Background: Previous research on HIV risk behavior among men who have sex with men (MSM) has mainly focused on unprotected anal sex without attention to other risky sexual practices. We investigated whether an indicator of HIV risk based on a combination of risky sexual practices would better identify MSM becoming HIV-positive in West Africa.
Methods: HIV-negative MSM were provided a quarterly preventive follow-up in the community-based cohort CohMSM in four West African countries (Mali, Cote d´Ivoire, Burkina Faso, Togo). They completed face-to-face questionnaires every 6 months including questions about four risky sexual practices: 1) inconsistent condom use (ICU) during anal sex; 2) ICU during oral sex; 3) receptive/versatile position during anal intercourse; 4) having ≥2 male sexual partners. Multi-trajectory modeling was used to combine these practices into a global single indicator of sexual behavioral profiles (SBP). The main outcome indicated whether seroconversions occurred or not over the 18 months of follow-up. Mixed logistic model was used to estimate odd-ratios (OR) for each separate practice and for the global indicator. The population-attributable risk percentage (PAR%) was calculated for each practice and for the global indicator of SBP to show its relative contribution to HIV seroconversions.
Results: For the 520 MSM included, two SBP were identified: high-risk exposure (HRE) (61%) and moderate-risk exposure (MRE) (39%). HRE-MSM (versus MRE-MSM) reported greater ICU during anal (53% versus 41%) and oral sex (84% versus 43%), receptive practices (93% versus 8%) and more multiple partners (63% versus 60%).
The global indicator identified the highest proportion of seroconversions (92% are HRE-MSM) compared to each separate practice (Table). The PAR% of seroconversions explained by the global indicator was 86.5 [95% Confidence Interval (CI); 78.8; 94.2]. Separate practices PAR% ranged from 5.9 [-6.7; 18.5] among MSM having ≥2 partners to 77.2 [66.8; 87.6] for those reporting receptive practices.
Conclusions: HIV risk behavior should be assessed by taking into account several risky sexual practices to better tailor risk reduction interventions among West African MSM.

 % HIV seroconversions (n=53)OR [95% CI]PAR% [95% CI]
High-risk exposure profile (Ref. Moderate risk exposure profile)927.9 [4.5; 14.2]86.5 [78.8; 94.2]
Inconsistent condom use during anal sex (Ref. No)551.4 [0.99; 1.9]16.9 [-0.2; 34.2]
Inconsistent condom use during oral sex (Ref. No)802.0 [1.3; 3.0]44.6 [24.4; 64.7]
Receptive/versatile position during anal sex (Ref. Exclusively insertive)874.9 [3.1; 7.9]77.2 [66.8; 87.6]
Having two or more male sexual partners (Ref. No)651.2 [0.8; 1.7]5.9 [-6.7; 18.5]
[Table: HIV seroconversions during the first of 18 months of follow-up and PAR% according to indicator of HIV risk behavior ]

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