In 2010, the Nyanza Reproductive Health Society (NRHS), in collaboration with the University of Illinois at Chicago (UIC), completed a respondent-driven sampling study of GBMSM in Kisumu. Four hundred and fifteen men of aged 18-62 years who reported oral or anal sex with another man in the last 6 months were recruited following the eleven original seeds. Overall HIV prevalence was 14%, with a prevalence among 18-19 year-olds of 4.2%, versus 28.9% among 25-29 year-olds. This highlights the need to emphasize prevention in young GBMSM before they become infected. Older age, herpes simplex virus type two seropositivity, having more than five paying male partners in the last 30 days, and condomless vaginal sex with the most recent female partners were some of the factors that were associated with HIV infection. This is an indication that risk reduction for GBMSM must focus not only on same-sex behavior, but also on sex with female partners since HIV prevalence among women aged 20-29 years in Kisumu is as high as 20%-30%. Before and during this work, NRHS founded a support group for GBMSM, called Kisumu Initiative for Positive Empowerment (KIPE), which rapidly grew to ≈350 active members. During 2011, KIPE provided HIV counseling and testing to 740 GBMSM in the greater Kisumu area, referring HIV-positive men to an ART clinic run by NRHS or an ART provider of their choice.
This work formed the basis for the CDC-funded Anza Mapema demonstration project, which aimed to: 1) find and test 700 GBMSM for HIV; 2) link and retain HIV-positive GBMSM in HIV care including ART; and 3) link and retain HIV-negative GBMSM in a non-ART care and risk reduction program including retesting every 3 months after enrollment. Anza Mapema participants were followed for twelve months, and benefited from services including risk reduction counseling, condoms and lubricants, STI screening and treatment, and post-exposure prophylaxis (PEP) as indicated, with ART for HIV-positive participants. Participants who tested positive for HIV during their participation in Anza Mapema were followed for an additional twelve months post seroconversion. In addition, social events such as theatrical events, movie nights, spiritual meetings, risk sharing sessions, and regular “coffee Wednesday” meetings to promote reduction in alcohol and substance use, are available and popular with participants. Between 31Aug2015 and 17Sep2016, 1,012 men were screened for study participation of whom 756 were eligible and 713 men were enrolled with an overall of 80% retained in the study. We had 13 persons seroconverting during follow-up (≈2.6 cases per 100 person years). Willingness to use PrEP was high overall (92.3%), and was not associated with baseline PrEP eligibility or baseline condomless receptive anal intercourse (RAI) with a partner of unknown or HIV-positive status (p=0.293 and p=0.832, respectively). Currently NRHS is following a subset of 168 MSM who have initiated PrEP to assess feasibility, acceptability and adherence. Adherence is measured through study visits attendance, pill count, participants’ self-report as well as by measurement of drug levels in plasma.
In January 2018, NRHS received a sub contract from LVCT Health to offer programmatic comprehensive HIV prevention, care and treatment services for 600 MSM in Kisumu. These are conducted at two NRHS centers within Kisumu; (1) the Anza Mapema Tom Mboya center which is the main hub of activities and is located within the Tom Mboya residential estate. This center is more ‘out’ and is identified with GBMSM to be a safe space where they can get services and engage in activities. The center has two reception areas, six rooms for offices and clinical rooms, and a wide-open area that has a seating capacity of about 300 people used for meetings and social activities. (2) The second center is the Anza Mapema Town Clinic that is located within the Central Business District of Kisumu and caters for more ‘hidden’ and ‘upper class’ GBMSM who do not want to be seen going to Anza Mapema Tom Mboya. The center also has flexible working hours to allow clients access in the evenings and early nights depending on their need. The programme is to follow the NASCOP guidelines on KP programming plus provide the GBMSM affirming activities that the community has come to expect from .