BACKGROUND: Men who have sex with men (MSM) are disproportionately impacted by HIV in sub-Saharan Africa (SSA), where condomless anal intercourse (CAI) is a major driver of HIV transmission among this hidden subpopulation. OBJECTIVES: To determine CAI drivers and prevalence among HIV-positive and HIV-negative MSM. METHOD: Data from 1538 MSM who participated in a biobehavioural survey in Zimbabwe were used. Secondary statistical data analysis methods were used to determine prevalences and drivers of CAI. RESULTS: A high prevalence of CAI, of at least 30%, among HIV-positive and HIV-negative MSM was found. Factors that led to a statistically significant higher CAI among HIV-positives compared to HIV-negatives included drunkenness (35% vs. 25%, P = 0.01), fear of partner (13% vs. 9%, P = 0.017), trusting the partner (10% vs. 6%, P = 0.008), and being offered more money (10% vs. 6%, P = 0.003). CONCLUSION: Our findings indicate that economic, socio-behavioural and perceptual dimensions increase men's likelihood to engage in risky sexual behaviour, suggesting the need for HIV prevention efforts that provide tailored education regarding HIV risk among MSM in SSA. This is the first large biobehavioural survey that generated valuable information useful for analysing condomless anal sex among MSM in Zimbabwe.

After four decades of the HIV epidemic, women from sub-Saharan Africa remain at a differentially high risk of acquisition. The Joint United Nations Programme on HIV and AIDS (UNAIDS) statistics show that the majority of HIV infections occur in this population and region. Evidence from previous humanitarian crises demonstrated adverse maternal consequences as a result of neglect for the provision of essential maternal, sexual and reproductive health services. The ongoing COVID-19 pandemic has had a similar effect, including an additional risk of HIV acquisition amongst women in sub-Saharan Africa. The COVID-19 pandemic has aggravated the risk of sub-Saharan Africa women to HIV infection because of a multitude of factors including child marriages, teenage pregnancies, dropping out of school, increase in incidence of sexual and gender-based violence and reduced access to preventive and treatment services for HIV and sexually transmitted infections. These include provision of care for rape and sexual and gender-based violence victims and provision of pre-exposure and postexposure prophylaxis for HIV and other STIs. Failure to urgently restore and maintain robust HIV prevention and treatment during the ongoing COVID-19 pandemic poses a risk of reversing the gains made over the years in reducing the incidence and morbidity from HIV amongst the population of sub-Saharan Africa women. There is need for an urgent and robust discourse to formulate effective interventions for protecting women and girls living in sub-Saharan Africa from an aggravated risk of HIV infection during the ongoing COVID-19 pandemic and other future humanitarian crises.

Abstract The COVID-19 pandemic has had an impact worldwide with regions experiencing varying degrees of severity. African countries have mounted different response strategies eliciting varied outcomes. Here, we compare these response strategies in Rwanda, South Africa and Zimbabwe and discuss lessons that could be shared. In particular, Rwanda has a robust and coordinated national health system that has effectively contained the epidemic. South Africa has considerable testing capacity, which has been used productively in a national response largely funded by local resources but affected negatively by corruption. Zimbabwe has an effective point-of-entry approach that utilizes an innovative strategic information system. All three countries would benefit having routine meetings to share experiences and lessons learned during the COVD-19 pandemic.