Correlates of retention in HIV care among homosexual and heterosexual men: a comparative study

Abstract

Background: Globally, men who have sex with men (MSM) have a disproportionately high HIV burden compared with heterosexual men. In Nigeria, the HIV seroprevalence rate among MSM has steadily increased, threatening progress towards ending the epidemic. Objective: This study, therefore, determined and compared the correlates of retention in HIV care among MSM and heterosexual men in Ibadan, Nigeria. Method: A prospective study of 650 HIV-positive men was conducted. Respondent-driven sampling was used to select 160 HIV-positive MSM, while convenience sampling was used to select 490 HIV-positive heterosexual men from antiretroviral treatment (ART) clinics in Ibadan. All respondents were over 18 years old and ART-naïve. Data were collected using a semi-structured, interviewer-administered questionnaire and a clinical pro forma to track retention over 24 months. Descriptive analysis and a binomial regression model were performed at α = 0.05. Adjusted Risk Ratios (ARRs), defined as the ratio of outcome probabilities between groups after adjustment for confounders, were estimated from the regression model. Result: The mean ages of heterosexual men and MSM were 43.1 ± 8.67 and 26.4 ± 5.82 years, respectively. Retention at 24 months was significantly higher among heterosexual men (87.6%) than MSM (68.1%) (P < 0.001). Heterosexual men were more likely to be retained if they had two or more wives (ARR): 1.19, 95% CI: 1.09–1.30), lived with a spouse (ARR): 1.23, 95% CI: 1.07–1.43), and had good knowledge of HIV (ARR: 1.16, 95% CI: 1.10–1.25). HIV-positive MSM who discussed HIV/AIDS with health workers/peer educators in the last 12 months ((ARR): 4.85, 95% CI: 4.17–5.63) and had a positive attitude to HIV (ARR): 6.14, 95% CI: 4.12–9.15) were more likely to be retained. Conclusion: Having social relationships, good knowledge of HIV and a positive attitude to HIV influenced retention in care. HIV programmes need periodic outreach education to address HIV knowledge gaps deterring retention among heterosexual men, while integrating peer support and counselling is recommended to reduce internalised stigma and improve attitude among MSM.