HIV seroprevalence, incidence, and viral suppression among Ugandan males with bar or sex worker partners: a population-based study

March 22, 2025 by
HIV seroprevalence, incidence, and viral suppression among Ugandan males with bar or sex worker partners: a population-based study
Aber Maurine
Wirtz2,6, Caitlin E. Kennedy6, Gertrude Nakigozi3, Eshan U. Patel2, Anthony Ndyanabo3, Hadijja Nakawooya3, Thomas C. Quinn1,2,4,5,6, Ronald M. Galiwango3, David Serwadda3, Victor Ssempijja4, Steven J. Reynolds2,3,4,5, Aaron A. R. Tobian1*, Robert Ssekubugu3*

Affiliations:

1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3Rakai Health Sciences Program, Kampala, Uganda
4National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
5Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
6Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

*These authors contributed equally to this work.

Corresponding author: M. Kate Grabowski, Ph.D., ScM, Department of Pathology, School of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Suite 446 C, Baltimore, MD 21205; Email: mgrabow2@jhu.edu; Phone: (443) 287-573


ABSTRACT

Background 

Female bar or sex workers (FBSWs) in Eastern Africa experience a high burden of HIV.

However, there is limited population-level data on HIV seroprevalence, incidence, and viral suppression

among their male partners.


Methods: 

Men who had sex with FBSWs in the past year were identified through longitudinal

population-based HIV surveillance in southern Uganda between 2013 and 2020. Surveillance was

conducted over four surveys in four Lake Victoria fishing communities (HIV seroprevalence~40%) and

37 inland agricultural and trading communities (~12%). Primary outcomes included laboratory-confirmed HIV seropositivity, incident infection, and viral suppression (<200 copies/mL). Prevalence and incidence rate ratios (PR, IRR) were estimated using univariable and multivariable Poisson regressions with 95% confidence intervals (95%CIs). 


Findings: 

17,438 male participants contributed 35,273 visits, with 2,420 (13.9%) reporting FBSW partners at ≥1 study visit. Men with FBSW partners tended to be older, have less education and lower incomes, and be previously married compared to those without. HIV seroprevalence was significantly higher among men with FBSW partners (vs. without FBSW partners) in both inland (21.0%vs.7.5%; PR=2.79,95%CI=2.41-3.23) and fishing communities (38.6%vs.23.0%; PR=1.67,95%CI=1.53-1.84). Overall, 154 HIV incident events occurred over 27,396 years of participant follow-up. HIV incidence was also higher among men with FBSW partners than those without (1.93vs.0.44/100 person-years; IRR=4.37,95%CI=3.04-6.16). Among men with HIV, viral suppression was similar among those with and without FBSW partners. However, the population prevalence of HIV viremia was 1.6 times higher (95%CI=1.41-1.84) among men with FBSW partners due to a higher background seroprevalence of HIV.


Interpretation: 

Men in Uganda frequently report sex with FBSWs, which is associated with a significantly higher risk of HIV acquisition. Tailored HIV prevention strategies, including the promotion and uptake of PrEP, are essential to reduce the HIV burden in this population.


Funding: 

National Institute of Allergy and Infectious Diseases, National Institutes of Health


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