Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland

Abstract

Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using "high," "medium" and "low" levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1-1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1-3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.

The relationship between higher social trust and lower late HIV diagnosis and mortality differs by race/ethnicity: results from a state‐level analysis

“…Table 2), which is adjusted for income inequality, socio-economic deprivation, religious involvement, % urban areas, population density, % foreign born, % age 18-34, residential instability, % insured, Affordable Care Act (yes/no). likelihood and higher community-level rates of HIV testing [17,20,63]. Also, Black/African American MSM test for HIV at higher rates than White MSM [64].…”

“…neighbourhood, state) networks and resource that individuals can draw upon for mutual support [14,15]. Social cohesion and capital (hereafter social cohesion/capital) has been theorized [6] and documented empirically to have protective associations with HIV-related behaviours and HIV care continuum outcomes [16][17][18][19] among key populations [20,21].…”

“…One indicator of social cohesion/capital is mutual trust among neighbours [11,12], which can facilitate the willingness of individuals to work towards achieving or realize collective goals that activate neighbourhood collective efficacy [22]. Mechanisms linking social cohesion/capital to HIV include increased supportive social norms, higher information exchange, reduced HIV/AIDS stigma resulting in timely HIV testing and engagement in HIV care [20,[23][24][25]. Next, the association between social cohesion/capital and HIV care continuum indicators differs across subgroups, for example sex [16,26,27].…”

Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross‐sectional online survey

“…Increasing HIV testing uptake and frequency is particularly important among MSM living in LMICs. Yet, HIV testing research on this key population has been limited in LMICs [29,30]. Insights into community engagement and other factors associated with HIV testing and syphilis testing can facilitate the development of MSM-led, community-level interventions.…”

Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing

“…It is plausible also that individuals with high socioeconomic status could use their political power to lobby for the placement and proximity of HIV testing facilities further away from their residences to disassociate themselves from HIV risk and HIV-related stigma (the “NIMBY” (not in my backyard) phenomenon) (Takahashi, 1997, 1998). Income inequality also erodes social capital and weaken social ties (Kawachi et al, 2008), which can influence HIV testing among individuals (Grover et al, 2016) because those with weaker ties may have less access to relevant HIV knowledge and educational resources (Jesmin and Chaudhuri, 2013). …”