Is contact between men who have sex with men and non-governmental organizations providing harm reduction associated with improved HIV outcomes?

ABSTRACT

OBJECTIVES: There is a high prevalence of HIV (5.2% in 2018) among men who have sex with men (MSM) in Ukraine. HIV testing, condom provision and facilitated linkage to HIV treatment have been funded by various bodies through non-governmental organizations (NGOs). We investigated whether contact with these NGOs was associated with improved prevention and treatment outcomes among MSM in Ukraine. METHODS: Data were taken from four rounds of integrated bio-behavioural surveys among MSM in Ukraine (2011, N = 5950; 2013, N = 8101; 2015, N = 4550; 2018, N = 5971) including HIV testing combined with questionnaire responses. Data were analysed using mixed-effect regression models, which estimated associations between being an NGO client and behavioural, HIV testing and HIV treatment outcomes, adjusted for demographic factors. RESULTS: Those MSM who were NGO clients were more likely than non-clients to have been HIV tested in the last year [adjusted odds ratio (aOR) = 7.01, 95% confidence interval (CI) 6.45-7.62] or ever (aOR = 11.00, 95% CI 9.77-12.38), to have used a condom for the last anal sex act (aOR = 1.32, 95% CI 1.21-1.43), and to have recently either bought or received condoms (aOR = 21.27, 95% CI 18.01-25.12). HIV-positive MSM were more likely to have contact with NGOs (aOR = 1.61, 95% CI 1.39-1.86). Among the HIV-positive MSM, those who were NGO clients were more likely to be registered at an AIDS centre (aOR = 2.24, 95% CI 1.61-3.11) and to be on antiretroviral treatment (aOR = 2.20, 95% CI 1.51-3.20). CONCLUSIONS: In Ukraine, being in contact with MSM-targeted NGOs is associated with better outcomes for HIV prevention, testing and treatment, suggesting that NGO harm reduction projects for MSM have had a beneficial impact on reducing HIV transmission and morbidity.