Prevalence of HIV, syphilis, and condomless sex among MSM in Nepal; findings based on an integrated biological and behavioral surveillance survey using respondent-driven sampling

In Nepal, men who have sex with men (MSM) encounter significant social stigma, which exacerbates their vulnerability to mental health issues. The interplay of these factors increases the likelihood of engaging in risky sexual behaviors, ultimately resulting in adverse health outcomes. This study assessed the prevalence of human immunodeficiency virus (HIV) and syphilis and factors associated with syphilis infection and condomless sex in the past 6 months among MSM in Nepal. We calculated HIV and syphilis prevalence and used bivariate and multivariate analyses to identify factors associated with syphilis infection and sexual risk. Among 250 participants, the weighted HIV prevalence was 2.6% (95% confidence interval [CI]: 0.6-4.6), and the syphilis prevalence was 13.1% (95% CI: 8.8-17.2). The practice of condomless sex was found to be in 71.4% (95% CI: 65.7-76.9) of the participants. Condomless sex in the past 6 months (respondent-driven sampling [RDS] weighted adjusted odds ratio [aOR]: 4.5; 95% CI: 1.1-18) and reported employment denial due to being MSM (RDS weighted aOR: 4.1; 95% CI: 1.5-10.8) were significantly associated with higher odds of syphilis infection. MSM who were single (RDS weighted aOR: 2.2; 95% CI: 1.1-4.4) and gay (RDS weighted aOR: 2.2; 95% CI 1.2-4.1) had a higher likelihood of having condomless sex in the past 6 months. These findings highlight the need for targeted interventions at multiple levels to address the specific needs of marginalized populations, such as MSM, to lower their risk of sexually transmitted infections and reduce unsafe sexual behaviors, notably unprotected sex.