Alcohol and Sexual Risk Behavior Among Men Who Have Sex with Men in South African Township Communities

Abstract

There are few studies of HIV risk behavior among men who have sex with men (MSM) in sub-Saharan Africa. We conducted a behavioral survey of MSM in peri-urban "township" communities in Gauteng province, South Africa. Between October 2004 and March 2005, 199 MSM completed an interviewer administered pen-and-paper standardized questionnaire. The sample was 94% black, 83% identified as gay, and 12% as bisexual. Among those reporting sex with other men in the prior six months (n = 147), 59% reported unprotected anal intercourse (UAI). Increased risk of UAI was associated with both regular drinking (adjusted odds ratio (OR) 4.1, 95% confidence interval (CI) 1.4, 12.6) regular drinking to intoxication (OR 2.6, 95% CI 1.0, 6.8), and reporting symptoms of rectal trauma resulting from anal intercourse (AI; OR 4.3, 95% CI 1.8, 10.4). Decreased risk of UAI was associated with the exclusive use of lubricants that are latex-compatible for AI (OR 0.3, 95% CI 0.1, 0.7). Township MSM in South Africa are at high risk of HIV infection. Targeted sexual health and risk reduction interventions that address the link between alcohol use and HIV risk are urgently needed.

Why do we have sex? Reflections from a Stepping Stones participatory action research with youth LGBTI in Johannesburg

“…Feelings of love, alcohol and persuasion or force seemed to be common with those presented in the other studies (Lane et al 2008). The motivations, and enablers, for engaging in sexual intercourse as reported in this article are no different from those of heterosexual youths such as being alone with the boyfriend/girlfriend, using alcohol, curiosity, pornographic media, physical stimulation and hearing about sex from others (Fongkaew et al 2012).…”

“…Other studies of risk behaviour amongst the youth present similar findings, in which different states of intoxication were found to be influential in the choices many individuals made with regards to risky sexual behaviour (Fritz et al 2002;Van Heijden and Swartz 2014;Kalichman et al 2007;Weiser et al 2006). Lane et al (2008) suggest that alcohol consumption influence the socialising pattern and depth of many young people, including same-sex coupling and is associated with unprotected sex. Nonetheless, they proposition, in line with Morojele et al (2006) that more focused explorations be conducted of the environment of social drinking, and economic, peer-group and interpersonal indicators.…”

“…Youth who identify as lesbian, gay, and/or bisexual may face different sexual socialisation from their heterosexual counterparts (Kuperberg and Padgett 2015b, a). Alcohol is mentioned in studies of gay and bisexual men's sexual activity from the United States of America (Newcomb, Clerkin, and Mustanski 2011) and South Africa (Lane et al 2008). The first author conducted Stepping Stones participatory workshops in the Pacific Islands in 2007.…”

“…In this sense, interventions on safer sex practices and access to health care amongst the youth must take into consideration these interweaving sexual and gender identities (Hamblin and Nduna 2013;Mdletshe and Nduna 2013;Nkoana and Nduna 2012;Nduna 2012). Lane et al (2008) and Mdletshe and Nduna (2013) further note that neglect of lesbian, gay, bisexual, transgender and intersex (LGBTI) community in national and/or local safer sex prevention efforts do not target the is pervasive in South Africa. Early research on sexuality amongst same-sex communities in sub-Saharan Africa has focused on risky sexual behaviour in institutional settings such as prisons or in migrant labour environments (Goyer and Gow 2001;Niehaus 2002, Odujinrin andAdebajo 2001).…”

“…The dominant debates on LGBTI youth in South African universities focuses on knowledge, attitudes and practices, stigma and discrimination and HIV risk (Abaver et al 2014, Mavhandu-Mudzusi andNetshandama 2013;Mavhandu-Mudzusi 2014;Mavhandu-Mudzusi and Sandy 2015;Arndt and de Bruin 2006;HEAIDS and NACOSA 2014). When discussing homosexual relationships, the focus is on the impact of being 'different' and on homosexual youths' self-worth, distress, stigma, discrimination, HIV and so on (Lane et al 2008;Nduna and Jewkes 2013;Newcomb, Clerkin, and Mustanski 2011). Data gathered through a series of…”