Men who have sex with men in sub-Saharan Africa, including in Mali, are highly stigmatized and widely perceived to be at high risk for HIV infection despite the paucity of data that accurately estimate this risk. Addressing the needs of this population has been a priority for the Mali Ministry of Health, which has been long considering ways to improve the social and cultural conditions for men who have sex with men in that country. With support from PEPFAR through the CDC, the Ministry of Health partnered with the Mailman School of Public Health’s ICAP and the International Center for Excellence in Research at the University of Bamako in 2014 to develop HIV surveillance activities by designing and implementing a bio-behavioral survey, specifically focused on this population. To set the stage, ICAP conducted an assessment to gain insights into the appropriate way to design and conduct the survey, using focus groups and interviews conducted among the men and service providers.
[Photo: Dr. Wafaa El-Sadr]
From October 2014 to February 2015, ICAP, the Ministry of Health, CDC, and ICER interviewed 550 men who have sex with men who consented to the survey. Data were collected on the men’s demographic characteristics, sexual history, drug and alcohol consumption, stigma, discrimination, and HIV knowledge, among other questions. Participants were offered HIV testing and counseling and those found to be HIV positive were referred to care and treatment services.
“We wanted to determine HIV prevalence among men who have sex with men in Mali, as well as to understand their HIV risk behaviors,” said Dr. Wafaa El-Sadr, director of ICAP and the Dr. Mathilde Krim-amfAR Chair of Global Health at the Mailman School. “We collected key information, such as HIV risk perception, condom use among other information that will guide prevention activities.”
Findings from the survey indicated that HIV prevalence among the men who have sex with men in Bamako was nine-fold higher (14 percent) than among men in the general population. The study also found that only 47 percent had been tested for HIV in the past 12 months and more than 87 percent of those found to be HIV-positive were unaware of their HIV infection.
“The inclusion of all populations in HIV surveillance activities is essential to developing and providing comprehensive HIV prevention, care, and treatment services,” said Dr. Seydou Doumbia, dean of the faculty of medicine and dentistry and deputy scientific director at ICER. “By supporting the development of the bio-behavioral survey for this group of men, ICAP is helping Mali gather data on disease burden and service needs among key populations to inform priorities, allocate resources, and shape Mali’s response to the HIV epidemic.”