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About the Authors:
Wolfgang Hladik
* E-mail: [email protected]
Affiliations Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Entebbe, Uganda, Department of Clinical Epidemiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Joseph Barker
Affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Entebbe, Uganda
John M. Ssenkusu
Affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Entebbe, Uganda
Alex Opio
Affiliation: Ministry of Health, Kampala, Uganda
Jordan W. Tappero
Affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Entebbe, Uganda
Avi Hakim
Affiliation: Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
David Serwadda
Affiliation: School of Public Health, Makerere University, Kampala, Uganda
for the Crane Survey Group
Introduction
Men who have sex with men (MSM) are a recognized high-risk group for infection with human immunodeficiency virus (HIV) in the industrialized world. MSM are also well described in select low- and medium-income countries such as Brazil and Thailand [1]. Although HIV epidemics have severely affected large parts of Africa for decades, only recently has there been attention to its spread among African MSM outside of South Africa [2], [3], [4], [5]. Even in the generalized HIV epidemics of sub-Saharan Africa, MSM are three to four times more likely to be HIV infected than the general adult population [6]. MSM in Africa frequently report bi-sexual, often concurrent, relationships, making their female partners an important, and often unwitting, bridging population [7]. Although reliable MSM population size estimates in Africa are largely lacking, the high HIV prevalence observed in several studies would suffice to account for a significant proportion of all new HIV infections in many of these generalized epidemics [4]. Despite this, tailored research for MSM in Africa, especially in HIV prevention, remains an unmet priority [4]. Illegality of homosexual behavior, human rights abuses, and severe stigma add to the specifics' of this continent's HIV epidemic among MSM [2], [8]. As a result, many national HIV policies, AIDS control programs, and HIV services either ignore or inadequately address the specific needs of this most-at-risk population (MARP)...