Joseph Larmarange

The Effect of Sexual and Gender Minority Violence on Depression, Hazardous Drinking, Condom Use, and HIV Acquisition: An Individual Participant Data Meta-Analysis of the CohMSM, HPTN 075, and Anza Mapema Cohort Studies in Africa

Joseph LARMARANGE — 2025-07-15T14:38:37Z

Authors

James Stannah, Jesse Knight, Theo Sandfort, Christian Laurent, Fredrick O. Otieno, Joseph Larmarange, Pierre-Julien Coulaud, Victor Mudhune, erica hamilton, Vanessa Cummings, Bruno Spire, Doerieyah Reynolds, Sufia Dadabhai, Duncan Okall, Bintou Dembélé Keita, Luis Sagaon-Teyssier, Ravindre Panchia, Marie-Claude Boily & Mathieu Maheu-Giroux

Abstract

Some sexual and gender minorities (SGM), including men who have sex with men and transgender women, are disproportionately vulnerable to HIV. Many SGM in Africa report experiencing verbal or physical violence due to their sexual and/or gender identities or behaviours. The pathways linking such SGM violence to HIV acquisition are complex. We described experiences of verbal and physical SGM violence and explored pathways to HIV acquisition among SGM assigned male sex at birth using a two-stage individual participant data meta-analysis of three African cohort studies: CohMSM (Burkina Faso, Côte d'Ivoire, Mali, Togo), HPTN 075 (Kenya, Malawi, South Africa), and Anza Mapema (Kenya). SGM violence was assessed at baseline and follow-up visits. We fit log-linear sequential conditional mean models using generalised estimating equations to estimate risk ratios linking SGM violence, moderate-to-severe depressive symptoms, hazardous drinking, condom use, and HIV acquisition, adjusted for baseline confounders and previous exposure and outcome. We pooled study estimates using random effects meta-analysis. SGM violence, mostly verbal, was reported by 36% (570/1590) participants at baseline (past 6–12 months), and 20% (321/1590) during the first year of follow-up (past 3–6 months). Baseline SGM violence was not associated with HIV acquisition (pooled adjusted risk ratio [aRR] = 1.0, 95% CI 0.5–1.9). During follow-up, SGM violence also showed no clear relationship with HIV, but was linked to depressive symptoms at the same visit (pooled aRR = 1.7, 1.3–2.1), in turn associated with hazardous drinking (pooled aRR = 1.4, 1.1–1.7). Impacts on condom use were inconclusive. SGM in Africa face high rates of violence, which are associated with depressive symptoms and hazardous drinking–potential routes to HIV vulnerability. While our study did not conclusively demonstrate higher HIV incidence among SGM reporting violence, interventions to reduce violence and support mental health remain crucial.

Pilot Implementation of HIV Self-Testing Delivery in Private Pharmacies Combined With a Respondent-Driven Sampling Method to Improve HIV Testing for Men Who Have Sex With Men and Transgender Women in Phnom Penh (ANRS 0100s): Protocol for a Prospective Mixed Method Feasibility Study

Joseph LARMARANGE — 2025-06-27T09:45:00Z

Pilot Implementation of HIV Self-Testing Delivery in Private Pharmacies Combined With a Respondent-Driven Sampling Method to Improve HIV Testing for Men Who Have Sex With Men and Transgender Women in Phnom Penh (ANRS 0100s): Protocol for a Prospective Mixed Method Feasibility Study

Chhavarath Dary , Olivier Ségéral , Joseph Larmarange , Emilie Mosnier , Mohamed Ben Mechlia , Vichea Ouk , Bruno Spire , Vonthanak Saphonn

JMIR Research Protocols, 2025, 14, pp.e65351. ⟨10.2196/65351⟩

Article dans une revue

inserm-05471400

Authors

Chhavarath Dary, Olivier Ségéral, Joseph Larmarange, Emilie Mosnier, Mohamed Ben Mechlia, Vichea Ouk, Bruno Spire, Vonthanak Saphonn

Abstract

Background: Regular testing is recognized as a key strategy for HIV control. The 2023 Integrated Biological and Behavioral Survey (IBBS) in Cambodia revealed that nearly one-third of men who have sex with men (MSM) and one-fourth of transgender women (TGW) were never tested for HIV or not for more than 12 months. The majority of MSM and TGW were tested at community-based organizations (CBOs) facilities and by CBO outreach workers, while private facilities are poorly used for HIV testing (6% for MSM and 9% for TGW). Private pharmacies could be able to deliver HIV self-testing kits giving the advantage of confidentiality, anonymity, and time savings, in particular for those reluctant to visit CBOs. The recruitment of participants using a respondent-driven sampling method could provide the opportunity to reach MSM and TGW outside the network of CBOs.

Objective: This pilot study aims to evaluate the feasibility of free HIV self-testing delivery by a private pharmacy combined with a respondent-driven sampling method to improve HIV testing among MSM and TGW in Phnom Penh, Cambodia.

Methods: Both qualitative and quantitative approaches are used in this prospective feasibility study. The protocol was approved by the National Ethics Committee for Health Research in Cambodia (N0 351 NECHR). MSM and TGW aged more than 18 years old will be recruited via a respondent-driven sampling method with seeds recruited at hot spots and on social networks. The seeds will then distribute electronic and paper coupons to their networks physically and via social media, messaging, and calling applications. Each recruited peer will bring the coupon to receive direct and free access to one HIV self-testing kit at partner pharmacies as well as 10 additional coupons to recruit members of their networks. As for quantitative analysis, data from the study website will be imported, appended into a single matrix using Stata version 18SE (StataCorp), and analyzed using descriptive statistics, with a statistical significance level of .05. After 6 months, a qualitative assessment will be conducted among users, providers, and policymakers or key stakeholders to evaluate the acceptability and appropriateness of the strategy and to identify the barriers, facilitators, and recommendations. All transcripts will be analyzed according to the 6-phase reflexive thematic approach by Braun and Clarke. The results will be reported by participant-based and provider-based issues. QSR NVivo V.14 for Windows will be used to manage the data.

Results: The study was funded by Agence nationale de recherches sur le sida, les hépatites, et les maladies infectieuses émergentes (ANRS) in September 2023. Approval of the study protocol was successfully obtained from the NECHR in Cambodia and the Commission Nationale de l'Informatique et des Libertés (CNIL) in France (Autorisation Tacite) in February 2025. Data collection will be conducted between September 2024 and December 2025. The initial results are expected to be published in February 2026.

Conclusions: This public-private partnership intervention could allow the hidden population of MSM and TGW in Phnom Penh to be reached and tested.

Trial Registration: ClinicalTrials.gov NCT05745168; https://clinicaltrials.gov/study/NCT05745168

FLUID · Développement d'une cohorte longitudinale sur la fluidité sexuelle chez les jeunes adultes au Canada, en France et au Royaume-Uni

Joseph LARMARANGE — 2025-02-28T14:20:09Z

Responsable scientifique

Pierre-Julien Coulaud (CERPOP)

Partenaires

Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP UMR1295, Université de Toulouse, Inserm) https://cerpop.inserm.fr/
Ceped (UMR 196, Université Paris Cité, IRD,, Université Sorbonne Paris Nord, Inserm) httsp ://www.ceped.org
École de santé publique de l'Université de Montréal (ESPUM) https://espum.umontreal.ca/
Robert Gordon University https://www.rgu.ac.uk/

Financement

ANRS | MIE

Résumé

La génération actuelle de jeunes (18-30 ans) arrive à un âge où la façon dont la sexualité est perçue et vécue change profondément. Des recherches ont montré que les jeunes connaissent des changements d'orientation sexuelle au cours du temps (aussi appelés fluidité sexuelle), notamment des changements d'attirances, d'identités et/ou de comportements sexuels. De nouvelles données démontrent aussi que la fluidité sexuelle est un déterminant essentiel des inégalités en matière de santé sexuelle, de santé mentale, de consommation de substances et de maladies chroniques. De plus, des études suggèrent que des facteurs contextuels (par exemple, les normes de genre, le climat politique) peuvent influencer les expériences de fluidité sexuelle, mettant en avant le besoin de mener des études comparatives entre pays pour mieux appréhender le rôle de ces facteurs. Des approches de recherche innovantes sont ainsi nécessaires pour comprendre comment évolue la sexualité des jeunes dans le contexte actuel.

Pour combler ces lacunes, notre objectif est de développer une nouvelle étude de cohorte longitudinale sur la fluidité sexuelle chez les jeunes au Canada, en France et au Royaume-Uni (RU). Pour cela, une étude pilote permettra d'identifier les mesures et les méthodes adaptées pour évaluer au mieux la diversité et la complexité des modèles et des trajectoires de fluidité sexuelle chez les jeunes. Cette étude offrira la possibilité d'établir des partenariats avec des leaders communautaires et des chercheurs locaux et internationaux qui faciliteront le développement de notre futur programme de recherche sur la fluidité sexuelle.

Mots-Clés

Fluidité sexuelle, orientation sexuelle, normes de genre, santé sexuelle, santé mentale

Zone géographique

Canada, France, Royaume-Uni

Calendrier

2025-2027

VIH : des solutions préventives à longue durée prometteuses

Joseph LARMARANGE — 2024-12-02T17:58:04Z

VIH : des solutions préventives à longue durée prometteuses

Louise Hurel , Christian Laurent , Joseph Larmarange , Karna Coulibaly

2024

Article de blog scientifique

hal-04815258

La PrEP avec le lénacapavir injectable est une solution efficace et prometteuse pour les populations vulnérables, à condition d'être accessible.

Des outils de prévention toujours plus efficaces et moins contraignants, adaptés aux conditions de vie et besoins réels des populations les plus exposées : voilà le nerf de la guerre contre le VIH. Parmi eux, la PrEP avec le lénacapavir nourrit de grands espoirs comme outil de prévention. Ce médicament est déjà utilisé pour soigner les patients ayant développé des résistances aux traitements les plus courants. Deux études viennent de démontrer qu'il était également pleinement efficace pour empêcher les nouvelles infections, à raison d'une injection sous-cutanée tous les six mois. Une révolution dans le domaine de la prévention !

En quoi le lénacapavir injectable peut apporter une solution pérenne ? À qui et sous quelles conditions ?

Explications avec trois scientifiques impliqués dans des projets de recherche auprès de populations clés : Christian Laurent, épidémiologiste IRD à TransVIHMI, coordinateur du projet CohMSM-PrEP, centré sur les hommes ayant des rapports sexuels avec les hommes (HSH) en Afrique de l'Ouest ; Joseph Larmarange, démographe IRD au Ceped, coordinateur du projet Princesse auprès de travailleuses du sexe en Côte d'Ivoire ; et Karna Coulibaly, démographe Ined et chercheur associé au Ceped, impliqué dans le projet Makasi qui a été réalisé auprès d'immigrés d'Afrique subsaharienne en situation de précarité vivant en Île-de-France.

Building better HIV models : a framework for incorporating evidence on structural determinants and interventions to estimate their impacts on HIV epidemics

Joseph LARMARANGE — 2024-10-28T15:41:00Z

Poster presented at HIVR4P 2024, the 5th HIV Research for Prevention Conference, October 2024, Lima, Peru.

Building better HIV models: a framework for incorporating evidence on structural determinants and interventions to estimate their impacts on HIV epidemics

James Stannah , Jorge Luis Flores Anato , Michael Pickles , Joseph Larmarange , Kate M. Mitchell , Adelina Artenie , Kostyantyn Dumchev , Serge Niangoran , Lucy Platt , Fern Terris-Prestholt Terris-Prestholt , Amteshwar Singh , Jack Stone , Peter Vickerman , Andrew Phillips , Leigh F Johnson , Mathieu Maheu-Giroux , Marie-Claude Boily

HIVR4P 2024, the 5th HIV Research for Prevention Conference, Oct 2024, Lima, Peru

Poster de conférence

hal-04971981

Authors

James Stannah, Jorge Luis Flores Anato, Michael Pickles, Joseph Larmarange, Kate M. Mitchell, Adelina Artenie, Kostyantyn Dumchev, Serge Niangoran, Lucy Platt, Fern Terris-Prestholt Terris-Prestholt, Amteshwar Singh, Jack Stone, Peter Vickerman, Andrew Phillips, Leigh F Johnson, Mathieu Maheu-Giroux, Marie-Claude Boily

Abstract

BACKGROUND : Structural determinants (SDs) are social, economic, political, cultural, organizational, and environmental factors that shape HIV inequalities across individuals and populations. UNAIDS' 10-10-10 targets aim to reduce exposure to SDs including punitive regulations, violence, stigma, and discrimination. Evidence-based dynamic HIV transmission models can help quantify the population-level impacts of SDs and structural interventions to inform decision-making. We appraised previous representations of SDs in HIV models to develop a new framework that supports the modelling and analysis of SDs.

METHODS : We performed a scoping review of HIV transmission dynamic modelling studies that modelled SDs, published until August 28, 2023, using Ovid Embase and Medline databases. To develop our framework, we considered how models represented exposures to SDs (statically vs dynamically) and reproduced causal pathways to estimate impacts on HIV, and the data they used.

RESULTS : We found 17 HIV modelling studies of SDs and/or structural interventions including incarceration of people who inject drugs (n=5) or Black men (n=2), violence against women (n=3), HIV-stigma (n=1), and homelessness (n=1), among other less well-defined exposures (e.g., “positive and negative attitudes”). Eight studies modelled SDs dynamically using granular exposure histories (e.g., current, recent, non-recent) that captured variation in duration and intensity of exposure. SDs mostly influenced HIV indirectly through simple causal pathways with single intermediate variables (mediators) – largely sexual/injecting partner numbers (n=9), mixing patterns (n=8), or condom use (n=6). Effects of SDs were mostly informed by cross-sectional data. Only seven studies fitted to observed trends in SDs or their effects on mediators/HIV. Using this, we developed our framework (Figure).

CONCLUSIONS : The representation of SDs in models could be refined to improve projections of their impacts and interventions using our framework. Fundamentally, this requires better inputs : more longitudinal studies investigating heterogeneity in SDs and their causal effects. Methods, findings, and limitations should be transparently communicated.

The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal

Joseph LARMARANGE — 2024-07-02T17:54:28Z

The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal

AIDS. Official journal of the international AIDS Society, 2024, ⟨10.1097/QAD.0000000000003974⟩

Article dans une revue

hal-04632874

Authors

Silhol Romain; Maheu-Giroux Mathieu; Soni Nirali; Simo Fotso Arlette; Rouveau Nicolas; Vautier Anthony; Doumenc-Aïdara Clémence; Geoffroy Olivier; N'guessan Kouassi Noel; Sidibé Younoussa; Kabemba Odé Kanku; Gueye Papa Alioune; Ndeye Pauline Dama; Mukandavire Christinah; Vickerman Peter; Keita Abdelaye; Ndour Cheikh Tidiane; Ehui Eboi; Larmarange Joseph; Boily Marie-Claude

Abstract

Objectives

To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal.

Design

HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM].

Methods

Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012–2021 averted by condom use and antiretroviral therapy (ART) uptake among key population and nonkey population, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012–2021 due to prevention gaps, and the distribution of undiagnosed PWH by risk group in January 2022 and their tPAF over 2022–2031.

Results

Condom use and ART may have averted 81–88% of new HIV infections over 2012–2021 across countries, mostly because of condom use by key population. The tPAF of all key populations combined over 2012–2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key population (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key population = 15%), 46% in Mali (male key population = 23%), and 69% in Senegal (male key population = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key population PWH in Côte d'Ivoire over 2022–2031, 53% in Mali, and 65% in Senegal.

Conclusion

Substantial HIV diagnosis gaps remain in Western Africa, especially among male key population. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.

Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults

Joseph LARMARANGE — 2024-07-02T17:25:52Z

Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults

Pierre-Julien Coulaud , Travis Salway , Nick Adams , William Ball , Joseph Larmarange , Michelle Kelly-Irving , Rod Knight

Journal of Epidemiology and Community Health, 2024, Online ahead of print. ⟨10.1136/jech-2023-221844⟩

Article dans une revue

hal-04631393

Authors

Pierre-Julien Coulaud, Travis Salway, Nick Adams, William Ball, Joseph Larmarange, Michelle Kelly-Irving, Rod Knight

Abstract

While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.

Bisexual men are at less risk of HIV infection than exclusive gay men in sub-Saharan Africa

Joseph LARMARANGE — 2023-09-27T08:39:35Z

Les hommes bisexuels sont moins exposés au virus de l'immunodéficience humaine que les homosexuels exclusifs en Afrique subsaharienne

Joseph Larmarange , Christophe Broqua

Santé Publique, 2022, 34 (HS2), pp.123-132. ⟨10.3917/spub.hs2.0123⟩

Article dans une revue

hal-04136246

Bisexual men are at less risk of HIV infection than exclusive gay men in sub-Saharan Africa

Joseph Larmarange , Christophe Broqua

Santé Publique, 2022, Santé des minorités sexuelles, sexuées et de genre, 34 (Hors série 2), pp.123-132. ⟨10.3917/spub.hs2.0123⟩

Article dans une revue

hal-04219505

Authors

Joseph Larmarange & Christophe Broqua

Abstract

Introduction: In sub-Saharan Africa, as in the rest of the world, men who have sex with men (MSM) are at greater risk of HIV infection than the general population. Bisexuals are often perceived to be more at risk than exclusive gay men.

Purpose of research: We propose a review of epidemiological surveys conducted in sub-Saharan Africa since 2005 to provide an overview of knowledge on HIV exposure among gay/bisexual men.

Results: We reviewed 355 publications and identified 62 measures of the association between bisexuality and HIV prevalence and 8 measures of the association between bisexuality and incidence. Except for 4 of 62 measures, the HIV prevalence observed among bisexuals was equal to or lower than that observed among exclusive gay men. In terms of incidence, all but one of the identified studies observed lower or equal HIV incidence among bisexuals. From a behavioural perspective, most studies found no difference in condom use. Bisexuals may have less frequent sex and consistently less receptive anal sex. They mainly started their sexual lives with men later, had fewer partners, and were less likely to know their HIV status.

Conclusions: Bisexuals are less likely to be at risk of HIV than exclusive gay men, partly because of behavioural differences. Prevention and treatment programs for MSM must take the specificities of bisexuals into account and design differentiated services.

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d'Ivoire, Mali, and Senegal

Joseph LARMARANGE — 2023-09-25T12:20:57Z

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d'Ivoire, Mali, and Senegal

Arsene Kra Kouassi , Arlette Simo Fotso , Kouassi Noël N'guessan , Olivier Geoffroy , Sidibé Younoussa , Odé Kanku Kabemba , Papa Alioune Gueye , Pauline Dama Ndeye , Nicolas Rouveau , Marie-Claude Boily , Romain Silhol , Marc d'Elbee , Mathieu Maheu-Giroux , Anthony Vautier , Joseph Larmarange

BMC Infectious Diseases, 2023, 22 (S1), pp.972. ⟨10.1186/s12879-023-08626-w⟩

Article dans une revue

hal-04216954

Authors

Arsène Kouassi Kra, Arlette Simo Fotso, Kouassi Noël N'guessan, Olivier Geoffroy, Sidibé Younoussa, Odé Kanku Kabemba, Papa Alioune Gueye, Pauline Dama Ndeye, Nicolas Rouveau, Marie-Claude Boily, Romain Silhol, Marc d'Elbée, Mathieu Maheu-Giroux, Anthony Vautier & Joseph Larmarange on behalf of the ATLAS team

Abstract

Background

Coverage of HIV testing remains sub-optimal in West Africa. Between 2019 and 2022, the ATLAS program distributed 400 000 oral HIV self-tests (HIVST) in Côte d'Ivoire, Mali, and Senegal, prioritising female sex workers (FSW) and men having sex with men (MSM), and relying on secondary redistribution of HIVST to partners, peers and clients to reach individuals not tested through conventional testing. This study assesses the proportion of first-time testers among HIVST users and the associated factors.

Methods

A phone-based survey was implemented among HIVST users recruited using dedicated leaflets inviting them to anonymously call a free phone number. We collected socio-demographics, sexual behaviours, HIV testing history, HIVST use, and satisfaction with HIVST. We reported the proportion of first-time testers and computed associated factors using logistic regression.

Results

Between March and June 2021, 2 615 participants were recruited for 50 940 distributed HIVST (participation rate: 5.1%). Among participants, 30% received their HIVST kit through secondary distribution (from a friend, sexual partner, family member, or colleague).

The proportion who had never tested for HIV before HIVST (first-time testers) was 41%. The main factors associated with being a first-time tester were sex, age group, education level, condom use, and secondary distribution. A higher proportion was observed among those aged 24 years or less (55% vs 32% for 25–34, aOR: 0.37 [95%CI: 0.30–0.44], and 26% for 35 years or more, aOR: 0.28 [0.21–0.37]); those less educated (48% for none/primary education vs 45% for secondary education, aOR: 0.60 [0.47–0.77], and 29% for higher education, aOR: 0.33 [0.25–0.44]). A lower proportion was observed among women (37% vs 43%, aOR: 0.49 [0.40–0.60]); those reporting always using a condom over the last year (36% vs 51% for those reporting never using them, aOR: 2.02 [1.59–2.56]); and those who received their HISVST kit through primary distribution (39% vs 46% for secondary distribution, aOR: 1.32 [1.08–1.60]).

Conclusion

ATLAS HIVST strategy, including secondary distribution, successfully reached a significant proportion of first-time testers. HIVST has the potential to reach underserved populations and contribute to the expansion of HIV testing services in West Africa.

Orientation sexuelle et identité de genre : quelles catégories d'enquête en Afrique subsaharienne ?

Joseph LARMARANGE — 2023-09-04T09:04:17Z

Orientation sexuelle et identité de genre : quelles catégories d'enquête en Afrique subsaharienne ?

Joseph Larmarange , Christophe Broqua

Wilfried Rault; Mathieu Trachman. Minorités de genre et de sexualité : objectivation, catégorisations et pratiques d'enquête, Ined Éditions, pp.191-207, 2023, Méthodes et Savoirs, 978-2-7332-8036-2. ⟨10.4000/books.ined.19336⟩

Chapitre d'ouvrage

hal-04194856

Auteurs

Joseph Larmarange & Christophe Broqua

Résumé

À l'inverse de quelques travaux pionniers en sciences humaines et sociales, la question de l'homosexualité masculine est restée inexistante dans les enquêtes quantitatives en Afrique subsaharienne jusqu'au début des années 2000, malgré les épidémies de VIH qui ravageaient le continent.

C'est en 2005 qu'est publiée, pour la première fois, une étude quantitative bio-comportementale (Wade et al., 2005) sur une population d'hommes ayant des rapports sexuels avec des hommes (HSH) en Afrique – en l'occurrence au Sénégal. Le principal résultat concernait la prévalence du VIH : sur les 463 hommes interrogés, 22 % étaient infectés par le VIH, et ce dans un pays, le Sénégal, connu pour sa faible prévalence en population générale (moins de 1 %). Mais l'enquête apportait aussi d'autres informations importantes, notamment au sujet de l'orientation sexuelle : 94 % des répondants déclaraient avoir eu des relations sexuelles avec des femmes au moins une fois au cours de leur vie. Cette proportion élevée d'hommes ayant des pratiques bisexuelles est devenue un élément récurrent des enquêtes sur les HSH en Afrique, et l'un des aspects les plus discutés.

Depuis le milieu des années 2000, parallèlement à une attention internationale croissante accordée aux HSH dans les pays à ressources limitées et une pression politique des bailleurs internationaux pour la prise en compte des populations dites « clés » dans la riposte aux épidémies de VIH, les enquêtes quantitatives sur les HSH se sont développées exponentiellement en Afrique subsaharienne. À partir des années 2010, une partie d'entre elles aussi exploré l'identité de genre et certaines publications ont concerné plus, spécifiquement, les personnes « transgenres ».

Ce chapitre fait le point sur ces dimensions telles qu'elles apparaissent dans la littérature disponible, en examinant les connaissances dont nous disposons sur les différentes populations que recouvre la catégorie HSH. À partir d'une revue de littérature exhaustive, nous recensons les catégories que mettent en évidence les enquêtes quantitatives du point de vue de l'orientation sexuelle (articulant plusieurs dimensions, dont le pôle d'activité sexuelle, l'orientation sexuelle déclarée et l'attirance sexuelle) et de l'identité de genre.

L'objectif est de savoir si les dimensions investiguées sont suffisantes pour la compréhension fine, tant des logiques sociales de la sexualité que des comportements et des identités, et de questionner la façon dont est pensée la diversité des profils au sein de la catégorie HSH. Nous faisons l'hypothèse que les catégories utilisées sont importées des pays du Nord et plaquées sur les pays africains au détriment des catégories et représentations locales, en suivant un agenda international lié à l'épidémie de VIH, qui dicte la définition des catégories à investiguer. Après de nombreuses décennies au cours desquelles s'est construite l'image d'un continent exclusivement hétérosexuel, le développement exponentiel des enquêtes épidémiologiques sur les HSH en Afrique ne témoigne-t-il pas lui aussi d'un travers, certes inverse, en dessinant des formes d'orientation sexuelle et d'identité de genre minoritaires de manière réductrice et schématique ?

Supplément

Tableau détaillé des résultats (doi : 10.5281/zenodo.4569342)

Note

Illustration extraite du film Woubi Chéri (1998)