Cải thiện dịch vụ chăm sóc và dự phòng HIV cho những người tình dục đồng giới nam_Improving HIV Prevention and Care Services for MSM in Cambodia: The SAHACOM

Cải thiện dịch vụ chăm sóc và dự phòng HIV cho những người tình dục đồng giới nam_Improving HIV Prevention and Care Services for MSM in Cambodia: The SAHACOMGlobal HIV Situation among MSMChallenges in HIV programs: Greater risk for HIV, less access to intervention programs, and less understood due to their more hidden and stigmatized nature (Altman et al., 2012HIV prevalence:3.0% in the Middle East and North Africa region to as high as 25.4% in the Caribbean (Beyrer et al., 2012)HIV and STI prevalence continues to rise (Beyrer et al., 2013)– Condom use and HIV testing: Considerably low in low and middleincome countries (Oldenburg et al., 2014)HIV Situation among MSM in CambodiaHIVSTI prevalence:2010: 2.2% (BROS Khmer Study, 2010) 2015: 2.4% (NCHADS, 2015)STI symptoms in the past 12 months: 51.5% HIV risk behaviors (past 3 months): (Yi et al., 2015)Mean number of sex partners: 4 Had sex with a girlfriend: 32.2%Had sex with FSWs: 14.6%Had sex with MSWs: 9.9%Sold sex to women: 8.9% Sold sex to men: 17.4%

Improving HIV Prevention and Care Services

for MSM in Cambodia: The SAHACOM

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7 th ICPH, Hue City, Vietnam | 26-27 September 2015

Siyan Yi, MD, MHSc, PhD

Director, Center for Population Health Research, KHANA

Adjunct Ass Professor, Center for Global Health Research, Touro

University California

Co-Investigators:

Pheak Chhoun, Kouland Thin, Carinne Brody

Khimuy Tith, Sovannary Tuot

Global HIV Situation among MSM

– Challenges in HIV programs: Greater risk for HIV,

less access to intervention programs, and less

understood due to their more hidden and stigmatized

nature (Altman et al., 2012

– HIV prevalence:

• 3.0% in the Middle East and North Africa region to as high as 25.4% in the Caribbean (Beyrer et al., 2012)

• HIV and STI prevalence continues to rise (Beyrer et al., 2013)

– Condom use and HIV testing: Considerably low in low- and middle-income countries (Oldenburg et al., 2014)

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Global HIV prevalence in MSM, from studies published 2007–2011 (Beyrer et al., 2012)

Global prevalence of HIV in MSM compared with regional adult prevalence (UNAIDS, 2010)

Map of the Study Sites

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03/03/2024 6

Estimations and Projections of HIV Prevalence among General Population

Aged 15-49 (1990-2015)

HIV Situation among MSM in Cambodia

– HIV/STI prevalence:

• 2010: 2.2% (BROS Khmer Study, 2010)

• 2015: 2.4% (NCHADS, 2015)

• STI symptoms in the past 12 months: 51.5%

– HIV risk behaviors (past 3 months): (Yi et al., 2015)

• Mean number of sex partners: 4

• Had sex with a girlfriend: 32.2%

• Had sex with FSWs: 14.6%

• Had sex with MSWs: 9.9%

• Sold sex to women: 8.9%

• Sold sex to men: 17.4%

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Condom Use among MSM in Cambodia

– Always used condoms (past 3 months): (Yi et al., 2015)

• Girlfriends: 55.1%

• Boyfriends: 64.2%

• Female sex workers: 75.9%

• Male sex workers: 73.0%

• Female clients: 78.1%

• Male clients: 70.3%

– Always used lubricant (past 3 months): (Siyan Yi et al 2015)

• Anal sex with boyfriends (80.8%)

• Selling anal sex (64.1%)

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Factors Associated Inconsistent Condom Use

among MSM in Cambodia

• Older age: ≥25

• Self-perception of higher HIV risk compared to

the general population (Higher: 36%, Same:

16.4%, Lower: 46.6%)

• Illicit drug use

• Reported consistent lubricant use when

having anal sex with men

• Self-reported quality of life as good or very

good

(Yi et al., 2015)

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HIV Testing among MSM in Cambodia

– HIV testing history:

• Lifetime: 83.6%

• Past 6 months: 65.1%

– Factors associated with HIV testing:

• Receiving any form of HIV education

• Self-perception of higher HIV risk compared to general

population

• Having been diagnosed with an STI

• Using a condom at last sex with a man or women

• Using a condom at last anal intercourse with a

boyfriend

(Yi et al., 2015)

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The SAHACOM Activities for MSM

1 Outreach and BCC to increase awareness of

risky sexual behaviors related to HIV and STI

2 Distribution of free condoms and lubricant

3 HIV and STI screening by peer counselors at

the community level for MSM and their

partners

4 Immediate enrolment in pre-ART/ART

services for HIV-positive MSM

5 Harm reduction intervention providing

education on HIV and illicit drug

overlapping risk behaviors

Siyan Yi et al JIAS 2015 (In press)

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Study Objective

To review the intervention activities and

measure the efficiency and effectiveness of

the programs by comparing outcome

indicators measured at midterm

and end line

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Study Population

• MSM definition: Males who have sex with males,

regardless of whether they have sex with women or have

a personal or social gay or bisexual identity (UNAIDS, 2011)

• Inclusion criteria:

– Biological male – 18 years of age – Reporting having sex with at least one male

partner in the past 12 months

– Khmer speaking– Able and willing to provide oral informed consent

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Study Sites

• Provinces: Battambang & Siem Reap - 70% of the

total of MSM covered by the SAHACOM

• Hot spots and venues:

– Night club/discotheque– Sauna/spa

– Barber/beauty salon– Streets

– Park/river bank– Specific community: private houses, pagoda,

etc

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Study Design & Sampling Procedures

• Midterm – endline comparisons:

– Midterm survey in 2012: 352 MSM– Endline survey in 2014: 394 MSM

• Sample size and sampling:

– Minimum required sample size: 350– Two-stage cluster sampling method:

o Communes: Under the SAHACOM for at least 12 months

o Venues/hotspots: At least 20 MSM – take all approach

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– Substance use– Access to care and support services

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– Student’s t-test or ANOVA for continuous variables

• Multivariable logistic regression model

– Covariates: Covariates: Sites, age, venues, income, and

all variables associated with outcome variables of interest at p< 0.05

– Significance level: Two-sided p< 0.05

– Soft wares: SPSS and STATA

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Ethical Considerations

• Ethical approval:

– National Ethics Committee for Health

Research (NECHR)

• Confidentiality & privacy protection:

– No personal identifier collected

– Interviews at private places

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Socio-demographic Characteristics

Characteristics Midterm End line OR (95% CI)

Mean age (in years) 23.3 ± 5.3 23.7 ± 5.2 0.84

HIV testing among MSM at midterm and end line

HIV testing experiences Midterm End line AOR (95% CI)

Tested for HIV in the past 6 months 289 (94.1) 252 (77.1) 2.9 (1.8-3.6)

Place of the most recent HIV test

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Sexual Behaviors, STIs, and Drug Use among MSM at Midterm and Endline

Sexual Behaviors & STIs Midterm End line AOR (95% CI)

Sexual behaviors

Number of sex partners in the past 3 months 6.2 ± 12.4 4.0 ± 5.5 0.03

Had paying sex with men in the past 3 month

67 (19.0) 38 (9.7)

2.0 (1.3-3.0)

Had sex with girlfriends in the past 3 months 59 (15.6) 118 (29.9) 1.8 (1.3-2.5) Always used condoms in the past three months 51 (73.9) 27 (73.0) 1.1 (0.6-2.0) Always used lubricant in the past 3 months 34 (49.3) 41 (64.1) 1.2 (0.7-2.2)

STI symptoms and illicit drug use

Had at least one STI symptom in the past 3 months 99 (28.1) 24 (6.1) 4.6 (2.9-7.4) Sought treatment for the most recent symptom 14 (14.1) 6 (20.7) 2.6 (1.1-6.9) Illicit drug use in the past 6 months 43 (12.2) 20 (5.1) 2.4 (1.4-4.2)

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• No baseline data:

– Compared outcome indicators at midterm

and end line

– Impacts of the programs could not be

fully evaluated

• Unknown validity of the tools

• Self-reported measures: Underreporting

and over-reporting

• Possibility of recall bias

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Conclusions & Recommendation

• SAHACOM is successful in:

• Not successful in:

–Increasing condom use rates in all relationships

–HIV testing rate was even going down

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Thank you!

Q & A

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