{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:20:04Z","timestamp":1790727604446,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"S6","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["Johns Hopkins University Center for AIDS Research\/"],"award-info":[{"award-number":["Johns Hopkins University Center for AIDS Research\/"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. Intern. AIDS Soc."],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Given intersecting biological, network and structural risks, men who have sex with men (MSM) and transgender women (TGW) consistently have a high burden of HIV. Although MSM are a key population in Rwanda, there are limited epidemiologic data to guide programming. This study aimed to characterize HIV prevalence and care cascade among MSM and TGW in Kigali.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>MSM and TGW\u00a0\u2265\u00a018\u00a0years were recruited using respondent\u2010driven sampling (RDS) from March\u2013August 2018 in Kigali. Participants underwent a structured interview including measures of individual, network and structural determinants. HIV and sexually transmitted infections (STI) including syphilis, Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) were tested. Viral load was measured for MSM living with HIV. Robust Poisson regression was used to characterize the determinants of HIV infection and engagement in the HIV treatment cascade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 736 participants were enrolled. The mean age was 27\u00a0years (range:18 to 68) and 14% (106) were TGW. HIV prevalence was 10% (RDS\u2010adjusted: 9.2% (95% CI: 6.4 to 12.1)). Unadjusted prevalence of any STI was 20% (147); syphilis: 5.7% (42); CT: 9.1% (67) and NG: 8.8% (65). Anticipated (41%), perceived (36%) and enacted stigmas (45%) were common and higher among TGW (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). In multivariable RDS adjusted analysis, higher age (aPR: 1.08 (95% CI: 1.05 to 1.12)) and ever having sex with women (aPR: 3.39 (95% CI: 1.31 to 8.72)) were positively associated with prevalent HIV. Being circumcised (aPR: 0.52 (95% CI: 0.28 to 0.9)) was negatively associated with prevalent HIV infection.<\/jats:p><jats:p>Overall, 61% (45\/74) of respondents reported knowing their HIV\u2010positive status. Among these, 98% (44\/45) reported antiretroviral therapy use (ART); 75% (33\/44) were virally suppressed using a cut\u2010off of &lt;200\u00a0copies\/mL. Of the 29 participants who did not report any previous HIV diagnosis or ART use, 38% (11\/29) were virally suppressed. Cumulatively, 59% (44\/74) of all participants living with HIV were virally suppressed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These data show a high burden of HIV among MSM\/TGW in Kigali, Rwanda. Bisexual concurrency was common and associated with prevalent HIV infection, demonstrating the need of comprehensive\u00a0screening for all sexual\u00a0practices\u00a0and preferences in the provision of comprehensive HIV prevention services\u00a0in Rwanda. Viral suppression was below the UNAIDS target suggesting poor adherence and potential ART resistance. There is a need for adherence support, screening for primary and secondary ART resistance and stigma mitigation interventions to optimize HIV\u2010related outcomes for MSM in Rwanda.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25604","type":"journal-article","created":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T07:57:30Z","timestamp":1601539050000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["HIV infection and engagement in HIV care cascade among men who have sex with men and transgender women in Kigali, Rwanda: a cross\u2010sectional study"],"prefix":"10.1002","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7954-1736","authenticated-orcid":false,"given":"Jean Olivier","family":"Twahirwa Rwema","sequence":"first","affiliation":[{"name":"Department of Epidemiology Key Populations Program Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8127-0704","authenticated-orcid":false,"given":"Carrie E","family":"Lyons","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Key Populations Program Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Herbst","sequence":"additional","affiliation":[{"name":"Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Liestman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Key Populations Program Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Nyombayire","sequence":"additional","affiliation":[{"name":"Projet San Francisco Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sosthenes","family":"Ketende","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Key Populations Program Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Mazzei","sequence":"additional","affiliation":[{"name":"Projet San Francisco Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8954-6426","authenticated-orcid":false,"given":"Oluwasolape","family":"Olawore","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Key Populations Program Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabin","family":"Nsanzimana","sequence":"additional","affiliation":[{"name":"HIV and AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placidie","family":"Mugwaneza","sequence":"additional","affiliation":[{"name":"HIV and AIDS Division Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aflodis","family":"Kagaba","sequence":"additional","affiliation":[{"name":"Health Development Initiative Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7728-0587","authenticated-orcid":false,"given":"Patrick S","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Allen","sequence":"additional","affiliation":[{"name":"Emory University Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Karita","sequence":"additional","affiliation":[{"name":"Projet San Francisco Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5482-2419","authenticated-orcid":false,"given":"Stefan D","family":"Baral","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Key Populations Program Center for Public Health and Human Rights Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/17290376.2012.743787"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000037"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60821-6"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.1.21270"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001593"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001512"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002422"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro794"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwz270"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217501"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(19)30239-5"},{"key":"e_1_2_10_13_1","article-title":"Rwanda Demographic and Health Survey 2014\u201315 \u2010 Final Report. Kigali \u2010 Rwanda","author":"NISR","year":"2016","journal-title":"National Insitute of Statistics of Rwanda"},{"key":"e_1_2_10_14_1","unstructured":"UNAIDS.Global AIDS update.UNAIDS.2019."},{"issue":"4","key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1080\/09540121.2010.507758","article-title":"High HIV risk behavior among men who have sex with men in Kigali, Rwanda: making the case for supportive prevention policy","volume":"23","author":"Chapman J","year":"2011","journal-title":"AIDS Care"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2017-053311"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/sti.2009.040162"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"2296","DOI":"10.1007\/s10461-016-1390-1","article-title":"Risk factors associated with HIV among men who have sex only with men and men who have sex with both men and women in three urban areas in Mozambique","volume":"20","author":"Isabel Sathane RH","year":"2016","journal-title":"AIDS Behav"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"e0211099","DOI":"10.1371\/journal.pone.0211099","article-title":"Social contexts as mediator of risk behaviors in Rwandan men who have sex with men (MSM): implications for HIV and STI transmission","volume":"14","author":"Adedimeji A","year":"2019","journal-title":"PLoS One"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.2307\/3096941"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-482"},{"key":"e_1_2_10_22_1","volume-title":"Global AIDS update 2017. Ending AIDS \u2010 progress towards the 90\u201390\u201390 targets","author":"UNAIDS","year":"2017"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000952"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0846-z"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0594-0"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.16.1789"},{"key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12879-019-3693-0","article-title":"Development and reliability of metrics to characterize types and sources of stigma among men who have sex with men and female sex workers in Togo and Burkina Faso","volume":"19","author":"Ashley Lynn Grosso SK","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"1","key":"e_1_2_10_29_1","first-page":"79","article-title":"Probability based estimation theory for respondent driven sampling","volume":"24","author":"Volz E","year":"2008","journal-title":"Journal of Offic Stat"},{"key":"e_1_2_10_30_1","unstructured":"UNAIDS.Rwanda HIV and AIDS estimates.2018."},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001593"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.16.4.18768"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-015-1281-x"},{"issue":"4","key":"e_1_2_10_34_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/OLQ.0b013e318164467f","article-title":"Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors","volume":"35","author":"Lau JT","year":"2008","journal-title":"Sex Transm Dis"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/850132"},{"issue":"4","key":"e_1_2_10_36_1","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30567-9","article-title":"Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta\u2010analysis of global data","volume":"7","author":"Yuan T","year":"2019","journal-title":"Lancet Global Health"},{"issue":"4","key":"e_1_2_10_37_1","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(19)30038-5","article-title":"Benefits of male circumcision for MSM: evidence for action","volume":"7","author":"Pintye J","year":"2019","journal-title":"Lancet Global Health"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.19.3.20774"},{"issue":"11","key":"e_1_2_10_39_1","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1080\/09540121.2018.1465175","article-title":"Gender identity and HIV risk among men who have sex with men in Cape Town, South Africa","volume":"30","author":"Jobson G","year":"2018","journal-title":"AIDS Care"},{"issue":"3","key":"e_1_2_10_40_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/QAI.0000000000001825","article-title":"Identification of Elite and viremic controllers from a large urban hiv ambulatory center in Kampala, Uganda","volume":"79","author":"Alex Kayongo EG\u2010G","year":"2018","journal-title":"J Acquir Immune Defic Syndr"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/15284336.2018.1531534"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.12680"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/COH.0000000000000200"},{"issue":"1","key":"e_1_2_10_44_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/0956462415581728","article-title":"The utility of population\u2010based surveys to describe the continuum of HIV services for key and general populations","volume":"27","author":"Hladik W","year":"2016","journal-title":"Int J STD AIDS"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.15.162933"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25604","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jia2.25604","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.25604","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T09:39:45Z","timestamp":1693906785000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.25604"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":44,"journal-issue":{"issue":"S6","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1002\/jia2.25604"],"URL":"https:\/\/doi.org\/10.1002\/jia2.25604","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"value":"1758-2652","type":"print"},{"value":"1758-2652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]},"assertion":[{"value":"2020-02-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e25604"}}