Background: Community HIV prevention efforts are increasingly focused on engaging men. We investigated how such efforts are influencing men''s HIV risk behaviors and service use in Eswatini.
Methods: Two cross-sectional surveys were conducted with 1,926 men ages 20-34 in Eswatini, in Dec. 2016 - Feb. 2017 (n=835) and June - Sept. 2018 (n=1,019). To reach men at risk of HIV, respondents were recruited at hot-spot venues across 19 districts where intensive combination-prevention programs, including DREAMS, were taking place.
Results: Men''s mean age was 26 and 15% were married/cohabiting at Rounds 1 and 2 (R1/R2). Mean number of sexual partners in the last year decreased from 2.7 at R1 to 1.9 at R2 (unadjusted p< 0.001 - vol 1). Mean number of adolescent partners (ages 15-19) decreased from 0.75 to 0.55 (p=0.04), and, for young women partners (ages 20-24), from 1.9 to 1.2 (p=0.001). Hazardous drinking decreased from 45% to 38% (p< 0.01). Consistent condom use with last three non-marital/non-cohabiting partners saw a nonsignificant increase, from 36% to 41%. Ever testing for HIV increased from 76.3% to 80.6% (p=0.04). Testing in last year increased from 39% to 57% (p< 0.001); for half at R2, the last test was their first-ever. Receiving voluntary medical male circumcision in last two years remained at about 4%. Among self-identified HIV-positive men, current antiretroviral treatment use increased from 79% to 97% (p< 0.05). In multivariable analyses controlling for demographic characteristics, nearly all R1-R2 differences retained their significance. Participation in HIV-related meeting(s), and awareness of DREAMS, were associated with increased odds of ever-testing (p< 0.01, p< 0.001, respectively), last-year testing (p< 0.001, p=0.01), and consistent condom use (meetings only; p< 0.05).
Conclusions: There are recent promising shifts in HIV risk behaviors and service uptake among men across Eswatini. Community-based HIV prevention programming (like DREAMS) may have contributed to increases in testing and condom use.