HIV Epidemiology, Risk Behaviours, and Structural Barriers among Men Who Have Sex with Men in Cabo Verde: Evidence from Three Bio-behavioural Surveys (2013–2023)

Introduction : Men who have sex with men (MSM) remain disproportionately affected by HIV globally. Cabo Verde, while maintaining a low HIV prevalence in the general population (< 1%), has reported a rising burden among MSM. This study synthesises findings from three consecutive bio-behavioral surveys (2013, 2017, 2023), providing the first longitudinal evidence on HIV epidemiology, risk behaviours, and vulnerabilities among MSM in Cabo Verde. Methods : Cross-sectional bio-behavioral surveys were conducted in 2013 (n = 316), 2017 (n = 243), and 2023 (n = 295). Respondent-driven and snowball sampling strategies recruited MSM in Praia, Mindelo, and other urban areas. Data collection combined structured questionnaires, in-depth interviews, and rapid HIV testing. Descriptive analyses compared prevalence, behaviours, and structural determinants across survey years. Multivariate logistic regression was performed on 2023 data. Results: HIV prevalence rose from 4.4% (2013) to 5.4% (2017) and 9.5% (2023). Condom use during anal intercourse declined from 72% (2013) to 63% (2023). Transactional sex increased, reaching 29% in 2023. Verbal (11–14%) and physical violence (6–8%) persisted, alongside police harassment (13–18%). Despite > 90% knowledge of prevention, consistent condom use remained low, and disclosure to family and partners was limited. In 2023, 80% reported HIV testing in the past year, 54% screened positive for mental health distress, and 72% expressed willingness to use pre-exposure prophylaxis (PrEP). Logistic regression indicated higher HIV risk among older MSM (≥ 25 years, AOR 1.8, 95% CI 1.1–2.9) and urban residents (AOR 1.6, 95% CI 1.0–2.5), with secondary or higher education protective (AOR 0.62, 95% CI 0.39–0.98). Conclusions: D espite progress in HIV awareness and testing, HIV prevalence among MSM in Cabo Verde nearly doubled over the past decade. Persisting stigma, violence, and declining condom use undermine prevention. Urgent scale-up of pre-exposure prophylaxis (PrEP), community-led stigma reduction, and MSM-friendly health services is essential to reverse current trends and achieve UNAIDS 2030 targets.