HIV Epidemiology, Risk Behaviours, and Structural Barriers among Men Who Have Sex with Men in Cabo Verde: Evidence from Three Bio-behavioural Surveys (2013–2023)

Abstract

Introduction. Men who have sex with men (MSM) remain disproportionately affected by HIV. In Cabo Verde, prevalence is below 1% in the general population but substantially higher among MSM. We compared three repeated cross-sectional bio-behavioural surveys to describe changes in HIV prevalence, risk behaviours, prevention practices, and structural vulnerabilities between 2013 and 2023. Patients and method. Surveys were conducted in 2013 (n = 316), 2016 (n = 243), and 2023 (n = 295). Participants were recruited through respondent-driven and snowball sampling in Praia, Mindelo, and other municipalities. Data came from structured questionnaires, qualitative interviews, focus groups, and rapid HIV testing. Descriptive analyses compared indicators across rounds. Prevalence estimates were not RDS-weighted and are sample-based. Factors associated with HIV-positive status were assessed using logistic regression on pooled data. Results. HIV prevalence rose from 4.4% in 2013 to 5.4% in 2016 and 9.5% in 2023. Condom use at last anal intercourse fell from 72% to 63%, and 29% reported transactional sex in 2023. Across rounds, 11 to 14% reported verbal violence, 6 to 8% physical violence, and 13 to 18% police harassment. In 2023, 79.3% had heard of PrEP and 55.3% had no concern about using it if offered nationally. About 31.1% reported stress, anxiety, or depressive symptoms in the previous week. Age ≥25 years and urban residence were associated with higher odds of HIV-positive status, whereas secondary or higher education was associated with lower odds. Conclusion. HIV burden appears to be increasing in the MSM samples studied. Comparisons across rounds require caution given differences in coverage, recruitment, sample composition, and the absence of RDS weighting. Expanded PrEP access, confidential MSM-responsive services, mental-health support, and community-led interventions against stigma and violence are needed.