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La littératie en santé (LS) est définie comme la capacité de comprendre, d’évaluer et d’appliquer l’information en santé. c'est un concept multidimensionnel. Le niveau de LS a un impact majeur sur notre état de santé. En effet, un niveau élevé de LS facilite la prévention des maladies dans la population générale et l'accès aux soins de santé. Pour les patients, un niveau élevé de LS est associé à une bonne autogestion de leur maladie, à une plus grande implication dans la prise de décision, à moins d'hospitalisations, à une utilisation réduite des soins d'urgence et à une diminution des coûts des soins de santé. Cependant, aucun outil de mesure de la LS validé n'est disponible en France.
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C.H. KOUNTA1, L. Sagaon-Teyssier1,2, G. Maradan1,2, M. Bourrelly1,2, P.-J. Coulaud1, A. Coulibaly3, A.A. keita3, B.D. Keita3, C. Laurent4, B. Spire1,2, CohMSM Study Group
1Aix Marseille Univ, INSERM, IRD, SESSTIM, Bouches de Rhône, Marseille, France.
2ORS PACA, Marseille, France.
3ARCAD Sida, Bamako, Mali.
4Unité TransVIHMI, IRD UMI 233, INSERM U 1175, Université de Montpellier, Montpellier, France.
Background: Men who have sex with men (MSM) are at much greater risk of HIV infection in Sub-Saharan Africa. Little is known about MSM involvement in transactional sex (TS) in Africa. We aimed to characterize MSM who practice TS and to identify factors associated with TS in that population.
Methods: The interventional prospective cohort study “CohMSM” was conducted in June 2015 in four West-African countries. The present study focused on 200 Malian MSM enrolled between June 2015 and May 2016. Data analysed came from 349 visits: This corresponded to 200 participants with one observation, and 149 with two observations. Information on sociodemographic and economic characteristics, sexual behaviours, HIV risk-reduction strategies, alcohol consumption and stigma was collected using standardized face-to-face questionnaires. we used Principal Component Analysis to construct 3 sub-scores as follows: 1) avoidance score: avoidance of at-risk situations as a protection strategy; 2) knowledge score: knowledge of ART-related strategies including informal Pre-exposure prophylaxis (PrEP), Treatment as prevention (TASP) and condomless sex only with treated/undetectable viral load HIV-positive; and 3) sero-adaptation score: avoidance of condomless sex with men known to be HIV-positive status or with unknown status. An experienced stigmatization score was also constructed and dichotomized at their median value. Data analysis used a generalized estimating equation method.
Results: Among the 349 visits analysed, 89(25.5%) corresponded to MSM who reported practising TS. Overall, MSM practising TS were mostly under 24 years old (61.8 %) and 82.0% qualified their financial situation as difficult. Practising TS was more frequently associated with younger age (OR[95%CI]:0.6[0.4-0.9]), alcohol consumption during sex (OR[95%CI]:6.4[1.5-27.7]), simultaneous multi-partner male sex (OR[95%CI]:5.7[2.6-12.9]), satisfaction with current sexual life (OR[95%CI]:4.7[1.5-15.2]), knowledge (OR[95%CI]:5.6[1.1-29.7]) and sero-adaptation scores (OR[95%CI]:11.9[1.2-120.3]), as well as an experienced stigmatization score greater than the median(>2) (OR[95%CI]:2.3[1.2-4.4]). Having had one’s most recent sexual encounter with one’s girlfriend (OR[95%CI]:0.4[0.2-0.9]), having had insertive anal intercourse with one’s boyfriend in the previous 6 months (OR[95%CI]:0.4[0.2-0.8]), and having an avoidance score (OR[95%CI]:0.1[0.02-0.6]) were all less frequently associated with TS.
Conclusions: Malian MSM practising TS may not be the sub-population most vulnerable to HIV infection, as they seem better informed about risk-reduction strategies, especially informal PrEP and TasP.
