Abstract
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Abstract; Background : Few studies have described STI and HIV testing practices among heterosexual male sex workers (MSW) in Sub-Saharan Africa. Our study aimed to assess recent HIV and syphilis screening practices among MSW in Uganda. Methods : Between August and December 2019, we conducted a cross-sectional study among 100 MSW and 240 female sex workers (FSW). Participants were enrolled through snowball sampling, and an interviewer-administered questionnaire used to collect data on HIV and syphilis in the prior 12 months. Integrated change model constructs were uses to assessed intentions, attitudes, social influences, norms and self-efficacy of 3-monthly Syphilis and 6-monthly HIV testing. Predictors of HIV and syphilis recent testing behaviors were estimated using negative binomial regression. Results : We enrolled 340 sex workers of whom 100 (29%) were MSW. The median age was 27 years (interquartile range [IQR] 25–30) for MSW and 26 years [IQR], (23–29) for FSW. The median duration of sex work was 36 and 30 months for MSW and FSW, respectively. MSW were significantly less likely than FSW to have tested for HIV in the prior 12 months (50% vs 86%; p = 0.001). For MSW, non-HIV testing was associated with higher education (adjusted prevalence ratio [aPR] 1.66; 95% confidence interval [CI] 1.09-2.50), poor intention to seek HIV testing (aPR 1.64; 95% CI: 1.35-2.04), perception that 6-monthly HIV testing was not normative (aPR 1.33; 95% CI: 1.09-1.67) and low self-efficacy (aPR 1.41; 95% CI: 1.12-1.79). Non-syphilis testing was associated with low intention to seek testing (aPR 3.13; 95% CI: 2.13-4.55), low self-efficacy (aPR 2.56; 95% CI: 1.35-4.76), negative testing attitudes (aPR 2.33; 95% CI: 1.64-3.33), and perception that regular testing was not normative (aPR 1.59; 95% CI: 1.14-2.22). Conclusions : Non-testing for HIV and syphilis was common among heterosexual MSW relative to FSW. Future studies should evaluate strategies to increase testing uptake for this neglected sub-population of sex workers.