HIV Risk and Associations of HIV Infection among men who have sex with men in Peri-Urban Cape Town, South Africa

Abstract

BackgroundThe HIV epidemic in Sub Saharan Africa has been traditionally assumed to be driven by high risk heterosexual and vertical transmission. However, there is an increasing body of data highlighting the disproportionate burden of HIV infection among MSM in the generalized HIV epidemics across of Southern Africa. In South Africa specifically, there has been an increase in attention focused on the risk status and preventive needs of MSM both in urban centers and peri-urban townships. The study presented here represents the first evaluation of HIV prevalence and associations of HIV infection among MSM in the peri-urban townships of Cape Town.MethodsThe study consisted of an anonymous probe of 200 men, reporting ever having had sex with another man, recruited through venue-base sampling from January to February, 2009.ResultsOverall, HIV prevalence was 25.5% (n = 51/200). Of these prevalent HIV infections, only 6% of HIV-1 infected MSM were aware of their HIV status (3/50). 0% of men reported always having safe sex as defined by always wearing condoms during sex and using water-based lubricants. Independent associations with HIV infection included inconsistent condom use with male partners (aOR 2.3, 95% CI 1.0-5.4), having been blackmailed (aOR 4.4, 95% CI 1.6-20.2), age over 26 years (aOR 4.2, 95% CI 1.6-10.6), being unemployed (aOR 3.7, 95% CI 1.5-9.3), and rural origin (aOR 6.0, 95% CI 2.2-16.7). Bisexual activity was reported by 17.1% (34/199), and a total of 8% (16/200) reported having a regular female partner. Human rights violations were common with 10.5% (n = 21/200) reporting having been blackmailed and 21.0% (n = 42/200) reporting being afraid to seek health care.ConclusionsThe conclusions from this study include that a there is a high risk and underserved population of MSM in the townships surrounding Cape Town. The high HIV prevalence and high risk sexual practices suggest that prevalence will continue to increase among these men in the context of an otherwise slowing epidemic. These data further highlight the need to better characterize risk factors for HIV prevention and appropriate targeted combination packages of HIV interventions including biomedical, behavioural, and structural approaches to mitigate HIV risk among these men.

Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil

“…Fifty-seven percent (95%CI: 51.6; 61.8) had experienced some type of discrimination in the year prior to the interview. 43.5% reported not having told their parents about their sexual attraction to other men (95%CI: 38.2; 48.8).…”

“…Sexual category was associated with the result of the syphilis test (prevalence of syphilis and HIV was higher among homosexuals). The literature generally reports an association between sexual identity and risky sexual practices for HIV infection 12,29,38,42 , stigma 29 , difficult access to health services 31,43 , and HIV infection 26,43 .…”

“In the Fell Clutch of Circumstance”: HIV and Men Who Have Sex With Men in Sub-Saharan Africa

“…In Kendall et al's [16] study in Angola for instance, 61.3 % of participants had never tested for HIV, while Vu et al [42] found that 45.1 % of their participants in Nigeria had never tested. In a study conducted in Cape Town, South Africa, Baral et al [56] found that only 6 % of HIVpositive MSM participants knew their HIV status. These findings again point to the urgent need for more widespread HIV-related interventions for MSM.…”

Sexual Minorities in Africa: A Challenge for Social Work

“…(National Coalition for Gay & Lesbian Equality v. Minister of Justice, CCT 11/98 per Sachs J., para. 126-127; cited inBaral, Burrell, Beyrer, & Bekker, 2009) …”