Long Term follow-up of HIV/TB/STIs/Malaria in the Living patterns in Men Who Have Sex with Men in Uganda

BACKGROUND:  This is a report on outcomes of activities to generate a profile of men who have sex with men (MSM) with a median follow-up of 2 years.

OBJECTIVE: We sought to determine whether:  100 MSM (18-52) sleep under Insecticide Treated Nets (ITNs), in case of TB/ STIs they seek treatment, which HIV Services they seek and whether any form of violence, abuse, discrimination and stigma affects them accessing any services.

DESIGN: This study investigated adherence patterns by MSM who had all first contacted MARPS IN UGANDA in January 2009 to access counselling, lubricants and condoms by phone.

SETTING: This study was community and office-based.

PARTICIPANTS: Those evaluated were MSM who underwent at least 5 counselling and follow-up sessions on status of life as an MSM in Uganda in light of staying/sleeping under ITNs and; whether they had pursued risk reduction practices between January 2009 and August 2011.

INTERVENTION: They were linked to HCT, given ITNs, given counselling in risk reduction against HIV/TB/STIs/Malaria, given lubricants and condoms every month.

MAIN OUTCOME MEASUREMENT: The primary outcomes measured were effect of stigma, gainful employment and sexual role on adherence plans by MSM.

RESULTS: One hundred MSM (18-52years) with a median follow-up of 20 months were followed. Fifty percent (50%) were also in a heterosexual relation, had a family and were engaged in regular paying work.  All had tested above 2 times (median tests were 3) to know their HIV status. Only 4 had tested five times.  5 were HIV+ve. During this time, 20 (20%) who were having permanent jobs and families (37-52 years) were lost to follow-up and 10 (10%) in receptive role who were their partners were also discouraged from continuing to call.  80 (80%) MSM had continued calling in a mean of 19 months. They called in to seek malaria treatment. 60 (60%) who were living in low cost sub-urban housing estates called in more frequently for malaria treatment especially during rainy seasons.  10 (10%) living in a distance beyond 5 miles outside Kampala called in only once for malaria treatment.  All the MSM living with HIV had an opportunity to check earlier and were enrolled on Cotrim-Prophylaxis. 40 (40%) of MSM were also engaged in hospitality, catering, clothier and hair-dressing industry.

LIMITATIONS: This exercise followed 100 MSM in Uganda as follows:  27 from Kampala, 20 from Mbale, 5 from Mbarara, 3 from Gulu and 45 from 3 Universities for 24 months. It followed those who could afford calling-in more than five times. There was loss to follow up by MSM above due to fear of tapping phones (as a result of news about a “phone tapping” Bill after January-2011).

CONCLUSIONS:  Working with MSM is opportunity to integrate HIV/TB/STIs/Malaria services. Stigma and ability to earn money to pay for life’s necessities have a drastic influence on life preserving practices among MSM.