Access to HIV Services at Non-Governmental and Community-Based Organizations among Men Who Have Sex with Men (MSM) in Cameroon: An Integrated Biological and Behavioral Surveillance Analysis

BackgroundMen who have sex with men (MSM) are more likely to be living with HIV than other adult men in low- and middle-income countries. MSM experience barriers to accessing HIV services including a lack of available specialized care, and community-level stigma and discrimination. This study aims to examine the uptake of HIV services at non-governmental and community-based organizations (NGOs/CBOs) to identify ways to improve coverage of HIV prevention and treatment among MSM.MethodsAn Integrated Biological and Behavioral Surveillance (IBBS) survey was conducted in Yaoundé and Douala, Cameroon in 2011 using the respondent driven sampling (RDS) method to recruit and interview 239 MSM in Yaoundé and 272 MSM in Douala.ResultsMSM in Yaoundé were statistically significantly more likely to have accessed NGO/CBO services or been reached by an outreach worker in the past 12 months if they had any STI symptoms (aOR 2.17 CI 1.02-4.59. p=0.04), or if they had a larger MSM social network (aOR 1.02 CI 1.01-1.04. pConclusionsWith appropriate funding and resources, community-based organizations that provide care specifically for MSM can improve access to HIV prevention, treatment, and care services. Additionally, using social networks to reach MSM can connect greater numbers of the population to effective HIV interventions, which will improve health outcomes and decrease onward transmission of HIV.

背景 男男性行为者（Men who have sex with men, MSM）在中低收入国家的HIV感染率高于其他成年男性。该群体在获取HIV相关服务时面临多重障碍，包括缺乏针对性的专科诊疗资源，以及社区层面的污名与歧视。本研究旨在调研非政府组织与社区组织（Non-Governmental Organizations/Community-Based Organizations, NGOs/CBOs）提供的HIV服务使用情况，以期探索提升男男性行为群体HIV预防与治疗服务覆盖范围的可行路径。方法 本研究于2011年在喀麦隆雅温得与杜阿拉开展整合生物行为监测（Integrated Biological and Behavioral Surveillance, IBBS）调查，采用应答者驱动抽样（Respondent Driven Sampling, RDS）方法招募并访谈了雅温得的239名男男性行为者，以及杜阿拉的272名男男性行为者。结果 雅温得的男男性行为者中，若在过去12个月内出现任意性传播感染（Sexually Transmitted Infection, STI）症状（调整优势比aOR=2.17，95%置信区间CI=1.02-4.59，p=0.04），或拥有规模更大的男男性行为社交网络（调整优势比aOR=1.02，95%置信区间CI=1.01-1.04，原文此处p值未完整标注），则其在过去12个月内更倾向于使用非政府组织/社区组织的服务，或曾获得外展工作人员的服务对接，该差异具有统计学显著性。结论 若获得充足的经费与资源支持，专为男男性行为群体提供服务的社区组织可有效提升该群体获取HIV预防、治疗与诊疗服务的可及性。此外，借助社交网络触达男男性行为群体，可将更多人群纳入有效的HIV干预措施中，从而改善该群体的健康结局，并降低HIV的续发传播风险。