HIV testing among female sex workers and associated factors in Burkina Faso: findings from a respondent-driven sampling survey.

BACKGROUND: In Burkina Faso, only 70% of people living with HIV knew their status in 2018, while the first 95 target of the UNAIDS suggests that by 2025 at least 95% of people living with HIV (PLHIV) know their HIV status. Female sex workers (FSW) are one of the most HIV-vulnerable groups, making it crucial to estimate the rate and associated factors of HIV testing among FSW. METHODS: We conducted a cross-sectional study focused on FSW in five main cities of Burkina Faso (Ouagadougou, Bobo-Dioulasso, Koudougou, Tenkodogo, and Ouahigouya). A respondent-driven sampling (RDS) approach was used to recruit participants. Data were collected through in-person interviews between June and August 2022. The HIV testing rate in the past twelve months was examined by sociodemographic characteristics and risky behaviors. A modified Poisson regression in a generalized estimating equation with an exchangeable correlation structure was used to explore the associated factors of HIV testing. RESULTS: Of 1338 FSW (average age: 27.6 ± 7.25 years) HIV negative, 57.8% (95% CI: 54.2-61.3) reported having been tested for HIV in the last 12 months. Among those who started sex work before the age of 18, 48.0% (95% CI: 39.1-57.1) reported having been tested for HIV in the last 12 months. The HIV testing rate among FSWs within the last 12 months was independently associated with age, education level, and being member of an FSW supportive association. Indeed, FSW aged 25 years and more had a 14% higher rate of being tested for HIV within 12 months compared to those 15 to 24 years old (adjusted prevalence ratio (aPR): 1.14 [95%CI: 1.05-1.24]). The HIV testing rate among those who are not members of an FSW supportive association was 16% lower (aPR: 0.84 [95%CI: 0.72-0.97]) than those who are members of FSW supportive associations. CONCLUSION: The HIV testing rate among FSW is low in Burkina Faso, suggesting an important challenge to reach the first 95% target of UNAIDS among FSW. Innovative diagnostic strategies for the early identification of HIV-infected FSW are essential to achieve the first 95 target by 2025 in Burkina Faso.

Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data.

BACKGROUND: Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. METHODS: Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15-49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women's background characteristics. RESULTS: PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. CONCLUSIONS: Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level-the main source of care for many women-which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly.

Evaluation of ten (10) SARS-CoV-2 rapid serological tests in comparison with WANTAI SARS-CoV-2 ab ELISA in Burkina Faso, West Africa.

BACKGROUND: The aim of this study was to evaluate the performance of ten (10) SARS-CoV-2 serological rapid diagnostic tests in comparison with the WANTAI SARS-CoV-2 Ab ELISA test in a laboratory setting. MATERIALS AND METHODS: Ten (10) SARS-CoV-2 serological rapid diagnostic tests (RDTs) for SARS-CoV-2 IgG/IgM were evaluated with two (2) groups of plasma tested positive for one and negative for the other with the WANTAI SARS-CoV-2 Ab ELISA. The diagnostic performance of the SARS-CoV-2 serological RDTs and their agreement with the reference test were calculated with their 95% confidence intervals. RESULTS: The sensitivity of serological RDTs ranged from 27.39 to 61.67% and the specificity from 93.33 to 100% compared to WANTAI SARS-CoV-2 Ab ELISA test. Of all the tests, two tests (STANDARD Q COVID-19 IgM/IgG Combo SD BIOSENSOR and COVID-19 IgG/IgM Rapid Test (Zhejiang Orient Gene Biotech Co., Ltd)) had a sensitivity greater than 50%. In addition, all ten tests had specificity greater than or equal to 93.33% each. The concordance between RDTs and WANTAI SARS-CoV-2 Ab ELISA test ranged from 0.25 to 0.61. CONCLUSION: The SARS-CoV-2 serological RDTs evaluated show low and variable sensitivities compared to the WANTAI SARS-CoV-2 Ab ELISA test, with however a good specificity. These finding may have implications for the interpretation and comparison of COVID-19 seroprevalence studies depending on the type of test used.

Prevalence and factors associated with the occurrence of sexual violence among people with disabilities in Burkina Faso.

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in Central, Central-East, Central-West and "Hauts Bassins" regions of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs. 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among females with disability. There is no association between the other demographic characteristics and sexual violence among people with disability.

Predicting factors of sexual behaviours at risk of HIV infection among people living with disabilities: a generalized structural equation model.

Many studies have shown the HIV vulnerability of people with disabilities (PWD). This vulnerability is supported by risky sexual behaviours, which need to be well described. The objective of this study is to identify predictors of sexual behaviours at risk of HIV infection among PWD in Burkina Faso. We conducted a population-based cross-sectional study on disability and HIV in four regions in Burkina Faso. PWD were selected through a probabilistic method. The Washington Group Short questionnaire was used to identify PWD. Five sexual risk behaviours were considered in this analysis (having multiple sex partners, starting sex at an early age, having had sex with a nonregular partner, sex in return for payment and condomless sex). A composite variable was created and called "risky sexual behaviour (RSB)", which was defined in three categories (low risk, moderate risk and high risk) based on the co-occurrence of the individual sexual risk behaviours. Generalized structural equation was used to identify the predictors of RSB withincome possession as a mediator. A total of 973 PWD were included in this study. The proportion of PWD who were engaged in at least two risky sexual behaviours was 9.5% (95%CI: 6.5-13.8), those with one risky sexual behaviour represented 42.8% (95%CI: 39.4-46.3) and less than half ( 47.7% (95%CI: 43.3-52.1)) werenot engaged in risky sexual behaviour. The prevalence of HIV increased with the level of risky sexual behaviour. Age, education level and type of disability have a significant direct effect on RSB. Indeed, the oddof engaging in sexual risk behaviour was low among PWD who attended at least secondary school compared to those who were not schooled (adjusted odds ratio (aOR): 0.62 (95%CI: 0.41-0.92). The indirect effect of sex on RSB mediating by income possession was significant. Indeed, women with income have a low oddof engaging in RSB compared to men (aOR: 0.83 [95%CI: 0.71-0.98]). Our results confirm a certain ambivalence in the sexuality of people with disabilities. Hence, there is a need for a particular focus on risky sexual behaviour to enable the development of an effective HIV strategy in this group.

Prevalence and risk factors of violence among persons with disabilities in Burkina Faso.

This study aimed to analyse factors associated with violence against people with disabilities in Burkina Faso. This is a secondary analysis of data from cross-sectional study among people with disability with Grade 3-4 between 15 and 65 years of age. The prevalence of violence was 13.9%. Persons with physical or multiple disabilities were more likely to suffer violence, while people with physical, intellectual, or multiple disabilities were less likely to suffer violence than those with visual disabilities. Additionally, those between 34 and 55 years were less likely to suffer violence than those over 55. Monogamous and polygamous people with disabilities were 1.9 and 4.3 times, respectively, more likely to be victims of violence than single people. People without formal education were 1.47 times more likely to experience violence than those with education; those living in a family or alone in a housing unit were 2.79 and 12.61 times, respectively, more likely to experience violence than those living with others in a housing unit. Findings suggest that violence is common against all persons with disabilities, but that some factors make violence more likely. There is a need for a policy against violence among people with disability.

Prevalence and factors associated with stigma among people with disabilities in Niger in 2018: a multi-level analysis.

People with disability face stigmatization in most of African countries. The objective of this study was to determine the prevalence and the factors associated with stigma among people living with a disability in Niger. This is a secondary analysis of data from a cross sectional study on disability and HIV conducted in Niger from June to November 2018. People with disabilities in grades 3 and 4 identify with Washington Group Short Set of Questions, aged 15-60, were included. Factors associated with stigma were identified by a binary multilevel regression model. A total of 820 participants were included. The prevalence of stigma was 18%. People with intellectual (adjusted odds ratio [aOR]: 1.89; 95% Confidence interval [95%CI] [1.58-5.03]) and cognitive (aOR:2.82; 95%CI 1, 14-3.13]were more likely to experience stigma than other types of disabilities. People with disabilities over the age of 20 were 57% to 71% less likely to be stigmatized than people with disabilities aged 15-19. Living in the same accommodation with other people with disabilities was also a protective factor against the experience. There is a need to implement interventions to reduce the stigmatization of people with disabilities in Niger.

Accessibility and use of HIV prevention services among people with disabilities in Burkina Faso and Niger.

ABSTRACTOur study aims to determine the predictors of access to HIV services among disabled persons in two West African countries. This was a secondary analysis from a cross-sectional study carried out in Burkina Faso, in 2017 and Niger, in 2018. People with a disability of severity 3 or 4 and aged 15-69 were included in the study. Access to HIV-related services was measured separately through three variables (access to condoms when needed, history of testing for HIV and ever attended at an HIV-related service). Factors associated with access to HIV-related services were identified using logistic regression. 1794 participants were recorded, including 973 in Burkina Faso and 821 in Niger. The ability to easily obtain a condom when needed was reported by 29.4% of respondents in Burkina Faso and 5.7% of respondents in Niger. The proportion of participants who had been tested for HIV was 32.2% in Burkina Faso and 13.6%. We observed that 5.7% and 3.5% of the participants were in contact with an HIV-related service. Only educational status was associated with access to HIV prevention services in both countries. There is a need to increase the access to HIV prevention for disabled persons in the two countries.

Prevalence and risk factors of HIV infection among people with disabilities in Burkina Faso.

This study aimed to determine the prevalence and risk factors of HIV infection among people with disabilities (PWDs) in Burkina Faso. We carried out a cross-sectional study on level 3 and/or 4 disabled people. Identification of PWDs aged 15-69 years was done in households using the Washington Group (WG) Short questionnaire, following by HIV behavioural survey and HIV testing. Multi-level binary logistics Bayesian analysis was done to identify factor associated with HIV. In total, 973 PWDs were included in this study. HIV prevalence was 4.6% (3.3-6.1%). Independent factors associated with HIV infection were aged 35-44 years old (AOR: 8.93; 95% CrI: 3.57-18.89), had visual or hearing impairments (AOR: 6.38; 95%CrI: 1.95-15.44), no income (AOR:6.11; 95% CrI: 2.49-12.48), and had casual sex partners (AOR: 6.28; 95% CrI: 3.27-11.13). HIV prevalence is high compared to the general population. These data suggest a need for comprehensive and specific HIV prevention among people with disabilities, including awareness for safer sexual behaviours.

Low prevalence of HIV infection among persons with disabilities in Niger: findings from a household-based cross-sectional study in 2018.

The aim of this work was to report for the first time the prevalence of HIV infection among people with disabilities (PWDs) in Niger. The Washington Group Short questionnaire was used to identify people with disabilities during a household survey. Blood samples for HIV testing were collected using the Dried Blood Sampling (DBS) method. HIV testing was performed according to the Niger national HIV testing guideline. A total of 21,979 persons aged 15-69 years were screened, of them 2237 (10.17%) had disabilities and 949 participants (4.32%) had severe disabilities (level 3 or 4). Finally, 821 participants agreed to participate in the HIV testing. Female persons with disabilities accounted for the majority (52.25%). People with physical impairment were mostly represented (39.27%) followed by those with visual impairment (38.66%). At least one-third had multiple impairs (36.91%). HIV prevalence among person with disabilities was 0.66% (95% CI: 0.33-1.30). There is no difference between HIV prevalence and type of disabilities or socio-demographic characteristics. Hence, there is a need to consider them in the development and implementation of an effective HIV strategy.

Prevalence and factors associated with HIV infection among people with disabilities in Mali.

Previous studies on HIV and disability have reported the vulnerability of people with disabilities (PWDs) to HIV and the need to include them in HIV prevention programs. However, in Mali, data on HIV among this population is scarce. This study aims to estimate HIV prevalence and risk factors among people with disabilities in Mali. We conducted a household-based cross-sectional study in six regions of Mali. The Washington Group (WG) short questionnaire was used to identify PWDs in the household. A total of 1051 PWDs were included in the study. The prevalence of HIV infection among people with disabilities in Mali was 2.38% (25/1051), with a 95% confidence interval (CI) of 1.58%-3.44%. HIV prevalence was higher in women (3.31% [95%CI: 2.14-4.88]) than in men (0.78% [95%CI: 0.22-2.06]). People with visual or intellectual functional limitations were the most affected, with 3.93% (95%CI: 2.22-6.44) and 2.67% (95%CI: 0.56-8.28), respectively. Multivariate analysis shows that age, sex, type of disability and sexual violence are the risk factors for HIV infection among people with disabilities in Mali. These results suggest that HIV strategies should include people with disabilities in order to achieve the target of ending the HIV/AIDS epidemic by 2030 in Mali.

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions.

BACKGROUND: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. METHOD: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. RESULTS: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. CONCLUSION: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.

Prevalence and factors associated to the occurrence of sexual violence among people with disabilities in Burkina Faso.

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in four regions (Central, Central-East, Central-West and 'Hauts Bassins' regions) of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among female with disability. No significant association was found between different and sexual violence among people with disabilities. Sexual violence is frequent among PWDs in Burkina Faso. Specific policy to protect PWDs particularly women with disabilities from sexual violence is urgently needed.

Pharmacokinetic study of two different rifabutin doses co-administered with lopinavir/ritonavir in African HIV and tuberculosis co-infected adult patients.

BACKGROUND: This study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. METHODS: This is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay. RESULTS: The Cmax and AUC0-12h medians in arm A (Cmax = 296 ng/mL, IQR: 205-45; AUC0-12h = 2528 ng.h/mL, IQR: 1684-2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403-717; AUC0-12h = 4042.5 ng.h/mL, IQR: 3469-5761), with a statistically significant difference in AUC0-12h (p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit (< 300 ng/mL) in the 150 mg RBT arm, while the Cmax was above this threshold for all patients in the 300 mg RBT arm. Additionally, at 48 h after drug ingestion, all patients had a mycobacterial minimum inhibitory concentration (MIC) above the limit (> 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm. CONCLUSION: This study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria. TRIAL REGISTRATION: PACTR201310000629390, 28th October 2013.

Pharmacokinetics of plasma lopinavir and ritonavir in tuberculosis-HIV co-infected African adult patients also receiving rifabutin 150 or 300 mg three times per week.

BACKGROUND: To evaluate the pharmacokinetic of plasma lopinavir (LPV) and ritonavir (RTV) when co-administered with three times weekly (TPW) rifabutin (RBT) at a dose of either 150 or 300 mg in African tuberculosis (TB) and HIV co-infected adult patients. METHODS: This is a pharmacokinetic study conducted in Ouagadougou among patients treated with a standard dosage of LPV/RTV 400/100 mg twice daily and RBT 150 mg TPW (arm A = 9 patients) or rifabutin 300 mg TPW (arm B = 7 patients) based regimens. Patients were recruited from the Bogodogo and Kossodo district hospitals in Ouagadougou from May 2013 to December 2015. Study inclusion criteria were that the patients were between 18 and 60 years of age, HIV-1 infected with pulmonary tuberculosis confirmed or suspected. Subsequent blood samples for pharmacokinetic monitoring were collected at 1, 2, 3, 4, 6, 8 and 12 h after combined drug ingestion for plasma drug monitoring using HPLC/MS assays. RESULTS: The medians LPV Cmax and Tmax were respectively, 20 µg/mL and 4 h for the RBT 150 mg group (arm A) and 7.7 µg/mL and 3 h for the RBT 300 mg group (arm B). The AUC0-12 of LPV was 111.8 µg h/mL in patients belonging to arm A versus 69.9 µg/mL for those in arm B (p = 0.313). The C0 of LPV was lower than 4 µg/mL in three patients receiving RBT 300 mg. Of note, the RTV plasma concentrations were nearly halved among patients on RBT 300 mg compared to those on lower RBT doses. The AUC0-12 of RTV in arm A was 12.7 µg h/mL versus 6.6 µg h/ml in arm B (p = 0.313). CONCLUSION: In our study, the pharmacokinetic of LPV and RTV was found to be highly variable when coadministrated with RBT 150 mg or 300 mg three times per week. There is a need for specific large study to verify clinical and virological effects of this variation, especially when coadministrated with RBT of 300 mg TPW, and to prevent viral resistance in response to under-dosing of LPV. Trial registration PACTR201310000629390. Registered 28 October 2013, http://www.pactr.org/.

Seroepidemiology of syphilis among men who have sex with men in Burkina Faso, West Africa.

Men who have sex with men (MSM) have a disproportionate risk of acquiring sexually transmitted infections (STIs), such as syphilis. However, prevalence and determinants of syphilis among this population are less known in West Africa. This study aims to estimate syphilis prevalence among MSM in Burkina Faso. We conducted a cross-sectional biological and behavior survey in the two main cities of Burkina Faso, Ouagadougou and Bobo-Dioulasso. MSM were recruited using Respondent Driven Sampling (RDS) methods. Data were collected from January to April 2013 in Ouagadougou and from May to August 2013 in Bobo-Dioulasso. Out of the 657 MSM screened for syphilis, 6.1% (40/657) tested positive for Treponema pallidum antibodies and 1.1% (7/657) for active syphilis. Population-weighted prevalence of active syphilis was 2.1% (95% CI, 01.1-04.4) in Ouagadougou and 0.0% in Bobo-Dioulasso. Serologic markers of syphilis (anti-Treponema antibodies) were found among 7.4% (95% CI 5.0-10.8) of MSM in Ouagadougou and 5.0% (95% CI 3.1-8.0) in Bobo-Dioulasso. No significant differences were found in syphilis serological markers prevalence by participants' sociodemographic and behavioral characteristics. The prevalence of syphilis among MSM is low and comparable to that of other individuals of reproductive age in Burkina Faso. This low prevalence is very encouraging and suggests implementation of effective public health intervention programs which direct resources and services toward MSM to prevent further spread of syphilis infection and to limit HIV transmission in this group.

Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso.

BACKGROUND: Stigma is a multifaceted concept that potentiates Human Immunodeficiency Virus and sexually transmitted infection acquisition and transmission risks among key populations, including men who have sex with men (MSM) and female sex workers (FSW). Despite extensive stigma literature, limited research has characterized the types and sources of stigma reported by key populations in Sub-Saharan Africa. METHODS: This study leveraged data collected from 1356 MSM and 1383 FSW in Togo and Burkina Faso, recruited via respondent-driven sampling. Participants completed a survey instrument including stigma items developed through systematic reviews and synthesis of existing metrics. Using exploratory factor analysis with promax oblique rotation, 16 items were retained in a stigma metric for MSM and 20 in an FSW stigma metric. To assess the measures' convergent validity, their correlations with expected variables were examined through bivariate logistic regression models. RESULTS: One factor, experienced stigma, included actions that were carried out by multiple types of perpetrators and included being arrested, verbally harassed, blackmailed, physically abused, tortured, or forced to have sex. Other factors were differentiated by source of stigma including healthcare workers, family and friends, or police. Specifically, stigma from healthcare workers loaded on two factors: experienced healthcare stigma included being denied care, not treated well, or gossiped about by healthcare workers and anticipated healthcare stigma included fear of or avoiding seeking healthcare. Stigma from family and friends included feeling excluded from family gatherings, gossiped about by family, or rejected by friends. Stigma from police included being refused police protection and items related to police confiscation of condoms. The Cronbach's alpha ranged from 0.71-0.82. Median stigma scores, created for each participant by summing the number of affirmative responses to each stigma item, among MSM were highest in Ouagadougou and among FSW were highest in both Ouagadougou and Bobo-Dioulasso. Validation analyses demonstrated higher stigma was generally significantly associated with suicidal ideation, disclosure of involvement in sex work or same-sex practices, and involvement in organizations for MSM or FSW. CONCLUSIONS: Taken together, these data suggest promising reliability and validity of metrics for measuring stigma affecting MSM and FSW in multiple urban centers across West Africa.

Human immunodeficiency virus (HIV) among men who have sex with men: results of the first integrated biological and behavioral survey in Burkina Faso, West Africa.

BACKGROUND: Many men who have sex with men (MSM) are at significant risk for HIV infection. The objective of this study was to determine the prevalence and correlates of HIV infection among MSM in Burkina Faso. METHODS: A cross-sectional biological and behavioral survey was conducted from January to August 2013 among MSM in Ouagadougou and Bobo-Dioulasso. MSM 18 years old and above were recruited using respondent driven sampling (RDS). A survey was administered to study participants followed by HIV testing. Population prevalence estimates and 95% confidence intervals (CI) adjusted for the RDS design were produced using the RDS Analysis Tool version 6.0.1 (RDS, Inc., Ithaca, NY). RESULTS: A total of 662 MSM were enrolled in Ouagadougou (n = 333) and Bobo-Dioulasso (n = 329). The majority were unmarried, with an average age of 22.1 ± 4.4 years old in Ouagadougou and 23.1 ± 4.7 years old in Bobo-Dioulasso. RDS-adjusted HIV prevalence was 1.7% (95% CI: 0.9-3.1) in Ouagadougou and 2.7% (95% CI: 1.6-4.6) in Bobo-Dioulasso. HIV prevalence among MSM under 25 years old was 1.3% (95% CI: 0.6-2.8) and 0.9% (95% CI: 0.4-2.5) respectively in Ouagadougou and Bobo-Dioulasso, compared to 5.4% (95% CI: 2.2-12.5) and 6.6% (95% CI: 3.4-12.3) among those 25 years old or older in these cities (p = 0.010 and p < 0.001). CONCLUSIONS: Results from this first biological and behavioral survey among MSM in Burkina Faso suggest a need for programs to raise awareness among MSM and promote safer sex, particularly for young MSM to prevent HIV transmission. These programs would need support from donors for innovative actions such as promoting and providing pre-exposure prophylaxis, condoms and water-based lubricants, HIV counseling, testing, early treatment initiation and effective involvement of the MSM communities.

Hepatitis B, C, and D virus and human T-cell leukemia virus types 1 and 2 infections and correlates among men who have sex with men in Ouagadougou, Burkina Faso.

BACKGROUND: Men who have sex with men (MSM) are considered to be at significant risk for sexually transmitted infections (STI) and bloodborne viruses including viral hepatitis types B, C, and D (HBV, HCV, and HDV) and human T-cell leukemia virus types 1 and 2 (HTLV 1&2). This study aimed to assess the seroprevalence and correlates of HBV, HCV, HDV, and HTLV 1&2 antibodies among MSM in Ouagadougou, Burkina Faso. METHODS: We conducted a cross-sectional survey to assess the biological and behavourial characteristics among MSM in Ouagadougou from January to April 2013. Serum specimens obtained were tested for the presence of HBV, HCV, HDV and HTLV-1&2 infections. MSM 18 years and older were recruited using respondent driven sampling (RDS). Population estimates and 95% confidence intervals (CI) adjusted for the RDS design were calculated using RDS Analysis Tool (RDSAT) version 6.0.1 (RDS, Inc., Ithaca, NY). Bivariate and multivariate logistic regression analyses were conducted to assess correlates of these infections using Stata 14. RESULTS: A total of 329 MSM were tested. Prevalence was 20.4% (95% CI: 16.4-25.1) for HBV, 11.0% (95% CI: 8.0-14.8) for HCV, and 0.0% for HDV. Anti-HTLV 1&2 antibodies were found in 4.0% (95% CI: 2.3-6.8) of MSM. Factors independently associated with HBV infection were lack of condom use during the last anal sex act with a main male sexual partner and experience of condom tearing during anal sex. Presence of anti-HTLV 1&2 antibodies was associated with history of genital or anal lesions and injection drug use. None of the variables included in our study were associated with HCV. CONCLUSIONS: This study shows that HBV, HCV and HTLV 1&2 prevalence among MSM in Burkina is high and suggests that comprehensive STI prevention and sexual health education services for this group are needed.

HIV prevalence and behavioral and psychosocial factors among transgender women and cisgender men who have sex with men in 8 African countries: A cross-sectional analysis.

INTRODUCTION: Sub-Saharan Africa bears more than two-thirds of the worldwide burden of HIV; however, data among transgender women from the region are sparse. Transgender women across the world face significant vulnerability to HIV. This analysis aimed to assess HIV prevalence as well as psychosocial and behavioral drivers of HIV infection among transgender women compared with cisgender (non-transgender) men who have sex with men (cis-MSM) in 8 sub-Saharan African countries. METHODS AND FINDINGS: Respondent-driven sampling targeted cis-MSM for enrollment. Data collection took place at 14 sites across 8 countries: Burkina Faso (January-August 2013), Côte d'Ivoire (March 2015-February 2016), The Gambia (July-December 2011), Lesotho (February-September 2014), Malawi (July 2011-March 2012), Senegal (February-November 2015), Swaziland (August-December 2011), and Togo (January-June 2013). Surveys gathered information on sexual orientation, gender identity, stigma, mental health, sexual behavior, and HIV testing. Rapid tests for HIV were conducted. Data were merged, and mixed effects logistic regression models were used to estimate relationships between gender identity and HIV infection. Among 4,586 participants assigned male sex at birth, 937 (20%) identified as transgender or female, and 3,649 were cis-MSM. The mean age of study participants was approximately 24 years, with no difference between transgender participants and cis-MSM. Compared to cis-MSM participants, transgender women were more likely to experience family exclusion (odds ratio [OR] 1.75, 95% CI 1.42-2.16, p < 0.001), rape (OR 1.95, 95% CI 1.63-2.36, p < 0.001), and depressive symptoms (OR 1.30, 95% CI 1.12-1.52, p < 0.001). Transgender women were more likely to report condomless receptive anal sex in the prior 12 months (OR 2.44, 95% CI 2.05-2.90, p < 0.001) and to be currently living with HIV (OR 1.81, 95% CI 1.49-2.19, p < 0.001). Overall HIV prevalence was 25% (235/926) in transgender women and 14% (505/3,594) in cis-MSM. When adjusted for age, condomless receptive anal sex, depression, interpersonal stigma, law enforcement stigma, and violence, and the interaction of gender with condomless receptive anal sex, the odds of HIV infection for transgender women were 2.2 times greater than the odds for cis-MSM (95% CI 1.65-2.87, p < 0.001). Limitations of the study included sampling strategies tailored for cis-MSM and merging of datasets with non-identical survey instruments. CONCLUSIONS: In this study in sub-Saharan Africa, we found that HIV burden and stigma differed between transgender women and cis-MSM, indicating a need to address gender diversity within HIV research and programs.