HIV-Untested Men Who Have Sex with Men in South Africa: The Perception of Not Being at Risk and Fear of Being Tested

Nel, Juan A.; Yi, Hana; Sandfort, Theo; Rich, Eileen

doi:10.1007/s10461-012-0329-4

Cited by 36 publications

(41 citation statements)

References 33 publications

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“…MSM may have higher rates of alcohol and drug intake [34], may feel they are not at risk of HIV or fear testing [35] and avoid services they perceive as anti-gay [36]–[38], and may avoid disclosing their sexual orientation in traditional VCT sessions [1]. While participants knew about the complex issues faced by high-risk MSM in their daily lives, very few described any alteration in their approach to standard risk-reduction planning.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

et al. 2013

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The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire) and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa.

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Section: Discussionmentioning

confidence: 99%

Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

et al. 2013

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“…In contrast, the Risk-Based Testers might benefit from prevention strategies designed to update their knowledge of HIV testing recommendations. As the Risk-Based Testers also described decreased testing frequency in the context of stable partnerships, an additional potentially useful strategy for targeting this group may be couples-based HIV testing, which has been shown to be theoretically acceptable and appealing to Black MSM [42], [43]. This is particularly important given that the majority of HIV transmissions among MSM in the U.S. are likely occurring between main partners [44].…”

Section: Discussionmentioning

confidence: 99%

HIV Testing Patterns among Black Men Who Have Sex with Men: A Qualitative Typology

et al. 2013

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BackgroundBlack men who have sex with men (MSM) in the Southeastern United States are disproportionately affected by HIV. Black MSM are more likely to have unrecognized HIV infection, suggesting that testing may occur later and/or infrequently relative to current recommendations. The objective of this qualitative study was to explore the HIV testing behaviors of Black MSM in Atlanta, Georgia, who were participants in the HIV Prevention Trials Network Brothers Study (HPTN 061).Methods and FindingsWe conducted 29 in-depth interviews and four focus groups with a community-recruited sample. Modified grounded theory methodologies were used to guide our inductive analysis, which yielded a typology comprised of four distinct HIV testing patterns. Participants could be categorized as: (1) Maintenance Testers, who tested regularly as part of routine self-care; (2) Risk-Based Testers, whose testing depended on relationship status or sexual behavior; (3) Convenience Testers, who tested irregularly depending on what testing opportunities arose; or (4) Test Avoiders, who tested infrequently and/or failed to follow up on results. We further characterized these groups with respect to age, socioeconomic factors, identity, stigma and healthcare access.ConclusionsOur findings highlight the heterogeneity of HIV testing patterns among Black MSM, and offer a framework for conceptualizing HIV testing in this group. Public health messaging must account for the diversity of Black MSM's experiences, and multiple testing approaches should be developed and utilized to maximize outreach to different types of testers.

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“…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). Finally, structural factors affecting HIV risk include poverty (Dunkle, Jewkes, Murdock, Sikweyiya, & Morrell, 2013;Jobson et al, 2013;Lane et al, 2011), unemployment (Baral et al, 2011), and low levels of formal education (Sandfort et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

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

Maleke

Makhakhe

Peters

et al. 2017

African Journal of AIDS Research

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Rural South African men who have sex with men (MSM) are likely to be underserved in terms of access to relevant healthcare and HIV prevention services. While research in urban and peri-urban MSM populations has identified a range of factors affecting HIV risk in South African MSM, very little research is available that examines HIV risk and prevention in rural MSM populations. This exploratory study begins to address this lack by assessing perceptions of HIV risk among MSM in rural Limpopo province. Using thematic analysis of interview and discussion data, two overarching global themes that encapsulated participants' understandings of HIV risk and the HIV risk environment in their communities were developed. In the first theme, "community experience and the rural social environment", factors affecting HIV risk within the broad risk environment were discussed. These included perceptions of traditional value systems and communities as homophobic; jealousy and competition between MSM; and the role of social media as a means of meeting other MSM. The second global theme, "HIV/AIDS knowledge, risk and experience", focused on factors more immediately affecting HIV transmission risk. These included: high levels of knowledge of heterosexual HIV risk, but limited knowledge of MSM-specific risk; inconsistent condom and lubricant use; difficulties in negotiating condom and lubricant use due to uneven power dynamics in relationships; competition for sexual partners; multiple concurrent sexual partnerships; and transactional sex. These exploratory results suggest that rural South African MSM, like their urban and peri-urban counterparts, are at high risk of contracting HIV, and that there is a need for more in-depth research into the interactions between the rural context and the specific HIV risk knowledge and behaviours that affect HIV risk in this population.

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HIV-Untested Men Who Have Sex with Men in South Africa: The Perception of Not Being at Risk and Fear of Being Tested

Cited by 36 publications

References 33 publications

Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

Challenges in Providing Counselling to MSM in Highly Stigmatized Contexts: Results of a Qualitative Study from Kenya

HIV Testing Patterns among Black Men Who Have Sex with Men: A Qualitative Typology

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

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