To conduct the first population size estimation and biological and behavioral surveillance survey among men who have sex with men MSM in Angola. Population size estimation with multiplier method and a cross-sectional study using respondent-driven sampling. Seven hundred ninety-two self-identified MSM accepted a unique object for population size estimation. Three hundred fifty-one MSM were recruited Bisexual mans Socorro respondent-driven sampling for biological and behavioral surveillance survey.
Interviews and testing for HIV and syphilis were conducted on-site.
Univariate, bivariate, and multivariate analyses examined factors associated with HIV and unprotected sex. Six imputation strategies were used for missing data for those refusing to test for HIV. A population size of MSM was estimated. Twenty-seven of individuals were tested positive. Adjusted HIV prevalence was 3. With imputation, HIV seroprevalence was estimated between 3.
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Risk behaviors are widely reported, but HIV seroprevalence is lower than expected. The difference between crude and adjusted values was mostly due to treatment of missing values in Respondent-Driven Sampling Analysis Tool. Solutions are proposed in this article. Although concerns were raised about feasibility and adverse outcomes for MSM, the study was successfully and rapidly completed with no adverse effects. SinceHIV prevalence in Angola has Bisexual mans Socorro estimated from sentinel prenatal sites.
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Over the past few years, a of epidemiological and behavioral studies have been conducted among MSM Bisexual mans Socorro Africa, even in countries where homosexuality is illegal. Such studies have demonstrated high rates of risky sexual behavior, associated with low perception of risk and vulnerability, and little knowledge of how to prevent sexually transmitted infections STIs and HIV. All these estimates are higher than those observed for the general population in their respective countries 14 based on UNAIDS estimates Other studies of MSM in Africa also indicate high rates of unprotected anal intercourse.
Another potential issue for surveillance and program is the occurrence of sexual acts between men who do not identify themselves as homosexual or who do not identify sex with another man as homosexual. The participants in the surveillance survey were recruited with RDS. Although conventional probabilistic sampling methods are ideal, they cannot be used to study hidden populations such as MSM. Most studies Bisexual mans Socorro used nonprobabilistic sampling methods to sample MSM, despite the risk of creating biased estimates that are difficult to evaluate.
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However, under certain conditions, as here, this weighting in apparently anomalous findings, as will be discussed below. To estimate the population size of MSM in Luanda, a capture—recapture method was used. We distributed a small flashlight key chain imported to Angola for this study as the unique object distributed. The objects were distributed in 91 locations identified by MSM as meeting places between January 19 and February 6,before the biological and behavioral surveillance survey BBSS by the study team and Bisexual mans Socorro coworkers and in consultation with the MSM community.
We calculated a sample size of MSM aged older than 18 years. The sample size is based on the feasibility of recruitment as assessed during formative research and estimated HIV and syphilis prevalence, with Bisexual mans Socorro de effect of 2 for RDS. In the absence of reliable data for MSM before the research, HIV and syphilis prevalence was estimated to be 4 times higher than that in the general population.
For syphilis, data from prenatal clinics have indicated a median prevalence of 3. Pretest and posttest counseling for HIV was provided, as was referral for monitoring and treatment of HIV and syphilis. After being interviewed, the seed-recruited participants received 3 coupons to recruit their peers.
This process was repeated until sample size was reached. They were also offered a secondary incentive of a unit phone card for each eligible participant recruited maximum of 3 recruits. The protocol called for a sample size of individuals. The actual survey population consisted 33 of MSM who fulfilled the following inclusion criteria: 1 had at least 1 receptive or insertive anal contact with another man in the 6 months; 2 aged 18 years or older; 3 fluent in Portuguese; 4 residing in 1 of the 9 municipalities of Luanda Province; 5 have not participated ly in the current BBSS study; 6 present a valid coupon to participate in the study; 7 agree to provide Bisexual mans Socorro informed consent for the questionnaire; and 8 not obviously under the influence of drugs or alcohol at the time of enrollment.
Transwomen were not excluded from the study.
Population size, hiv, and behavior among msm in luanda, angola: challenges and findings in the first ever hiv and syphilis biological and behavioral survey
Two of the interviewers identified themselves as members of the MSM community, 1 did not. Data were downloaded daily and checked. HIV and syphilis testing was consented separately from the questionnaire. Whole blood was used in all diagnostic tests, and manufacturer instructions for storage, use, and disposal were closely followed. Wicklow, Ireland. If the of these tests are discordant, a new blood sample collected immediately for retesting.
Responses to the questionnaire were stored in an SPSS compatible database. Coupons were managed with custom software developed for the project in Excel. The field supervisor, a Brazilian surveillance official, remained on-site through the entire data collection period, monitoring all phases of the study, including recruitment, consent, interviews, coupon management, data management, data security and confidentiality, and clinical and laboratory procedures.
The office was staffed with a receptionist, 3 Bisexual mans Socorro, 4 health professionals for testing and counseling, and the field supervisor. All were trained and participated in a pilot study.
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Written standard operating procedures were available. This study was conducted in accordance with all relevant ethical guidelines and regulations in the United States and Angola. RDSAT was used to weight responses to partially control for these biases.
Multivariate analyses were performed using non-conditional logistic regression to estimate predictors of HIV infection and factors associated with having unprotected sex with any partner. Because there is no consensus on the best statistical Bisexual mans Socorro for more complex analyses such as logistic regression using RDS, we followed the recommendations of Johnston et al.
It breaks the chain, and in treating the next respondent as a seed, ignores their response for the variable selected. To correct for this, the analysis needs to impute values in place of missing. For the population estimation, MSM were approached, of whom agreed to participate. Of these, were eligible and volunteered to take the keychain.
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In the BBSS study, the proportion of participants who said they received the keychain was A total of men visited the study site to be interviewed. Of these, 5. The majority of respondents identified themselves as ethnically Kimbundu A large minority reported no occupation Total of participants Of those who did, 52 Ten 5.
Of the respondents, Most, Of the participants, Six strategies were used for imputation of seroprevalence. varied between 3. CIs were quite large Table 1. Many respondents About The majority of MSM reported having a regular partner in the last 6 months More than one-third The of partners over the last 6 months varied, regardless of the type of partner, from 1 to partners Table 2. Of the respondents who reported a regular partner transwomen, man, or womanthe percentage of always use of condoms during vaginal or anal sex was low, ranging from Bisexual mans Socorro The use of condom at last sexual intercourse was lowest Ignorance of the serostatus of regular partners was high Almost half of MSM With respect to homophobia, Among those who reported episodes of discrimination because of sexual Bisexual mans Socorro Table 3.
Among the perpetrators were friends, acquaintances, partners, or unknown people.
A quarter of participants reported having been forced to have sex against their will. For many, this occurred in childhood and adolescence. Friends and acquaintances were most cited.
A very small percentage of participants 2. Given an increasing vitriolic public debate about homosexuality in Africa, the project team considered other potential outcomes.