Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa

Autoři: Cheick Haïballa Kounta aff001;  Luis Sagaon-Teyssier aff001;  Pierre-Julien Coulaud aff001;  Marion Mora aff001;  Gwenaelle Maradan aff001;  Michel Bourrelly aff001;  Abdoul Aziz Keita aff003;  Stéphane-Alain Babo Yoro aff004;  Camille Anoma aff004;  Christian Coulibaly aff005;  Elias Ter Tiero Dah aff005;  Selom Agbomadji aff007;  Ephrem Mensah aff007;  Adeline Bernier aff008;  Clotilde Couderc aff009;  Bintou Dembélé Keita aff003;  Christian Laurent aff009;  Bruno Spire aff001
Působiště autorů: Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France aff001;  ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur, Marseille, France aff002;  ARCAD Sida, Bamako, Mali aff003;  Espace Confiance, Abidjan, Côte d’Ivoire aff004;  Association Africaine Solidarité, Ouagadougou, Burkina Faso aff005;  Centre Muraz, Bobo-Dioulasso, Burkina Faso aff006;  Espoir Vie Togo, Lomé, Togo aff007;  Coalition Internationale Sida, Pantin, France aff008;  IRD, INSERM, Univ Montpellier, TransVIHMI, Montpellier, France aff009
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0217115


Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d’Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39–2.50]), less educated (aOR[95%CI]:1.49[1.09–2.03]), unmarried status (aOR[95%CI]:1.79[1.10–2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06–1.88]), group sex with men (aOR[95%CI]:2.07[1.46–2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40–2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12–1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97–3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08–1.93]) and drug use (aOR[95%CI]:1.82[1.24–2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07–1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53–0.99]) was negatively associated with TS.

Klíčová slova:

Africa – Alcohol consumption – Copulation – Finance – HIV epidemiology – HIV prevention – Men who have sex with men


1. United Nations. United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019, Online Edition. 2019. Available:

2. World Bank Report 2018.

3. AIDSInfos/UNAIDS. UNAIDS report: Global AIDS Monitoring 2019. Available:

4. Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low-and middle-income countries 2000–2006: a systematic review. PLoS Med. 2007;4: e339. Available: = 10.1371/journal.pmed.0040339 doi: 10.1371/journal.pmed.0040339 18052602

5. Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. The Lancet. 2012;380: 367–377. doi: 10.1016/S0140-6736(12)60821-6 22819660

6. UNAIDS, 2017. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2017. Geneva: UNAIDS; 2017. 2017.

7. Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe HW. Men who have sex with men and HIV/AIDS in sub-Saharan Africa. The Lancet. 2009;374: 416–422. doi: 10.1016/S0140-6736(09)61118-1

8. Kounta CH, Sagaon-Teyssier L, Coulaud P-J, Mora M, Maradan G, Bourrelly M, et al. Male clients of male sex workers in West Africa: A neglected high-risk population. Clark JL, editor. PLOS ONE. 2019;14: e0212245. doi: 10.1371/journal.pone.0212245 31042757

9. Bui TC, Nyoni JE, Ross MW, Mbwambo J, Markham CM, McCurdy SA. Sexual Motivation, Sexual Transactions and Sexual Risk Behaviors in Men who have Sex with Men in Dar es Salaam, Tanzania. AIDS Behav. 2014;18: 2432–2441. doi: 10.1007/s10461-014-0808-x 24890184

10. Sanders EJ, Graham SM, Okuku HS, van der Elst EM, Muhaari A, Davies A, et al. HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya: AIDS. 2007;21: 2513–2520. doi: 10.1097/QAD.0b013e3282f2704a 18025888

11. Okal J, Luchters S, Geibel S, Chersich MF, Lango D, Temmerman M. Social context, sexual risk perceptions and stigma: HIV vulnerability among male sex workers in Mombasa, Kenya. Cult Health Sex. 2009;11: 811–826. doi: 10.1080/13691050902906488 19484638

12. Geibel S, Luchters S, Kingʼola N, Esu-Williams E, Rinyiru A, Tun W. Factors Associated With Self-Reported Unprotected Anal Sex Among Male Sex Workers in Mombasa, Kenya: Sex Transm Dis. 2008;35: 746–752. doi: 10.1097/OLQ.0b013e318170589d 18650772

13. Choudhry V, Ambresin A-E, Nyakato VN, Agardh A. Transactional sex and HIV risks–evidence from a cross-sectional national survey among young people in Uganda. Glob Health Action. 2015;8: 27249. doi: 10.3402/gha.v8.27249 26001780

14. Henry E, Marcellin F, Yomb Y, Fugon L, Nemande S, Gueboguo C, et al. Factors associated with unprotected anal intercourse among men who have sex with men in Douala, Cameroon. Sex Transm Infect. 2010;86: 136–140. Available: doi: 10.1136/sti.2009.036939 19703845

15. Oldenburg CE, Perez-Brumer AG, Biello KB, Landers SJ, Rosenberger JG, Novak DS, et al. Transactional Sex Among Men Who Have Sex With Men in Latin America: Economic, Sociodemographic, and Psychosocial Factors. Am J Public Health. 2015;105: e95–e102. doi: 10.2105/AJPH.2014.302402 25790381

16. Berg RC, Schmidt AJ, Weatherburn P, The EMIS Network. Transactional Sex: Supply and Demand Among European Men Who have Sex with Men (MSM) in the Context of Local Laws. Int J Sex Health. 2015;27: 286–302. doi: 10.1080/19317611.2014.982263 26430474

17. Stoebenau K, Heise L, Wamoyi J, Bobrova N. Revisiting the understanding of “transactional sex” in sub-Saharan Africa: A review and synthesis of the literature. Soc Sci Med. 2016;168: 186–197. doi: 10.1016/j.socscimed.2016.09.023 27665064

18. Oldenburg CE, Perez-Brumer AG, Reisner SL, Mattie J, Bärnighausen T, Mayer KH, et al. Global Burden of HIV among Men Who Engage in Transactional Sex: A Systematic Review and Meta-Analysis. Prestage G, editor. PLoS ONE. 2014;9: e103549. doi: 10.1371/journal.pone.0103549 25068720

19. Barros AB, Dias SF, Martins MRO. Hard-to-reach populations of men who have sex with men and sex workers: a systematic review on sampling methods. Syst Rev. 2015;4. doi: 10.1186/s13643-015-0129-9 26518345

20. Klingelschmidt J, Parriault M-C, Van Melle A, Basurko C, Gontier B, Cabié A, et al. Transactional sex among men who have sex with men in the French Antilles and French Guiana: frequency and associated factors. AIDS Care. 2016; 1–7. doi: 10.1080/09540121.2016.1234680 27690562

21. Le VIH et le commerce du sexe : note d’orientation de l’ONUSIDA.: 32.

22. Stoebenau K, Nair RC, Rambeloson V, Rakotoarison PG, Razafintsalama V, Labonté R. Consuming sex: the association between modern goods, lifestyles and sexual behaviour among youth in Madagascar. Glob Health. 2013;9: 13. doi: 10.1186/1744-8603-9-13 23510104

23. Dunkle KL, Jewkes RK, Brown HC, Gray GE, McIntryre JA, Harlow SD. Transactional sex among women in Soweto, South Africa: prevalence, risk factors and association with HIV infection. Soc Sci Med. 2004;59: 1581–1592. doi: 10.1016/j.socscimed.2004.02.003 15279917

24. Ranganathan M, Heise L, Pettifor A, Silverwood RJ, Selin A, MacPhail C, et al. Transactional sex among young women in rural South Africa: prevalence, mediators and association with HIV infection. J Int AIDS Soc. 2016;19: 20749. doi: 10.7448/IAS.19.1.20749 27469061

25. Vuylsteke B, Semdé G, Sika L, Crucitti T, Ettiègne Traoré V, Buvé A, et al. HIV and STI Prevalence among Female Sex Workers in Côte d’Ivoire: Why Targeted Prevention Programs Should Be Continued and Strengthened. Vermund SH, editor. PLoS ONE. 2012;7: e32627. doi: 10.1371/journal.pone.0032627 22403685

26. Matovu J, Ssebadduka N. Knowledge, attitudes & barriers to condom use among female sex workers and truck drivers in Uganda: a mixed-methods study. Afr Health Sci. 2014;13: 1027. doi: 10.4314/ahs.v13i4.24 24940328

27. Traore IT, Meda N, Hema NM, Ouedraogo D, Some F, Some R, et al. HIV prevention and care services for female sex workers: efficacy of a targeted community-based intervention in Burkina Faso. J Int AIDS Soc. 2015;18. doi: 10.7448/IAS.18.1.20088 26374604

28. Scheibe A, Drame FM, Shannon K. HIV prevention among female sex workers in Africa. SAHARA-J J Soc Asp HIVAIDS. 2012;9: 167–172. doi: 10.1080/17290376.2012.743809 23237073

29. Akoku DA, Tihnje MA, Vukugah TA, Tarkang EE, Mbu RE. Socio-economic vulnerabilities and HIV: Drivers of transactional sex among female bar workers in Yaoundé, Cameroon. Ranganathan M, editor. PLOS ONE. 2018;13: e0198853. doi: 10.1371/journal.pone.0198853 29912969

30. Scorgie F, Chersich MF, Ntaganira I, Gerbase A, Lule F, Lo Y-R. Socio-Demographic Characteristics and Behavioral Risk Factors of Female Sex Workers in Sub-Saharan Africa: A Systematic Review. AIDS Behav. 2012;16: 920–933. doi: 10.1007/s10461-011-9985-z 21750918

31. Wamoyi J, Stobeanau K, Bobrova N, Abramsky T, Watts C. Transactional sex and risk for HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. J Int AIDS Soc. 2016;19. doi: 10.7448/IAS.19.1.20992 27809960

32. Jenness SM, Kobrak P, Wendel T, Neaigus A, Murrill CS, Hagan H. Patterns of Exchange Sex and HIV Infection in High-Risk Heterosexual Men and Women. J Urban Health. 2011;88: 329–341. doi: 10.1007/s11524-010-9534-5 21286827

33. Dunkle Kristin L., Jewkes R, Nduna M, Jama N, Levin J, Sikweyiya Y, et al. Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: Prevalence, predictors, and associations with gender-based violence. Soc Sci Med. 2007;65: 1235–1248. doi: 10.1016/j.socscimed.2007.04.029 17560702

34. Oldenburg CE, Perez-Brumer AG, Reisner SL, Mimiaga MJ. Transactional Sex and the HIV Epidemic Among Men Who have Sex with Men (MSM): Results From a Systematic Review and Meta-analysis. AIDS Behav. 2015;19: 2177–2183. doi: 10.1007/s10461-015-1010-5 25652233

35. Baral SD, Friedman MR, Geibel S, Rebe K, Bozhinov B, Diouf D, et al. Male sex workers: practices, contexts, and vulnerabilities for HIV acquisition and transmission. The Lancet. 2015;385: 260–273. doi: 10.1016/S0140-6736(14)60801-1 25059939

36. Baral S, Logie CH, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health. 2013;13: 482. Available: 23679953

37. Möller LM, Stolte IG, Geskus RB, Okuku HS, Wahome E, Price MA, et al. Changes in sexual risk behavior among MSM participating in a research cohort in coastal Kenya: AIDS. 2015;29: S211–S219. doi: 10.1097/QAD.0000000000000890 26562810

38. Ha H, Ross MW, Risser JMH, Nguyen HTM. Measurement of Stigma in Men Who Have Sex with Men in Hanoi, Vietnam: Assessment of a Homosexuality-Related Stigma Scale. J Sex Transm Dis. 2013;2013: 1–9. doi: 10.1155/2013/174506 26316952

39. Cui J. QIC program and model selection in GEE analyses. The Stata Journal. 2007;7: 12.

40. Cluver L, Boyes M, Orkin M, Pantelic M, Molwena T, Sherr L. Child-focused state cash transfers and adolescent risk of HIV infection in South Africa: a propensity-score-matched case-control study. Lancet Glob Health. 2013;1: e362–e370. doi: 10.1016/S2214-109X(13)70115-3 25104601

41. Semugoma P. Semugoma P, Beyrer C, Baral S. Assessing the effects of anti-homosexuality legislation in Uganda on HIV prevention, treatment, and care services. SAHARA-J: Journal of Social Aspects of HIV/AIDS. 2012; 9:173–176. [PubMed: 23237074]. doi: 10.1080/17290376.2012.744177 23237074

42. Sandfort T, Bos H, Knox J, Reddy V. Gender Nonconformity, Discrimination, and Mental Health Among Black South African Men Who Have Sex with Men: A Further Exploration of Unexpected Findings. Arch Sex Behav. 2016;45: 661–670. doi: 10.1007/s10508-015-0565-6 26067298

43. Cook SH, Sandfort TGM, Nel JA, Rich EP. Exploring the Relationship Between Gender Nonconformity and Mental Health Among Black South African Gay and Bisexual Men. Arch Sex Behav. 2013;42: 327–330. doi: 10.1007/s10508-013-0087-z 23440563

44. Nyoni JE, Ross MW. Condom use and HIV-related behaviors in urban Tanzanian men who have sex with men: A study of beliefs, HIV knowledge sources, partner interactions and risk behaviors. AIDS Care. 2013;25: 223–229. doi: 10.1080/09540121.2012.699671 22788911

45. Kim M, McKenney J, Khosropour CM, Prater AB, Rosenberg ES, Siegler AJ, et al. Factors Associated With Condom Breakage During Anal Intercourse: A Cross-Sectional Study of Men Who Have Sex With Men Recruited in an Online Survey. JMIR Public Health Surveill. 2016;2: e7. doi: 10.2196/publichealth.5298 27227161

46. Musinguzi G, Bastiaens H, Matovu JK, Nuwaha F, Mujisha G, Kiguli J, et al. Barriers to condom use among high risk men who have sex with men in Uganda: a qualitative study. PloS One. 2015;10: e0132297. doi: 10.1371/journal.pone.0132297 26172374

47. Jerome R. C., & Halkitis P. N. (2009). Stigmatization, Stress, and the Search for Belonging in Black Men Who Have Sex With Men Who Use Methamphetamine. Journal of Black Psychology, 35(3), 343–365.

48. Woolf-King SE, Maisto SA. Alcohol Use and High-Risk Sexual Behavior in Sub-Saharan Africa: A Narrative Review. Arch Sex Behav. 2011;40: 17–42. doi: 10.1007/s10508-009-9516-4 19705274

49. Lane T, Shade SB, McIntyre J, Morin SF. Alcohol and Sexual Risk Behavior Among Men Who Have Sex with Men in South African Township Communities. AIDS Behav. 2008;12: 78–85. doi: 10.1007/s10461-006-9197-0 17295075

50. Liu S, Detels R. Recreational Drug Use: An Emerging Concern Among Venue-Based Male Sex Workers in China. Sex Transm Dis. 2012;39: 251–252. doi: 10.1097/OLQ.0b013e31824a0903 22421689

51. Myers T, Aguinaldo JP, Dakers D, Fischer B, Bullock S, Millson P, et al. How Drug using men who have sex with men account for substance use during Sexual Behaviours: Questioning assumptions of Hiv Prevention and Research. Addict Res Theory. 2004;12: 213–229. doi: 10.1080/16066350310001640161

52. Deiss RG, Clark JL, Konda KA, Leon SR, Klausner JD, Caceres CF, et al. Problem drinking is associated with increased prevalence of sexual risk behaviors among men who have sex with men (MSM) in Lima, Peru. Drug Alcohol Depend. 2013;132: 134–139. doi: 10.1016/j.drugalcdep.2013.01.011 23434130

53. Smith AMA. Associations between the sexual behaviour of men who have sex with men and the structure and composition of their social networks. Sex Transm Infect. 2004;80: 455–458. doi: 10.1136/sti.2004.010355 15572613

54. Crowell TA, Keshinro B, Baral SD, Schwartz SR, Stahlman S, Nowak RG, et al. Stigma, access to healthcare, and HIV risks among men who sell sex to men in Nigeria. Journal of the International AIDS Society. 20:21489. 2017. Available: doi: 10.7448/IAS.20.01.21489 28453241

55. Luke N. Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann. 2003;34: 67–86. Available: 12889340

56. World Bank. 2016. World Development Indicators 2016. Washington, DC: World Bank. doi: 10.1596/978–1–4648–0683–4 License: Creative Commons Attribution CC BY 3.0 IGO.

57. Johnston LG, Holman A, Dahoma M, Miller LA, Kim E, Mussa M, et al. HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania. Int J Drug Policy. 2010;21: 485–492. doi: 10.1016/j.drugpo.2010.06.001 20638262

58. Sanders EJ, Okuku HS, Smith AD, Mwangome M, Wahome E, Fegan G, et al. High HIV-1 incidence, correlates of HIV-1 acquisition, and high viral loads following seroconversion among MSM: AIDS. 2013;27: 437–446. doi: 10.1097/QAD.0b013e32835b0f81 23079811

59. Wheeler DP, Lauby JL, Liu K, Van Sluytman LG, Murrill C. A Comparative Analysis of Sexual Risk Characteristics of Black Men Who Have Sex with Men or with Men and Women. Arch Sex Behav. 2008;37: 697–707. doi: 10.1007/s10508-008-9372-7 18509753

60. Stahlman S, Sanchez TH, Sullivan PS, Ketende S, Lyons C, Charurat ME, et al. The Prevalence of Sexual Behavior Stigma Affecting Gay Men and Other Men Who Have Sex with Men Across Sub-Saharan Africa and in the United States. JMIR Public Health Surveill. 2016;2: e35. doi: 10.2196/publichealth.5824 27460627

61. Anderson AM, Ross MW, Nyoni JE, McCurdy SA. High prevalence of stigma-related abuse among a sample of men who have sex with men in Tanzania: implications for HIV prevention. AIDS Care. 2015;27: 63–70. doi: 10.1080/09540121.2014.951597 25162483

62. Fay H, Baral SD, Trapence G, Motimedi F, Umar E, Iipinge S, et al. Stigma, Health Care Access, and HIV Knowledge Among Men Who Have Sex With Men in Malawi, Namibia, and Botswana. AIDS Behav. 2011;15: 1088–1097. doi: 10.1007/s10461-010-9861-2 21153432

63. Risher K, Adams D, Sithole B, Ketende S, Kennedy C, Mnisi Z, et al. Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland. J Int AIDS Soc. 2013;16. doi: 10.7448/IAS.16.3.18715 24242263

Článek vyšel v časopise


2019 Číslo 11