While male-to-male sexual behavior has been recognized as a primary risk factor for human immunodeficiency virus (HIV), research targeting men who have sex with men (MSM) in less-developed countries has been limited due to high levels of stigma and discrimination. In response, the Population Council's Horizons Program began implementing research activities in Africa and South America beginning in 2001, with the objectives of gathering information on MSM sexual risk behaviors, evaluating HIV-prevention programs, and informing HIV policy makers. The results of this nearly decade-long program are presented in this article as a summary of the Horizons MSM studies in Africa (Senegal and Kenya) and Latin America (Brazil and Paraguay), and include research methodologies, study findings, and interventions evaluated. We also discuss future directions and approaches for HIV research among MSM in developing countries.
References
1.
StallRDHaysRBWaldoCREkstrandMMcFarlandW. The gay '90s: A review of research in the 1990s on sexual behavior and HIV risk among men who have sex with men. AIDS2000;14(Suppl 3): S101–14.
2.
CaceresCF. HIV among gay and other men who have sex with men in Latin America and the Caribbean: A hidden epidemic?AIDS2002;16(Suppl 3):S23–33.
3.
RamirezJSuarezEde la RosaGCastroMAZimmermanMA. AIDS knowledge and sexual behavior among Mexican gay and bisexual men. AIDS Educ Prev1994;6:163–74.
4.
ZimmermanMARamirez-VallesJSuarezEde la RosaGCastroMA. An HIV/AIDS prevention project for Mexican homosexual men: An empowerment approach. Health Educ Behav1997;24:177–90.
5.
Kerr-PontesLRGondimRMotaRSMartinsTAWypijD. Self-reported sexual behaviour and HIV risk taking among men who have sex with men in Fortaleza, Brazil. AIDS1999;13:709–17.
6.
HarrisonLHdo LagoRFFriedmanRKRodriguesJSantosEMde MeloMF. Incident HIV infection in a high-risk, homosexual, male cohort in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr1999;21:408–12.
7.
CarneiroMde Figueiredo AntunesCMGrecoMOliveiraEAndradeJLignaniL. Design, implementation, and evaluation at entry of a prospective cohort study of homosexual and bisexual HIV-1-negative men in Belo Horizonte, Brazil: Project Horizonte. J Acquir Immune Defic Syndr2000;25:182–7.
8.
TabetSRde MoyaEAHolmesKKKroneMRde QuinonesMRde ListerMB. Sexual behaviors and risk factors for HIV infection among men who have sex with men in the Dominican Republic. AIDS1996;10:201–6.
9.
BeyrerCEiumtrakulSCelentanoDDNelsonKERuckphaopuntSKhamboonruangC. Same-sex behavior, sexually transmitted diseases and HIV risks among young northern Thai men. AIDS1995;9:171–6.
ZhangBLiuDLiXHuT. A survey of men who have sex with men: Mainland China. Am J Public Health2000;90:1949–50.
12.
MelbyeMNjelesaniEKBayleyAMukelabaiKManuweleJKBowaFJ. Evidence for heterosexual transmission and clinical manifestations of human immunodeficiency virus infection and related conditions in Lusaka, Zambia. Lancet1986;2:1113–5.
13.
RonaldARNdinya-AcholaJOPlummerFASimonsenJNCameronDWNgugiEN. A review of HIV-1 in Africa. Bull N Y Acad Med1988;64:480–90.
14.
HunterDJ. AIDS in sub-Saharan Africa: The epidemiology of heterosexual transmission and the prospects for prevention. Epidemiology1993;4:63–72.
15.
TeunisN. Homosexuality in Dakar: Is the bed the heart of a sexual subculture?J Gay Lesb Bisex Ident1996;1:153–69.
16.
McKennaN. On the margins: Men who have sex with men and HIV in the developing world. London: Panos Institute; 1996.
17.
RoscoeWMurraySO, editors. Boy-wives and female husbands: Studies in African homosexualities. New York: PALGRAVE; 1998.
18.
EngelkeM. “We wondered what human rights he was talking about”: Human rights, homosexuality and the Zimbabwe International Book Fair. Crit Anthropol1999;19:289–314.
19.
NyamuHJ. Gays have no business fighting for recognition in Kenya. Daily Nation (Nairobi)2007 Sep 28;Sect. 1:11 (col. 1).
20.
NkangiM. Govt must tighten screws on gays, lesbians. Daily Monitor (Kampala)2007 Nov 28;Sect. 1:12 (col. 1).
21.
TapsobaPMoreauANiangYNiangC. What kept away African professionals from studying MSM and addressing their needs in Africa?Challenges and obstacles. 15th International AIDS Conference; 2004 Jul 11–15; Bangkok, Thailand [abstract WePeC6155].
22.
NiangCITapsobaPWeissEDiagneMNiangYMoreauAM. “It's raining stones”: Stigma, violence and HIV vulnerability among men who have sex with men in Dakar, Senegal. Cult Health Sex2003;5:499–512.
23.
Onyango-OumaWBirungiHGeibelS. Understanding the HIV/STI risks and prevention needs of men who have sex with men in Nairobi, Kenya. Horizons Final Report. Washington: Population Council; 2005.
24.
MoreauATapsobaPLyANiangCIDiopAK. Implementing STI/HIV prevention and care interventions for men who have sex with men in Senegal. Horizons Research Summary. Washington: Population Council; 2007.
25.
GeibelSLuchtersSKing'olaNEsu-WilliamsERinyiruATunW. Factors associated with self-reported unprotected anal sex among male sex workers in Mombasa, Kenya. Sex Transm Dis2008;35:746–52.
26.
GeibelSvan der ElstEMKing'olaNLuchtersSDaviesAGetambuEM. “Are you on the market?”: A capture-recapture enumeration of men who sell sex to men in and around Mombasa, Kenya. AIDS2007;21:1349–54.
27.
de MelloMde Araujo PinhoAChinagliaMTunWJúniorABIlárioMCFJ. Assessment of risk factors for HIV infection among men who have sex with men in the metropolitan area of Campinas City, Brazil, using respondent-driven sampling. Washington: Population Council; 2008.
28.
ChinagliaMTunWde MelloMInsfranMDíazJ. Assessment of risk factors for HIV infection in female sex workers and men who have sex with men in Ciudad del Este, Paraguay. Washington: Population Council; 2008.
29.
MagnaniRSabinKSaidelTHeckathornD. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS2005;19(Suppl 2):S67–72.
30.
HeckathornDD. Respondent-driven sampling: A new approach to the study of hidden populations. Soc Probl1997;44:174–99.
31.
Abdul-QuaderASHeckathornDDSabinKSaidelT. Implementation and analysis of respondent driven sampling: Lessons learned from the field. J Urban Health2006;83(6 Suppl):i1–5.
32.
HeckathornDD. Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl2002;49:11–34.
33.
SalganikMJ. Variance estimation, design effects, and sample size calculations for respondent-driven sampling. J Urban Health2006;83(6 Suppl):i98–112.
34.
Ramirez-VallesJHeckathornDDVázquezRDiazRMCampbellRT. From networks to populations: The development and application of respondent-driven sampling among IDUs and Latino gay men. AIDS Behav2005;9:387–402.
35.
Abdul-QuaderASHeckathornDDMcKnightCBramsonHNemethCSabinK. Effectiveness of respondent-driven sampling for recruiting drug users in New York City: Findings from a pilot study. J Urban Health2006;83:459–76.
36.
YekaWMaibani-MichieGPrybylskiDColbyD. Application of respondent driven sampling to collect baseline data on FSWs and MSM for HIV risk reduction interventions in two urban centres in Papua New Guinea. J Urban Health2006;83(6 Suppl):i60–72.
37.
KajubiPKamyaMRRaymondHFChenSRutherfordGWMandelJS. Gay and bisexual men in Kampala, Uganda. AIDS Behav2008;12:492–504.
38.
JohnstonLDahomaMHolmanASabinKOthmanAMartinR. HIV infection and risk factors among men who have sex with men in Zanzibar (Ugunja), Tanzania. 17th International AIDS Conference; 2008 Aug 3–8; Mexico City [abstract WEPE0742].
39.
PinkertonSDAbramsonPR. Effectiveness of condoms in preventing HIV transmission. Soc Sci Med1997;44:1303–12.
40.
DavisKRWellerSC. The effectiveness of condoms in preventing heterosexual HIV transmission. Fam Plann Perspect1999;31:272–9.
WadeASKaneCTDialloPADiopAKGueyeKMboupS. HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS2005;19:2133–40.
43.
AngalaPParkinsonAKilonzoNNatechoATaegtmeyerM. Men who have sex with men (MSM) as presented in VCT data in Kenya. 16th International AIDS Conference; 2006 Aug 13–18; Toronto [abstract MOPE0581].
44.
SandersEJGrahamSMOkukuHSvan der ElstEMMuhaariADaviesA. HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS2007;21:2513–20.
45.
VoellerBCoulsonAHBernsteinGSNakamuraRM. Mineral oil lubricants cause rapid deterioration of latex condoms. Contraception1989;39:95–102.
46.
RosenADRosenT. Study of condom integrity after brief exposure to over-the-counter vaginal preparations. South Med J1999;92: 305–7.
47.
SteinerMPiedrahitaCGloverLJoanisCSpruytAFoldesyR. The impact of lubricants on latex condoms during vaginal intercourse. Int J STD AIDS1994;5:29–36.
48.
GeibelSKingolaNLuchtersS. Impact of male sex worker peer education on condom use in Mombasa, Kenya. Presented at the 5th IAS Conference on HIV Pathogenesis Treatment and Prevention; 2009 Jul 21; Cape Town, South Africa [abstract TUAD204].
49.
JohnsonCA. Off the map: How HIV/AIDS programming is failing same-sex practicing people in Africa. New York: International Gay and Lesbian Human Rights Commission; 2007.
50.
BaralSTrapenceGMotimediFUmarEIipingeSDausabF. HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS One2009;4:e4997.
51.
SandfortTNelJRichEReddyVYiH. Race-related differences in rates of HIV testing and infection in South African MSM. Presented at the 17th International AIDS Conference; 2008 Aug 3–8; Mexico City [abstract TUPE0729].
52.
LaneTRaymondHFDladlaSRasetheJStruthersHMcFarlandW. High HIV prevalence among men who have sex with men in Soweto, South Africa: Results from the Soweto Men's Study. AIDS Behav2009 Aug 7. [Epub ahead of print]
53.
LaneTShadeSBMcIntyreJMorinSF. Alcohol and sexual risk behavior among men who have sex with men in South African township communities. AIDS Behav2008;12(Suppl 4):S78–85.
54.
SandfortTGNelJRichEReddyVYiH. HIV testing and self-reported HIV status in South African men who have sex with men: Results from a community-based survey. Sex Transm Infect2008;84:425–8
55.
HenryEMarcellinFYombYFugonLNemandeSGueboguoC. Factors associated with unprotected anal intercourse (UAI) among men who have sex with men (MSM) in Douala, Cameroun. Sex Transm Infect2009 Aug 24. [Epub ahead of print]
56.
BaralSSifakisFCleghornFBeyrerC. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: A systematic review. PLoS Med2007;4:e339.
57.
NdoyeI. L'expérience sénégalaise: Quelles leçons à partager?Presented at the Third Social Aspects of HIV/AIDS Research Alliance Conference [welcome address]; 2005 Oct 10; Dakar, Senegal.
58.
National AIDS Control Council of Kenya, Office of the President, Kenya. UNGASS 2008 country report for Kenya. Nairobi: NACC, Office of the President, Kenya; 2008.
59.
National AIDS Control Council of Kenya, Population Council. The overlooked epidemic: Addressing HIV prevention and treatment among men who have sex with men in sub-Saharan Africa, report of a consultation. Nairobi: Population Council; 2009.
