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. 2023 Sep;27(9):3027-3037.
doi: 10.1007/s10461-023-04025-z. Epub 2023 Mar 16.

Risk Factors Associated with HIV Acquisition in Males Participating in HIV Vaccine Efficacy Trials in South Africa

Mookho Malahleha  1   2 , Fatima Laher  3 , Athmanundh Dilraj  4   5 , Philip Smith  6 , Glenda E Gray  3   7 , Doug Grove  8 , Jackline A Odhiambo  8 , Michele P Andrasik  8 , Nicole A Grunenberg  8 , Zoe Moodie  8 , Yunda Huang  8 , Bhavesh R Borate  8 , Kevin M Gillespie  8 , Mary Allen  9 , Millicent Atujuna  6 , Nishanta Singh  10 , Dishiki Kalonji  7   10 , Graeme Meintjes  11 , Phillip Kotze  12 , Linda-Gail Bekker  6 , Holly Janes  8
Affiliations

Risk Factors Associated with HIV Acquisition in Males Participating in HIV Vaccine Efficacy Trials in South Africa

Mookho Malahleha et al. AIDS Behav. 2023 Sep.

Abstract

In South Africa, HIV acquisition risk has been studied less in people assigned male at birth. We studied the associations between risk behaviors, clinical features and HIV incidence amongst males in two South African HIV preventive vaccine efficacy trials. We used Cox proportional hazards models to test for associations between demographics, sexual behaviors, clinical variables and HIV acquisition among males followed in the HVTN 503 (n = 219) and HVTN 702 (n = 1611) trials. Most males reported no male sexual partners (99.09% in HVTN 503) or identified as heterosexual (88.08% in HVTN 702). Annual HIV incidence was 1.39% in HVTN 503 (95% CI 0.76-2.32%) and 1.33% in HVTN 702 (95% CI 0.80-2.07%). Increased HIV acquisition was significantly associated with anal sex (HR 6.32, 95% CI 3.44-11.62), transactional sex (HR 3.42, 95% CI 1.80-6.50), and non-heterosexual identity (HR 16.23, 95%CI 8.13-32.41) in univariate analyses and non-heterosexual identity (HR 14.99, 95% CI 4.99-45.04; p < 0.01) in multivariate analysis. It is appropriate that prevention efforts in South Africa, although focused on the severe epidemic in young women, also encompass key male populations, including men who have sex with men, but also men who engage in anal or transactional sex.

Keywords: HIV incidence; HIV risk factors; Males at birth; Non-heterosexual identity; Sexual behavior.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Cumulative incidence of HIV infection by sexual orientation and diagnosis of syphilis, Neisseria gonorrhoeae, or Chlamydia trachomatis at baseline for HVTN 702 and by anal sex and diagnosis of HSV2 at baseline for HVTN 503 in males
Fig. 2
Fig. 2
Cumulative incidence of HIV infection in males by tertiles (low, medium, high risk) of the HIV risk score developed using the super-learner method
See this image and copyright information in PMC

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