HIV Prevalence And Associated Risk Factors Among Young Tertiary Student Men Who Have Sex With Men (MSM) In Nairobi, Kenya: A Respondent-Driven Sampling Survey

Abstract Background: Young men who have sex with men (MSM), are a key population at higher risk of HIV infection yet they are underrepresented in research. We conducted a bio-behavioral survey to estimate HIV prevalence and associated risk factors among tertiary student MSM (TSMSM) in Nairobi, Kenya. Methods: Between February and March 2021, 248 TSMSM aged ≥18 years who reported sex with another man in the past year participated in a respondent-driven sampling (RDS) based cross-sectional survey. Participants completed an electronically self-administered behavioral survey and provided a blood sample for HIV antibody testing, alongside urine, anorectal and oropharyngeal swabs for pooled testing of sexually transmitted infections using a multiplex nucleic acid amplification test. RDS-Analyst v.0.72 and Stata v.15 software were used for data analysis. Differences in proportions were examined using chi-square (X 2 ) test, and unweighted multivariate logistic regression was used to assess factors associated with HIV infection. Results: HIV prevalence among study participants was 8.3%, whereas the weighted prevalence was 3.6% (95 % CI: 1.3% - 6.0%). Median ages of participants and at self-reported first anal sex with a man were 21 and 18 years, respectively. Majority (89.3%) of TSMSM owned a smart phone, 46.5% had ever used a geosocial networking app for MSM such as Grindr ® and 55.8% usually met sex partners online. Almost three-quarters (71.3%) had >1 male sex partner in the year before the survey. A third (34.3%) did not use condoms with their last sex partner, 21.2% received money from their last sex partner and 40.9% had taken alcohol/another drug during their last sexual encounter. HIV infection was associated with studying in private institutions (adjusted odds ratio/AOR=6.0; 95% CI: 1.2-30.0, p=0.027), preferring a sex partner of any age – younger, same or older (AOR=5.2; 95 CI: 1.1-25.2, p=0.041), last sex partner being >25 years (AOR=6.4; 95% CI: 1.2-34.6, p=0.030), meeting the last sex partner online (AOR=4.2; 95% CI; 1.1-17.0, p=0.043) and testing positive for Neisseria gonorrhea (AOR=7.8; 95% CI: 2.0-29.9, p=0.003). Conclusions: HIV prevalence among TSMSM in Nairobi is alarmingly high, demonstrating a need for tailored prevention and control interventions for this young key population.