Changes in sexual risk behavior among MSM participating in a research cohort in coastal Kenya

Abstract

Objective: To describe changes in sexual risk behavior among Kenyan MSM who received regular risk reduction counseling (RRC).

Design: Data were derived from two cohorts of HIV-1-negative and HIV-1-positive MSM in Kenya. Behavioral data were collected at enrollment and at monthly or quarterly scheduled follow-up visits. At each visit, RRC was provided to all men and HIV-1 testing to seronegative men.

Methods: Random effects logistic and Poisson regression models with time since study entry as main variable of interest were used to evaluate changes in number of sex partners and unprotected sex in the past week, and insertive, receptive, and unprotected anal intercourse in the past 3 months. Analyses were adjusted for HIV-1-status, calendar year of follow-up, and several baseline characteristics. Trends over follow-up time were allowed to differ by HIV-1-status. Men were censored when they seroconverted for HIV.

Results: Number of regular and casual sex partners and unprotected anal intercourse decreased in both HIV-1-negative and HIV-1-positive men. Unprotected sex with both regular and casual sex partners decreased more strongly early in follow-up in HIV-1-positive men than in HIV-1-negative men. Decreases in insertive anal intercourse were found for HIV-1-positive men only, whereas decreases in receptive anal intercourse were found for HIV-1-negative men only.

Conclusion: MSM who were regularly exposed to RRC showed some reductions in sexual risk behavior, but it is uncertain if these reductions are sustained over time. As HIV-1 incidences in Kenyan MSM are very high, RRC should be supported by comprehensive biomedical interventions.

Fig. 1. Trends in number of partners in the past week over follow-up time, among men who have sex with men, Kilifi, Kenya, 2006–2011

(a) Number of regular sex partners in the past week. (b) Number of casual sex partners in the past week.

Fig. 2. Trends in unprotected sex in the past week over follow-up time among men who have sex with men, Kilifi, Kenya, 2006–2011

(a) Unprotected sex with regular sex partner in the past week. (b) Unprotected sex with casual sex partner in the past week.

Fig. 3

Trends in unprotected anal intercourse in the past 3 months over follow-up time among men who have sex with men, Kilifi, Kenya, 2006–2011.

Fig. 4. Trends in insertive and receptive anal intercourse in the past 3 months over follow-up time among men who have sex with men, Kilifi, Kenya, 2006–2011

(a, b) Insertive anal intercourse in the past 3 months among MSM who paid (dashed line) or not paid (solid line) for sex. (c, d) Receptive anal intercourse in the past 3 months among MSM who received payment (dashed line) or not received payment (solid line) for sex.