Introduction: Epidemiological data on HIV infection in male urethral discharge syndrome (UDS) in Africa are limited. We describe the prevalence of HIV and associated demographic and sociobehavioral factors among men with UDS in selected public clinics in Kampala, Uganda.

Methods: Within a cross-sectional study of men seeking care for UDS from October 2019 to July 2022, we performed interviewer-administered demographic and sociobehavioral questionnaires. Point-of-care (POC) rapid sequential algorithmic HIV testing was conducted. Bivariate and adjusted multivariable log-binomial regression analyses were performed to determine factors associated with HIV.

Results: Of 450 male participants, 441(98%) were included in this analysis; 9 declined HIV testing. Median (IQR) age was 24 (22-32) years, 87% (n = 384) reported a previous HIV test. Overall, 18.4% (n = 81) were people living with HIV (PLWHIV). Of these, 86.4% and 13.6% were aged ≥ 25 and < 25 years, respectively. Overall, 8.6% (n = 7) were newly diagnosed with HIV; of those, 42.9% (n = 3) were aged < 25 years. While 94% (70/74) with known HIV reported antiretroviral therapy (ART) use, 52.9% (n = 37) had suppressed viral loads by self-report. Five of the 441 participants (1.1%) reported 'always' condom use, 45.4% (n = 200) reported transactional sex, 59.6% (n = 263) ≥ 2 sexual partners in the past six months; 46.7% (n = 206) had notified their partners of UDS symptoms. Multivariable analysis demonstrated significant associations between HIV and older age ≥ 25 years (aPR,6.35; 95% C.I., 3.44-11.75; P < 0.001), and hazardous alcohol use (aPR,1.62; 95% C.I., 1.03-2.54; P = 0.038).

Conclusions: Almost one in five men presenting with UDS were PLWHIV, with just over half of those on ART reporting viral suppression. Older age and hazardous alcohol use were associated with HIV. Men with UDS represent a key population where HIV diagnosis, prevention, and ART adherence interventions may have a significant impact.