Associations between punitive policies and legal barriers to consensual same-sex sexual acts and HIV among gay men and other men who have sex with men in sub-Saharan Africa: a multicountry, respondent-driven sampling survey
Associations between punitive policies and legal barriers to consensual same-sex sexual acts and HIV among gay men and other men who have sex with men in sub-Saharan Africa: a multicountry, respondent-driven sampling survey
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DOI：
10.1016/s2352-3018(22)00336-8
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发表时间：
2023-03-01
期刊：
影响因子：
16.1
通讯作者：
Baral, Stefan
中科院分区：
文献类型：
--
作者：
Beyrer, Prof C.;Lyons, Carrie E.;Baral, Stefan
背景对男同性恋者和其他男男性行为者(MSM)中结构性因素与艾滋病毒之间的相关性进行的评估很少，特别是在撒哈拉以南非洲地区。我们的目标是检查生活在法律环境不同的十个国家的男男性行为者的艾滋病毒检测历史、艾滋病毒状况和污名。方法这项研究使用了在布基纳法索、喀麦隆、科特迪瓦、冈比亚、几内亚比绍、尼日利亚、塞内加尔、埃斯瓦蒂尼、卢旺达和多哥的25个地点进行的十个特定国家的横断面研究的汇集数据。男男性接触者是通过受访者驱动的抽样方式招募的，如果他们满足特定国家对年龄、居住地和自我报告的出生时被指定为男性并在过去12个月内与男性发生肛交的要求，他们就有资格。每个国家与同性性行为相关的政策被归类为非刑事化或刑事化。还根据最近与同性性行为有关的起诉报告对国家进行了分类。法律障碍被定义为在法律上阻止与性取向有关的民间社会组织登记或运作的障碍。通过面试者管理的社会行为问卷和艾滋病毒检测收集关于艾滋病毒检测史、艾滋病毒状况和耻辱的个人数据。使用随机截距的多水平Logistic回归分析政策、最近的起诉、对公民组织的法律障碍和HIV相关因素与调整的优势比(AORS)和95%CI之间的关系。4886人(60中点7%)生活在将同性性行为定为刑事犯罪的国家。男男性接触者中HIV感染率在犯罪化环境中高于非犯罪化环境(AOR 5中心点15，95%CI 1中心点12-23中心点57)；在最近起诉的环境中高于未起诉的环境(12中心点06，7中心点19-20中心点25)；在对公民组织设置障碍的环境中比没有障碍的设置更高(9中心点83，2中心点00-48中心点30)。艾滋病毒检测或地位意识与惩罚性政策或做法无关。耻辱与艾滋病毒状况有关，但在不同的法律环境中并不总是不同。在惩罚性环境中，男男性接触者与其他成年男性之间的艾滋病毒感染率差异最大。解释结构性风险，包括歧视性的国家一级政策、起诉和法律障碍，可能会导致男男性接触者中更高的艾滋病毒感染率。综上所述，这些数据突显了合法化和减少执法的重要性，以及减少耻辱，作为有效控制艾滋病毒的核心。基金会国立卫生研究院。版权所有(C)2023由Elsevier Ltd.出版。保留所有权利。
Background Few assessments of associations between structural-level factors and HIV among gay men and other men who have sex with men (MSM) have been conducted, especially in sub-Saharan Africa. Our objective was to examine HIV testing history, HIV status, and stigmas among MSM living in ten countries with heterogeneous legal environments.Methods This study used pooled data from ten country-specific, cross-sectional studies done in 25 sites in Burkina Faso, Cameroon, Cote d'Ivoire, The Gambia, Guinea-Bissau, Nigeria, Senegal, Eswatini, Rwanda, and Togo. MSM were recruited by respondent-driven sampling and were eligible if they met country-specific requirements for age, area of residence, and self reported being assigned male sex at birth and having anal sex with a man in the past 12 months. Policy related to same-sex sexual behaviour for each country was categorised as not criminalised or criminalised. Countries were also categorised on the basis of recent reports of prosecutions related to same-sex sexual acts. Legal barriers were defined as those that legally prevented registration or operation of sexual orientation related civil society organisations (CSOs). Individual data on HIV testing history, HIV status, and stigma were collected via interviewer-administered sociobehavioural questionnaires and HIV testing. Multilevel logistic regression with random intercepts was used to assess the association between policies, recent prosecutions, legal barriers to CSOs, and HIV-related factors with adjusted odds ratios (aORs) and 95% CIs.Findings Between Aug 3, 2011, and May 27, 2020, we recruited 8047 MSM with a median age of 23 years (IQR 21-27). 4886 (60 center dot 7%) lived in countries that criminalise same-sex sexual acts. HIV prevalence among MSM was higher in criminalised settings than non-criminalised settings (aOR 5 center dot 15, 95% CI 1 center dot 12-23 center dot 57); higher in settings with recent prosecutions than in settings without prosecutions (12 center dot 06, 7 center dot 19-20 center dot 25); and higher in settings with barriers to CSOs than without barriers to CSOs (9 center dot 83, 2 center dot 00-48 center dot 30). HIV testing or status awareness was not associated with punitive policies or practices. Stigma was associated with HIV status but did not consistently vary across legal environments. Disparities in HIV prevalence between MSM and other adult men were highest in punitive settings.Interpretation Structural risks including discriminatory country-level policies, prosecutions, and legal barriers might contribute to higher HIV prevalence among MSM. Taken together, these data highlight the importance of decriminalisation and decreasing enforcement, alongside stigma reduction, as central to effective control for HIV.Funding National Institutes of Health.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved.