Contextual Correlates of Per Partner Unprotected Anal Intercourse Rates Among MSM in Soweto, South Africa

Abstract

Men who have sex with men (MSM) throughout the world are at high-risk of HIV acquisition and transmission. Although individual behavior remains a central feature of HIV prevention efforts in sub-Saharan Africa and beyond, contextual factors likely influence behavioral risk. We identify contextual factors at the individual, dyadic (within the partnership), and extra-dyadic (relationships external to the focal dyad) levels that are associated with increased rates of unprotected anal intercourse with a given male partner among MSM in Soweto, South Africa. Drawing on data from The Soweto Men’s Study, multilevel models were applied to 758 partnerships nested within 377 MSM respondents. Independent of overall sexual engagement, dyadic (e.g. description of partner as ‘regular’), psychosocial (e.g. experiences of homonegativity), and sociocultural (e.g. income) contextual factors were significant predictors of differential 6-month rates of UAI with a given partner. By contrast, sexual partnerships outside of the focal sexual pair were not significantly related to UAI rates within the focal pair. Our findings support the need for continuing to understand and intervene on partner-level, psychosocial, and sociocultural dimensions of sexual behavior and sexual risk among MSM in Soweto.

High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria

“…The potentially stigmatizing nature of receiving care at MSM-friendly community health centres and the potential for harassment by authorities or others may have impeded recruitment into this study. This analysis evaluated characteristics at the level of individual participants in the cohort and did not account for relationship status, such as casual versus regular partnership or exchange of sex for goods or money, which could vary across any one participant’s multiple sexual encounters and could influence sexual behaviours that contribute to the risk of HIV and other STIs [48,49]. Finally, the analysis of risk factors for HIV and other STIs used pooled data from both Abuja and Lagos, and the estimation of risk ratios did not incorporate weighting to account for recruitment via RDS, which could have biased some effect estimates.…”

Concentrated HIV subepidemics in generalized epidemic settings

“…74 The same pattern was observed in Tanzania and South Africa, where 37% and 50% of MSM reported having had a female sexual partner, respectively. 30, 75 Interventions targeting MSM thus has the potential to yield benefits for both the MSM and the heterosexual community, depending on the extent with which the two sexual communities are linked. Despite the potential contribution of MSM to HIV transmission in generalized epidemics, few phylogenetic studies have examined to which extent transmission is behaviourally segregated between MSM and the general population.…”

HIV risk and prevention among men who have sex with men in rural South Africa

“…In terms of demographics, South African MSM older than 25 have consistently been found to have higher HIV infection rates than other MSM (Baral et al, 2011;Lane et al, 2011;Sandfort, Knox, Collier, Lane, & Reddy, 2015). Psychosocial factors contributing to HIV risk include: sexual self-identity (Lane et al, , 2014Rispel et al, 2011;Sandfort, Lane, Dolezal, & Reddy, 2015); experiences of stigma and homophobia (Arnold, Struthers, McIntyre, & Lane, 2013;Tucker et al, 2014); low self-efficacy for protective behaviours (Tucker et al, 2014); beliefs about trust and condom use in relationships (Knox, Yi, Reddy, Maimane, & Sandfort, 2010); being in a relationship with a regular partner (Arnold et al, 2013;Knox et al, 2010); and experiencing depression (Tucker et al, 2013). Behavioural risk factors for HIV infection identified in previous research include: transactional sex Nel, Yi, Sandfort, & Rich, 2013); high numbers of sexual partners Tucker et al, 2014); and alcohol and drug use Lane, Shade, McIntyre, & Morin, 2008;Parry et al, 2008;Sandfort, Yi, Knox, & Reddy, 2013).…”