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Men who have sex with men (MSM) and transfeminine people in sub-Saharan Africa (SSA) are disproportionately affected by HIV infection. Condoms are highly effective in preventing HIV infection; however, limited research has explored how multiple ecological domains are associated with condom use among these groups in SSA.
Methods:
This study explored how individual, sexual partner, and sexual interaction level factors among MSM and transfeminine people in SSA are associated with reports of always using condoms during anal intercourse. This secondary study used data from the HIV Prevention Trials Network (HPTN) 075 (2015-2017). Participants (N= 401) were recruited from Malawi, Kenya, and South Africa, enrolled in a 1-year prospective cohort, and asked questions about their sexual behaviors over five study visits.
Results:
Of 401 participants, 151 (38%) reported using a condom during all anal intercourse occasions. Participants who self-identified as gay (N = 83), transgender, nonbinary, or female (N = 19, 23%) and experienced sexual abuse before the age of 16 (N = 22) were less likely to have used condoms with their partners consistently. Consistent condom use was reported in 1,615 (74%) of the 2,185 sexual interactions discussed with participants. Consistent condom use was positively associated with not knowing whether a sexual partner was having sex with other persons (AOR = 1.56, 95% CI: 1.03, 2.35) but negatively associated with sex while under the influence of alcohol/drugs (AOR = 0.47, 95% CI: 0.37, 0.59) and forced sex (AOR = 0.25, 95% CI: 0.18, 0.36) during sexual interactions. Additional correlates of condom use were also identified.
Conclusions and Implications:
To improve consistent condom use among MSM and transfeminine persons in SSA, trauma-informed and harm-reduction approaches need to be incorporated into HIV prevention interventions, sexual health education, and public health communication for these sexual and gender minority groups.