Human Papillomavirus/Human Immunodeficiency Virus Co- Infection and Anogenital Cancer Among Men Who Have Sex With Men in Machakos County, Kenya

Purpose of Study: This study determined the epidemiology of human papillomavirus (HPV) and human immunodeficiency virus (HIV) co-infection among men who have sex with men (MSM) in Machakos County, Kenya. Specifically, it assessed HPV prevalence and genotype distribution, HIV prevalence, HPV/HIV co-infection, anogenital cytological abnormalities, and behavioural and healthcare-related factors. Methodology: A descriptive cross-sectional study was conducted among 472 MSM recruited consecutively from four Drop-in Centre clinics in Machakos County. Structured questionnaires collected socio-demographic and behavioural information. Anogenital swabs were analysed for HPV DNA using polymerase chain reaction and sequencing, blood samples were tested for HIV, and anal cytology was performed using the Papanicolaou technique. Data were analysed using SPSS. Findings: Anogenital HPV infection was detected in 68.2% of participants, while 41.9% tested HIV-positive. Among HPV-positive participants, 79.8% carried at least one high-risk genotype, with HPV16 being the most prevalent at 26.1%. Multiple concurrent HPV genotypes occurred in 42.2% of HPV-positive participants. HPV/HIV co-infection occurred in 37.3% of the total participants and was significantly associated with HIV infection (χ² = 60.84, p < 0.001). Among participants with high-risk HPV, 51.4% had abnormal anal cytology, including LSIL, HSIL, and anogenital carcinoma. Multiple sexual partners, inconsistent condom use, absence of HPV vaccination, uncircumcised status, substance use, and limited access to LGBTQ+-friendly healthcare were significantly associated with co-infection. Conclusion: MSM in Machakos County experience a substantial burden of HPV, HIV, co-infection, and HPV-associated anogenital abnormalities. The findings support integrating HPV DNA testing, anal cytology, vaccination, and HIV services, while strengthening confidential, stigma-free healthcare access and targeted prevention interventions for this population.