Determinants of linkage to HIV care and treatment among men who have sex with men (msm) in Kisumu county, Kenya

Abstract

HIV remains a global and national public health challenge, with significant impacts on the lives of those affected by the virus. Kisumu County in western Kenya has one of the highest rates of HIV infection in the country. This situation is further exacerbated by the vulnerability of MSM, who often face a disproportionate burden of HIV infection. HIV prevalence among MSM in Kisumu County is higher than the general population, highlighting the urgent need to address this problem. Early and consistent access to HIV care and treatment is paramount to reducing HIV-related morbidity and mortality, and is also critical to reducing HIV transmission in the community. However, significant gaps remain in our understanding of the factors that promote or impede linkage to care and treatment among MSM in this region. Therefore, this study examined the determinants of the linkage to HIV care and treatment among MSM in Kisumu County, Kenya. The specific objectives of the study were; to determine the (1) individual factors, (2) interpersonal factors, (3) the socio-cultural factors, and (4) the institutional factors influencing linkage to HIV care and treatment among MSM in Kisumu County, Kenya. A descriptive cross-sectional study design was employed. The questionnaire for quantitative was administered to 400 respondents who consented and 11 KIIs were also conducted. Quantitative data was analysed with the aid SPSS version 21. Frequencies, means and percentages were used to analyse socio-demographic characteristics of study population and to determine prevalence of LARC. Chi-square test was used to check for association while logistic regression model was used to establish the strength of the association at 95% CI. Qualitative data was analysed using thematic analysis approach in coding and development of the emerging themes using NVivo software. From the analysis, the mean age of respondents was 26.22 with standard deviation of 6.58, majority 232(58.0%) attained secondary education whereas 190 (47.4%) of MSM were informally employed. The individual determinants associated with not accessing HIV care and treatment were religion (OR=0.3;95%CI,0.13-0.72; p=0.007), primary education (OR=0.5;95%CI,0.23-0.97; p=0.040), earns less monthly (OR=0.1;95%CI,0.01-0.26; p=0.001). Additionally, the factors associated with accessing HIV care and treatment included: The interpersonal factors disclosing sexual orientation to family/friends (OR=2.3;95%CI,1.29-4.26; p=0.005), disclosing sexual orientation to health care provider (OR=4.4;95%CI,2.35-8.37; p<0.0001) discrimination by family (OR=10;95%CI,3.45-30.12; p<0.0001); The socio-cultural factors were MSM who felt community members were uncomfortable with them (OR=2.4;95%CI,1.11-5.01; p=0.027), MSM felt they would lose respect (OR=2.5;95%CI,1.13-5.31; p=0.031); The Institutional factors were MSM who had gone for treatment at health facilities and MSM who were HIV positive (OR=5.9;95%CI,1.67-21.27;p<0.0001), (OR=14.9;95%CI,2.86-5.08; p<0.0001) respectively. MSM believe that government institutions do have conversation with them (OR=70.4;95%CI,9.64-513.74; p<0.0001), MSM who thinks that there are systems that guards them (OR=10.8;95%CI,5.87-19.72; p<0.0001). In conclusion, the findings of the study highlight the need for comprehensive, targeted interventions, including cultural sensitivity training, income support programs, and legal reforms, to enhance healthcare access and reduce disparities within this marginalized community