Men Who Have Sex with Both Men and Women in West Africa: Factors Associated with a High Behavioral Risk of Acquiring HIV from Male Partners and Transmission to Women (CohMSM ANRS 12324—Expertise France)
Authors: Fiorentino Marion , Coulibaly Bakary , Couderc Clotilde , Keita Bintou Dembélé , Anoma Camille , Dah Elias , Mensah Ephrem , Aka Thomas Niamkey , Touré Juste Rodrigue , Camara Drissa , Kokouba Anouwarsadat Rodolphe , Maradan Gwenaëlle , Mora Marion , Bourrelly Michel , Riegel Lucas , Rojas-Castro Daniela , Spire Bruno , Laurent Christian , Sagaon-Teyssier Luis ,   The CohMSM Study Group, Boyer Véronique , Delaporte Eric , Granouillac Bruno , Izard Suzanne , March Laura , Peeters Martine , Serrano Laetitia , Berenger Cyril , Coulaud Pierre-Julien , Mrenda Bakri M’madi , Parisi Enzo , Bernier Adeline , Trenado Emmanuel , Cisse Oumar , Coulibaly Alou , Keita Bintou Dembele , Diallo Fodié , Diarra Mahamadou , Gadjigo Mady , Keita Abdoul Aziz , Maiga Kader , Traore Fodé , Aka Niamkey Thomas , Kouame Malan Jean-Baptiste , N’guessan Frédéric Dibi , Anglaret Xavier , Yoro Stéphane-Alain Babo , Masumbuko Jean-Marie , Oga Maxime , Coulibaly Christian , Dah Ter Tiero Elias , Ilboudo Ousseni , Ouedraogo Joseph , Thio Elisabeth , Traore Abdoulazziz , Meda Nicolas , Agbomadji Kouakou Kokouvi Selom , Agboyibor Richard Mawuényégan Kouamivi , Badjassim Aléda Mawuli , Ekon Agbégnigan Lorette , Yaka Kossi Jeff , Dagnra Claver Anoumou Yaotsè 
Published: November 2023

HIV is highly prevalent in men who have sex with men (MSM) in West Africa. Many MSM in the region also have sex with women (MSMW). Accordingly, they are a potential bridge subpopulation for HIV transmission to women. We aimed to evaluate the proportions and characteristics of West African MSMW at high behavioral risk of acquiring HIV from male partners and transmitting it to female partners (HBRMF). The cohort ANRS-12324 CohMSM Study included 630 HIV-negative MSM in Burkina Faso, Cote d’Ivoire, Mali, and Togo. Among MSMW (i.e., with ≥ 1 female partner) in the cohort, HBRMF was identified using trajectory models based on seven at-risk sexual practices with male and female partners, including inconsistent condom use, multiple partnerships, and receptive same-sex anal intercourse. To assess the relevance of using trajectory models, we compared the proportions of participants who seroconverted during the cohort follow-up among those at HBRMF and those not at HBRMF. Factors associated with HBRMF were identified using a generalized estimation equation logistic regression model accounting for longitudinal data. Approximately half (47%) of the 304 MSMW (22% of all CohMSM study participants) were at HBRMF. This group accounted for 75% of the 28 HIV seroconversions observed during follow-up (p = 0.001). HBRMF was positively associated with being aged < 25 years (aOR 95% CI 1.67 [1.23–2.27]), being sexually attracted only to men (1.97 [1.38–2.78]), feelings of loneliness (1.92 [1.38–2.65]), and homonegative violence score (1.22 [1.05–1.41]). HBRMF was negatively associated with having had both stable and casual female partners in the previous 6 months (0.34 [0.20–0.60] vs. only a stable female partner). HBRMF tended to be negatively associated with having ≥ 4 sexual intercourses with female partners in the previous four weeks (0.54 [0.27–1.06] vs. no intercourse). Establishing official relationships with women might be a strategy for young and/or stigmatized MSMW to comply with social pressure to display a heterosexual lifestyle. However, this seems to increase the risk of HIV transmission to female partners. In the present study, almost half of MSMW were at HBRMF. This result stresses the need to adapt HIV research and prevention to MSMW and their female partners.