TY - JOUR
T1 - Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM)
T2 - Implications for HIV and STI transmission
AU - Adedimeji, Adebola
AU - Sinayobye, Jean d.Amour
AU - Asiimwe-Kateera, Brenda
AU - Chaudhry, Junaid
AU - Buzinge, Lydia
AU - Gitembagara, Andre
AU - Murenzi, Gad
AU - Mugenzi, Pacifique
AU - Patel, Viraj V.
AU - Castle, Philip E.
AU - Mutesa, Leon
AU - Palefsky, Joel
AU - Anastos, Kathryn M.
N1 - Funding Information:
For the study was received from the National Institutes of Health/National Cancer Institute (1 U54 CA 190163-01) for the HIV malignancies research capacity building program. The authors wish to thank all the participants for volunteering their time to participate in the study. We also wish to acknowledge the cooperation of the leadership of LGBT associations in Kigali for facilitating contact with participants.
Publisher Copyright:
© 2019 Adedimeji et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/1
Y1 - 2019/1
N2 - Introduction Men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS resulting from risky sexual behaviors. Social and contextual factors are known to mediate risk behaviors, but there is limited information about the prevalence of risky sexual practices of Rwandan MSM and the concomitant socio-contextual determinants making it difficult to assess implications for preventing HIV/STI transmission in this key population. Methods Using exploratory qualitative design, we obtained socio-contextual information regarding prevalence of risky sexual behavior and assessed implications for HIV/ STIs transmission and preventive measures taken by MSM to improve sexual health and wellbeing. Thirty MSM were recruited to participate in in-depth interviews using respondent-driven sampling from LGBT associations in Kigali. Data were analyzed using standard qualitative data analysis procedures. Results Respondents’ were between 18–40 years old; all completed primary education and are mostly low-socioeconomic status. Risky sexual practices were common, but differed by peculiar individual and contextual factors. Older MSM often reported occasional sexual relations with women to avoid suspicion and social stigma. Younger MSM’s risky sexual practices are mostly transactional and mediated by the need for social acceptance and support. Knowledge of STIs was poor, but prevalence, especially of HPV was high. The options for improving sexual wellbeing are limited and mostly clandestine. Conclusion Risky sexual behavior of Rwandan MSM has major implications for HIV/STI transmission. An environment of intense social stigma and social isolation makes it difficult to obtain information or services to improve sexual health. Effective interventions that address individual and contextual determinants of risk and access to health services are urgently needed to limit the consequence of MSM as a bridge for HIV transmission to the general population.
AB - Introduction Men who have sex with men (MSM) are disproportionately impacted by HIV/AIDS resulting from risky sexual behaviors. Social and contextual factors are known to mediate risk behaviors, but there is limited information about the prevalence of risky sexual practices of Rwandan MSM and the concomitant socio-contextual determinants making it difficult to assess implications for preventing HIV/STI transmission in this key population. Methods Using exploratory qualitative design, we obtained socio-contextual information regarding prevalence of risky sexual behavior and assessed implications for HIV/ STIs transmission and preventive measures taken by MSM to improve sexual health and wellbeing. Thirty MSM were recruited to participate in in-depth interviews using respondent-driven sampling from LGBT associations in Kigali. Data were analyzed using standard qualitative data analysis procedures. Results Respondents’ were between 18–40 years old; all completed primary education and are mostly low-socioeconomic status. Risky sexual practices were common, but differed by peculiar individual and contextual factors. Older MSM often reported occasional sexual relations with women to avoid suspicion and social stigma. Younger MSM’s risky sexual practices are mostly transactional and mediated by the need for social acceptance and support. Knowledge of STIs was poor, but prevalence, especially of HPV was high. The options for improving sexual wellbeing are limited and mostly clandestine. Conclusion Risky sexual behavior of Rwandan MSM has major implications for HIV/STI transmission. An environment of intense social stigma and social isolation makes it difficult to obtain information or services to improve sexual health. Effective interventions that address individual and contextual determinants of risk and access to health services are urgently needed to limit the consequence of MSM as a bridge for HIV transmission to the general population.
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U2 - 10.1371/journal.pone.0211099
DO - 10.1371/journal.pone.0211099
M3 - Article
C2 - 30657797
AN - SCOPUS:85060131550
SN - 1932-6203
VL - 14
JO - PloS one
JF - PloS one
IS - 1
M1 - e0211099
ER -
