Grant: Project Grant - PA: Sex, Gender & Health Research - Integration & Innovation

Our proposed research aims to 1) set up a cohort study to uncover the risk factors for diseases related to human papillomavirus (HPV) (i.e., anal warts and anal cancer), employing novel community-based strategies, and 2) generate new scientific knowledge relating to the clinical, social, epidemiological, and biological aspects of HPV infection among a group of highly stigmatized men who have sex with men (MSM) living in Nairobi, Kenya. These MSM attend the community-run sexual health program known as Health Options for Young Men Against STIs (HOYMAS). According to program data we collected with HOYMAS between 2016 and 2018, anal warts-the most common STIs observed in sexually active populations-persist among program participants at high rates. Yet HOYMAS participants rarely request anal exams and those who do often present with anal warts at very late stages. Within the context of high HIV prevalence (26% in Nairobi) and homophobia, which inhibits and delays health services utilization, the growing frequency and late presentation of HPV-related anal warts among Kenyan MSM often appear as large, obstructive masses that require invasive surgical intervention-procedures which are accompanied by intense pain and suffering during the recovery and major losses of income for those who earn a living through sex work. Anal cancer is also being diagnosed and treated at a late stage. We currently lack the evidence base necessary to inform an effective HPV prevention or early detection and treatment program. By nesting our study within a mature and dynamic HIV program following >5000 MSM in Nairobi, we will build a multidisciplinary evidence base that feeds out from and into a community-driven intervention with the aim of drastically reducing the frequency of future severe HPV-related disease. Our project responds to the global health alarm over emerging cancer epidemics in African contexts hardest hit by the HIV epidemic.