Expanding test and Treat for HIV Prevention in Men Who Have Sex with Men in Kisumu, Kenya

Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately burdened by HIV. In sub-Saharan Africa, the prevalence of HIV among GBMSM is 2-4 times greater compared to that of the general male population. In Kenya, the Ministry of Health recognizes the importance that GBMSM play in the national HIV epidemic and there is an urgent need to expand HIV prevention and treatment interventions among this population. Evidence from observational, experimental, and modeling studies demonstrates that antiretroviral therapy (ART) used to treat HIV infection improves individual health and reduces transmission to negative sexual partners. As a result, the expansion of ART has been prioritized by national and international organizations and there has been sustained interest to implement find, test, link, and retain strategies in combination HIV prevention interventions. Gay, bisexual, and other men who have sex with men face numerous barriers that limit engagement in prevention and care services including stigma related to gay or homosexual identity, social isolation, discrimination by health care workers and medical professionals, and criminalization of same-sex behaviors. The Anza Mapema Study implemented a find, test, link, and retain model that was specifically targeted to GBMSM of Kisumu, Kenya in order to improve access to testing, increase awareness of HIV status, reduce barriers to ART, reduce ART initiation delays, and retain men in treatment and prevention services. In the studies examined here, we sought to identify the sociodemographic, behavioral, psychosocial, and clinical characteristics associated with: 1) HIV infection status; 2) viral suppression among HIV-positive GBMSM who were offered treatment and followed for 12 months; and 3) missed follow-up visits among HIV-negative participants enrolled in prevention and education services.