization and social rejection of homosexuality in most sub-Saharan African countries reinforce stigma and tend to exclude MSM from prevention activities, including HIV testing. The purpose of this paper is to determine factors associated with having never been HIV tested (NHT) among a sample of Cameroonian MSM.
Method / Issue: The study was conducted in Douala, the economic capital city of Cameroon, in 2008, in collaboration with a local community-based NGO, recruiting participants through the snowball technique and administering an 85-item questionnaire during face-to-face interviews. Proximity to HIV was investigated according to the following criteria: knowing at least one person living with HIV and having been exposed to HIV prevention interventions. NHT was defined as reporting to have never had a HIV test. A logistic regression was used to identify factors associated with NHT.
Results / Comments: Among the 174 MSM enrolled, the 165 who reported not being HIV positive filled in the questionnaire. Median age of the sample was 25 (range: 18-44). 52% were in active employment, 12% were married and 28% had at least one child. 43% were Catholic, 40% were Protestants and 10% were Muslims. 58% had previously been exposed to HIV prevention interventions and 46% reported knowing at least one person living with HIV. Overall, 19% reported NHT. Factors independently associated with NHT were as follows: younger age (AOR=0.90 [0.82-0.99]), being Muslim (AOR=7.23 [1.78-29.35]), not having a steady male partner (AOR=3.09 [1.17-8.12]), not knowing any person living with HIV (AOR=6.70 [2.11-21.26]) and never having been exposed to HIV prevention interventions (AOR=2.78 [1.09-7.13]).
Discussion: In this MSM population, one in five men reported to have never been HIV tested in their lives, but this rate was higher among those who had never been in proximity to HIV. The sub-Saharan African context is very hostile toward all MSM, but Muslim MSM may be more stigmatized than their Catholic counterparts. Muslims are a minority in Cameroon and consequently may reject homosexual practices more than other religions do, as there may be a stronger desire to preserve their traditions. This result is a further argument for continuing HIV prevention interventions and extending them to difficult-to-reach MSM. Such prevention interventions should be both specific and peer-based, in order to better integrate HIV testing into all MSM prevention behaviors.
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