HIV Testing among Men Who Have Sex with Men in Harare, Zimbabwe, 2021: Are There Barriers?

Sexually Transmitted Diseases

Background: Men who have sex with men (MSM) are a key population disproportionately at higher risk of HIV infection. Access to HIV services such as testing is often affected by stigma. According to a 2020 Zimbabwe bio-behavioral survey, 65% of people living with HIV among MSM were unaware of their status against a target of 95%. We identified barriers to HIV testing among MSM in Harare.

Methods: We conducted an analytic cross-sectional study among 329 MSM aged 18 years and above selected using respondent driven sampling. Behavioral, client and service-related data were collected using interviewer administered questionnaires. We performed logistic regression analysis at 95% confidence interval to determine independent factors associated with HIV testing among MSM.

Results: Of 329 MSM interviewed, 71 (21.6%) had not tested for HIV in the preceding six months. Median age was 21 (IQR19-23) years for those tested and 22 (IQR 19-24) years for those not tested for HIV. MSM who reported fear to test [aOR 10.40; 95 CI (4.81-22.44)] and using illicit drugs [aOR 2.85; 95CI (1.29-6.30)] were less likely to test for HIV. MSM accessing HIV services at key population friendly clinics [aOR 0.30; 95 CI (0.13-0.64] and reporting taking pre-exposure prophylaxis (PrEP) [aOR 0.09; 95 CI (0.04-0.23)] were more likely to test for HIV.

Conclusions: Key population friendly clinics were key enablers to HIV testing among MSM. Client centered factors were major barriers for HIV testing. Addressing client centered factors such as fear of testing and substance abuse is key to reaching the 95% target of people living with HIV knowing their status. Improving access to key population friendly clinics will contribute to the goal of ending AIDS by 2030. We sensitized program managers on the need to integrate mental health into HIV testing services for MSM.

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