HIV Prevalence, Virological Suppression, and Consistent Condom Use Among Social Venue-Going Men in Zimbabwe: Insights from the 2022 Priorities for Local AIDS Control Efforts (PLACE) Surveys

Men attending social venues face barriers to accessing HIV prevention and care services. These venues-such as bars, guesthouses, nightclubs, and transport hubs-facilitate new sexual partnerships but lack cohesive social networks, making it challenging to design and implement effective HIV prevention strategies. Men who attend social venues are more likely to pay for sex, potentially increasing their risk of acquiring or transmitting HIV. However, data on how HIV-related behaviours and service engagement differ between men who do and do not pay for sex among those attending venues remain limited. This study examines whether men who pay for sex have higher rates of HIV prevalence, lower rates of virological suppression, and poor HIV-prevention-related behaviours compared to those who do not. Using the Priorities for Local AIDS Control Efforts (PLACE) methodology, we collected cross-sectional data from April to December 2022 across 190 venues in four cities and towns in Zimbabwe. Participants underwent finger-prick HIV testing; those testing positive provided dried blood spots (DBS) for viral load measurement. We also collected sexual behaviour data, including condom use. We applied survey weights and used weighted Poisson regression models with robust standard errors to investigate factors associated with HIV status, virological suppression, and condom use among venue-going men, treating paying for sex as the primary exposure variable. All reported percentages are weighted. Among venue-going 2,827 men, 984 (40.1%) reported paying for sex in the past 12 months, and 531 (15.1%) reported consistent condom use in the past month. Overall, HIV prevalence was 10.7%. Among men living with HIV, virological suppression was 67.9%. In adjusted analyses, there were no significant associations between paying for sex and HIV status (adjusted prevalence ratio (aPR) = 1.12, 95% CI: 0.64-1.94), self-reported consistent condom use in the past month (aPR = 0.87, 95% CI: 0.57-1.34), or rates of virological suppression among men living with HIV (aPR = 0.97, 95% CI: 0.71-1.34). Findings indicate substantial HIV risk and suboptimal prevention and treatment engagement among men frequenting social venues, irrespective of paying for sex. Therefore, targeted interventions are needed for both paying and non-paying men.