This study explored HIV risk behavior among men who have sex with men (MSM) in Kigali, Rwanda. It found high rates of unprotected sex, multiple partners, and transactional sex. Over 70% of participants reported casual male partners and rates of condom use were low. Many MSM engaged in commercial sex or exchanged sex for goods. Based on these risks, the study recommends improved HIV services for MSM, including dedicated clinics, increased availability of condoms and lubricants, and awareness campaigns to address stigma.

1. Andrew Koleros, MEASURE Evaluation, Rwanda Dr. Agnes Binagwaho, MOH, Rwanda Dr. Jenifer Chapman, MEASURE Evaluation, USA Elisabetta Pegurri, UNAIDS, Rwanda Yves Utazirubanda, MEASURE Evaluation, Rwanda Rose Gahire, AIDS Healthcare Foundation, Rwanda High HIV risk behavior among men who have sex with men (MSM) in Kigali, Rwanda

6. Study management team MSM Study Coordinator MSM (seed) MSM (seed)… MSM recruit MSM recruit MSM recruit MSM recruit Summary of recruitment strategy MSM recruit MSM recruit MSM recruit MSM recruit Wave 1 Wave 2

9. Key Results

11. Self-described sexuality (N=94)

12. Number of male partners in last 12 months Number of male sex partners 8% reported no male partners 29% reported no casual male partners 21% reported one male partner (boyfriend) 30% reported 1-2 casual male partners 71% reported at least one casual male partner 26% reported 3-5 male partners 15% reported >5 male partners

13. Sexual mobility Reported anal sex with another man in the last 12 months, by location (N=88) 0% 20% 40% 60% 80% 100% Kigali Gisenyi Butare Another place in Rwanda Another country No Yes

14. Commercial & transactional sex (selling) Table 12: Reported commercial / transactional sex (selling) Ever Last 12 months Exchanged oral and/or anal sex for both money and goods 10 8 Exchanged oral and/or anal sex for money only 12 10 Exchanged oral and/or anal sex for goods only 8 7 TOTAL 30 25

15. Commercial & transactional sex (buying) Ever Last 12 months Exchanged both money and goods for oral and/or anal sex 6 4 (3 anal sex) Exchanged money only for oral and/or anal sex 12 11 (9 anal sex) Exchanged goods only for oral and/or anal sex only 6 5 (4 anal sex) TOTAL 24 20

17. Reported condom use Reported condom use at last sex, by partner type Type of partner n % TOTAL Last sex with boyfriend 23 50% 46 Last casual male partner (among those reporting a boyfriend) 8 n/a 15 Last casual male partner (among those not reporting a boyfriend) 23 55% 42 Last commercial male partner (selling) 10 55% 18 Last transactional male partner (selling) 6 n/a 14 Last commercial male partner (buying) 7 n/a 11 Last transactional male partner (buying) 5 n/a 7 Last female partner 16 64% 25

18. HIV Services needed in Kigali Services needed in Kigali Respondents citing this (multiple responses possible) N = 91 % Dedicated, confidential health clinic for MSM 46 51% Improved availability of condoms designed for anal sex 33 36% Improved availability of lubricants for anal sex 35 39% HIV/AIDS stigma reduction campaigns 28 31% Awareness-raising 16 18% Counseling for MSM 6 6.6% MSM associations / mobilization 4 4.4% Other 11 N/A