HIV/Sexually Transmitted Infection Prevalence and Sexual Behavior of Men Who Have Sex With Men in 3 Districts of Botswana: Results From the 2012 Biobehavioral Survey

Background: Men who have sex with men (MSM) suffer significant stigma and discrimination; hence, they are reluctant to access health services. The Botswana Second National Strategic Framework for 2010-2016 stipulates the need to increase HIV prevention services for key populations as one of its prevention implementation strategies. We report here the prevalence of HIV and other sexually transmitted infections and risk factors for HIV infection among MSM in Botswana. Methods: We conducted a cross-sectional survey using respondent driven sampling in 3 districts of Botswana: Gaborone, Francistown, and Kasane. Results: Of the 454 participants recruited, most were Batswana (97.6%) with a mean age of 23.2 years (range, 18-53 years), with 74.9% aged between 20 and 29 years. The overall unadjusted HIV prevalence was 13.1% (95% confidence interval, 10.0-16.3), with 12.3%, 11.7%, and 25.9% in Gaborone, Francistown, and Kasane, respectively. Chlamydia trachomatis prevalence was higher than Neisseria gonorrhoeae in both urine and anal swabs, at 7.1% and 5.9%, respectively, versus 1.4% and 1.7%. Overall, 46.7% of respondents reported having sex with female partners. Men who have sex with men who thought they had a high chance of acquiring HIV had a significantly lower likelihood of using condom consistently than those who reported they had a lower chance of acquiring HIV (odds ratio = 0.4; 95% confidence interval, 0.2-0.7; P = 0.003). Conclusion: HIV prevalence of MSM was lower than what has been reported in other sub-Saharan African countries with generalized epidemics; however, their degree of participation in heterosexual sex signifies sexual networks beyond the MSM subpopulation.