Factors associated with viral suppression among HIV-positive Kenyan gay and bisexual men who have sex with men

Bibliographic Data

ID19440317
AuthorsColin Kunzweiler (0000-0002-6683-4839, University of Illinois Chicago, corresponding author), Colin P Kunzweiler (University of Illinois Chicago), Robert C Bailey (0000-0002-9202-1794, University of Illinois Chicago), Supriya D Mehta (0000-0002-7926-2489, University of Illinois Chicago), Duncan Okall (Nyanza Reproductive Health Society), Duncan O Okall (Nyanza Reproductive Health Society, Kisumu, Kenya), Eve Obondi (Nyanza Reproductive Health Society, Kisumu, Kenya), Gaston Djomand (Centers for Disease Control and Prevention), Boaz Otieno Nyunya (Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya), Fredrick O Otieno (0009-0009-0913-9774, Nyanza Reproductive Health Society, Kisumu, Kenya), Fredrick Otieno (0000-0003-0823-412X, Nyanza Reproductive Health Society), Susan M Graham (0000-0001-7847-8686, Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA, USA)
Year2018
Volume30
Issuesup5
PagesS76-S88
Publication date2018-08-23
Open AccessYes
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2018.1510109
PMID30897938
OpenAlexW2924412927
LanguageEN
Citations received10
References cited31

The UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08-0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03-1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area

Biology · Kenya · Sociology · Adolescent Sexual and Reproductive Health · Demography · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Psychology · Virology

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