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Gumindega GC, Maharaj P. Challenges with couples HIV counselling and testing among black MSM students: perspectives of university students in Durban, South Africa. SAHARA J 2022; 19:22-31. [PMID: 35912646 PMCID: PMC9344953 DOI: 10.1080/17290376.2022.2101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Research suggests that HIV infections among men who have sex with men (MSM) are acquired from primary partners, yet MSM continually fail to take part in couples HIV counselling and testing (CHCT). To identify factors that inhibit MSM in universities from regularly testing for HIV with their sexual partners, this study considered the perspectives and experiences of 15 MSM students in Durban, South Africa. The findings show that despite appreciating the value of couple testing it is relatively uncommon. MSM resist doing so with their casual partners as this would presumably signal an intention to advance the relationship beyond the short-term. Other barriers included; experienced and perceived homophobia at public testing centres, trust-based assumptions that primary partners need not test for HIV and fear of discord. They also employed alternative strategies to purportedly determine their casual and primary partners' status in the absence of CHCT. Alternative strategies include; initiating sexual relationships with casual partners whose sexual history is known and making use of home-based testing kits to avoid CHCT at public testing centres. These findings emphasise the need for LGBTIQ-friendly couple-based approaches as a necessary component of HIV prevention interventions among MSM in universities.
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Affiliation(s)
- Geogina Charity Gumindega
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa, Geogina Charity Gumindega School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban4041, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
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Metheny N, Stephenson R, Darbes LA, Chavanduka TMD, Essack Z, van Rooyen H. Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia. AIDS Behav 2022; 26:2003-2014. [PMID: 34997385 DOI: 10.1007/s10461-021-03549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.
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Affiliation(s)
- Nicholas Metheny
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Drive, Coral Gables, FL, 33146, USA.
| | - Rob Stephenson
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Lynae A Darbes
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Tanaka M D Chavanduka
- University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan Center for Sexuality and Health Disparities, Ann Arbor, MI, USA
| | - Zaynab Essack
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- School of Law, University of KwaZulu-Natal, KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council of South Africa, Pretoria, Gauteng, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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HIV Testing, Knowledge and Willingness to Use PrEP Among Partnered Men Who Have Sex With Men in South Africa and Namibia. AIDS Behav 2021; 25:1993-2004. [PMID: 33389373 DOI: 10.1007/s10461-020-03129-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 01/30/2023]
Abstract
There is strong evidence that gay, bisexual and other men who have sex with men (GBMSM) in African countries experience high prevalence of HIV. However, missing from the literature is an understanding of the HIV risk behaviors and prevention needs of partnered GBMSM in African countries. The Together Tomorrow project sampled 440 partnered GBMSM (220 couples) in South Africa and Namibia. Prevalence of HIV was high at 42%, with 33% of men in sero-discordant relationships. Despite high levels of HIV testing in the past 6 months (65%), condom use with main and outside sex partners was low. Men reported low levels of willingness to use pre-exposure prophylaxis (PrEP) (16%). HIV testing in the past 12 months and willingness to use PrEP were significantly associated with recent binge drinking and substance use. Men in sero-discordant relationships, those with sexual agreements and those who had experienced any form of IPV were all less likely to report that they had recently tested for HIV. There is a need to develop interventions that meet the unique needs of African partnered GBMSM and tackle stigma and discrimination as drivers of HIV risk in these settings.
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Wall KM, Inambao M, Kilembe W, Karita E, Chomba E, Vwalika B, Mulenga J, Parker R, Sharkey T, Tichacek A, Hunter E, Yohnka R, Streeb G, Corso PS, Allen S. Cost-effectiveness of couples' voluntary HIV counselling and testing in six African countries: a modelling study guided by an HIV prevention cascade framework. J Int AIDS Soc 2020; 23 Suppl 3:e25522. [PMID: 32602618 PMCID: PMC7325504 DOI: 10.1002/jia2.25522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Couples' voluntary HIV counselling and testing (CVCT) is a high-impact HIV prevention intervention in Rwanda and Zambia. Our objective was to model the cost-per-HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost-effectiveness. METHODS We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling-up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs-per-couple tested were also estimated based on our previous studies. We used these parameters as well as country-specific inputs to model the impact of CVCT over a five-year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs-per-HIV infection averted by CVCT. We applied 3%/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted. RESULTS We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs-per-HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country's President's Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost-per-couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access. CONCLUSIONS Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries' five-year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.
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Affiliation(s)
- Kristin M Wall
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of EpidemiologyRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologyNdola Central HospitalNdolaZambia
| | - William Kilembe
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Etienne Karita
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | | | - Bellington Vwalika
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Obstetrics and GynecologySchool of MedicineUniversity of ZambiaLusakaZambia
| | - Joseph Mulenga
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Rachel Parker
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Tyronza Sharkey
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Eric Hunter
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
- Department of Pathology & Laboratory MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
- Emory Vaccine CenterYerkes National Primate Research CenterEmory UniversityAtlantaGAUSA
| | - Robert Yohnka
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
| | - Gordon Streeb
- Departments of Economics and Political ScienceEmory UniversityAtlantaGAUSA
| | | | - Susan Allen
- Rwanda Zambia HIV Research GroupDepartment of Pathology & Laboratory MedicineSchool of Medicine and Hubert Department of Global HealthRollins School of Public HealthLaney Graduate SchoolEmory UniversityAtlantaGAUSA
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High Prevalence of Concurrent Male-Male Partnerships in the Context of Low Human Immunodeficiency Virus Testing Among Men Who Have Sex With Men in Bamako, Mali. Sex Transm Dis 2018; 44:565-570. [PMID: 28809774 DOI: 10.1097/olq.0000000000000655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Concurrent male-male sexual partnerships have been understudied in sub-Saharan Africa and are especially important because human immunodeficiency virus (HIV) prevalence and acquisition probability are higher among men who have sex with men (MSM) than among heterosexual men and women. METHODS We conducted a respondent-driven sampling survey of 552 men who have sex with men in Bamako, Mali from October 2014 to February 2015. Eligibility criteria included 18 years or older, history of oral or anal sex with another man in the last 6 months, residence in or around Bamako in the last 6 months, ability to communicate in French. RESULTS HIV prevalence was 13.7%, with 86.7% of MSM with HIV unaware of their infection. Concurrent male-male sexual partnerships were common, with 60.6% of MSM having a concurrent male sexual partnerships or believing their sex partner did in the last 6 months, and 27.3% having a concurrent male sexual partnerships and believing their sex partner did in the last 6 months. Over half (52.5%) of MSM had sex with women, and 30.8% had concurrent male partnerships and sex with a woman in the last 6 months. Concurrency was more likely among MSM with limited education, telling only MSM of same-sex behaviors, high social cohesion, and not knowing anyone with HIV. CONCLUSIONS The high proportion of HIV-infected MSM in Bamako who are unaware of their HIV infection and the high prevalence of concurrent partnerships could further the spread of HIV in Bamako. Increasing testing through peer educators conducting mobile testing could improve awareness of HIV status and limit the spread of HIV in concurrent partnerships.
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Trends in HIV testing and associated factors among men in South Africa: evidence from 2005, 2008 and 2012 national population-based household surveys. Public Health 2016; 143:1-7. [PMID: 28159020 DOI: 10.1016/j.puhe.2016.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/10/2016] [Accepted: 10/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In Sub-Saharan African countries, including South Africa, uptake of human immunodeficiency virus (HIV) testing among men remains a major challenge. Few studies have explored HIV testing uptake among men and factors that influence their testing behaviours. This article explores trends in HIV testing uptake and associated factors among men aged 15 years and older in South Africa using national HIV population-based household surveys conducted in 2005, 2008 and 2012. STUDY DESIGN A multistage cross-sectional design was used in the three nationally representative household-based surveys. METHODS P-trend Chi-squared statistic was used to analyze changes in HIV testing in relation to demographic factors, and HIV-related risk behaviours across the three surveys. Univariate and multivariate logistic regression models were used to assess the associations between ever testing for HIV, demographic factors and HIV-related risk behaviours. RESULTS HIV testing uptake among men was 28% in 2005, 43% in 2008 and 59% in 2012. A trend was also observed in HIV testing by sociodemographic factors, but differences existed within variables. HIV testing uptake was mainly influenced by the effects of selected population characteristics. Reduced likelihood of HIV testing was significantly associated with males aged 15-24 years, Black African race group, being single and unemployed, those residing in urban informal and rural informal areas, and those men who ever had sex. CONCLUSION The observed sociodemographic differentials suggest that an effective expansion strategy for HIV testing needs to prioritize those most unlikely to test as identified by the current findings.
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Evans MGB, Cloete A, Zungu N, Simbayi LC. HIV Risk Among Men Who Have Sex With Men, Women Who Have Sex With Women, Lesbian, Gay, Bisexual and Transgender Populations in South Africa: A Mini-Review. Open AIDS J 2016; 10:49-64. [PMID: 27347271 PMCID: PMC4893624 DOI: 10.2174/1874613601610010049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/10/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The HIV epidemic in South Africa is characterized mainly by heterosexual transmission. Recently, the importance of targeting key populations and marginalized groups, including men who have sex with men (MSM) and transgender people, has been added to the national agenda. OBJECTIVES This mini-review explores the current state of empirical research on HIV risk and MSM, women who have sex with women (WSW), lesbian, gay, bisexual and transgender (LGBT) populations in South Africa in order to assess the current state of research and identify gaps in the literature. METHOD Peer-reviewed empirical social and behavioral articles on HIV prevalence and risk focusing on MSM, WSW, and LGBT populations published since 2006 were included in this mini-review. RESULTS In total 35 articles were included: 30 on MSM, gay, and/or bisexual male-identified populations, three on WSW, lesbian, and/or bisexual female-identified populations, two on LGB youth, and none on transgender populations. CONCLUSION Despite South Africa being the country with the largest number of people living with HIV in the world, there is a limited amount of research in South Africa on HIV and non-normative gender identities and sexualities, especially WSW, lesbian, and/or bisexual female-identified populations, transgender populations, and LGB youth. Research with MSM, WSW, and LGBT populations should be prioritized in South Africa in order to appropriately inform HIV prevention strategies that meet the specific needs of these marginalized groups.
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Affiliation(s)
- Meredith G. B. Evans
- HUMA (Institute for Humanities in Africa) and Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Allanise Cloete
- HAST (HIV/AIDS, STIs and TB) Program, Human Sciences Research Council, Cape Town, South Africa
| | - Nompumelelo Zungu
- HAST (HIV/AIDS, STIs and TB) Program, Human Sciences Research Council, Cape Town, South Africa
| | - Leickness C. Simbayi
- HAST (HIV/AIDS, STIs and TB) Program, Human Sciences Research Council, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Jobson G, Struthers H, McIntyre J. "In the fell clutch of circumstance": HIV and men who have sex with men in sub-Saharan Africa. Curr HIV/AIDS Rep 2016; 12:164-72. [PMID: 25637162 DOI: 10.1007/s11904-014-0249-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Men who have sex with men (MSM) in sub-Saharan Africa (SSA) have been repeatedly found to have high risk of HIV infection, and in spite of the differing nature of the HIV epidemic in the general population between East and Southern Africa, and West and Central Africa, MSM are disproportionately affected by HIV across the entire region. Recent research has examined the drivers of HIV risk, and the dynamics of the MSM HIV epidemic in greater detail. However, this growing knowledge has generally not been translated into effective HIV prevention interventions. In part, this is due to the highly stigmatised and frequently criminalised nature of same-sex sexualities in much of the region. Without human-rights-based advocacy targeting governments and interventions aiming to decrease stigma and homophobia, translating research into effective HIV interventions for MSM in SSA at the scale needed to reduce HIV transmission in this population remains highly unlikely.
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Muhindo R, Nakalega A, Nankumbi J. Predictors of couple HIV counseling and testing among adult residents of Bukomero sub-county, Kiboga district, rural Uganda. BMC Public Health 2015; 15:1171. [PMID: 26603280 PMCID: PMC4659154 DOI: 10.1186/s12889-015-2526-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/18/2015] [Indexed: 12/22/2022] Open
Abstract
Background Studies have shown that couple HIV counseling and testing (CHCT) increased rates of sero-status disclosure and adoption of safer sexual behaviors with better linkage to treatment and care. However, current evidence suggests that new HIV infections are occurring among heterosexual couples in stable relationships where the majority of the individuals are not aware of their partner’s serostatus. This study examined the predictors of CHCT uptake among married or cohabiting couples of Bukomero sub-county Kiboga district in Uganda. Methods This cross-sectional correlational study was conducted among 323 individuals who were either married or cohabiting, aged 18–49 years. Participants were enrolled from randomly selected households in Bukomero sub-county. Data were collected using an interviewer-administered questionnaire on socio-demographics, self-rating on awareness of CHCT benefits, couple discussion about HIV testing and CHCT practices. Couples were compared between those who had reported to have tested as a couple and those who had not. Binary logistic regression was performed to determine the adjusted odds ratio [aOR] and 95 % confidence intervals [CI] for CHCT uptake and the other independent variables. Results Of the participants 288 (89.2 %) reported to have ever taken an HIV test only 99 (34.4 %) did so as a couple. The predictors of testing for HIV as a couple were discussing CHCT with the partner (adjusted odds ratio 4.95[aOR], 95 % confidence interval [CI]:1.99–12.98; p < 0.001), awareness of CHCT benefits (aOR 3.23; 95 % CI 1.78–5.87; p < 0.001) and having time to test as a couple (aOR 2.61; 95 % CI 1.22–5.61; p <0.05). Conclusion Uptake of HIV counseling and testing among couples was low. Discussing CHCT with partner, awareness of CHCT benefits, and availability of time to test as a couple were predictive of CHCT uptake. Thus CHCT campaigns should emphasize communication and discussion of HIV counseling and testing among partners.
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Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | | | - Joyce Nankumbi
- Department of Nursing, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
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de Voux A, Baral S, Bekker LG, Beyrer C, Phaswana-Mafuya N, Siegler A, Sullivan P, Winskell K, Stephenson R. A social network typology and sexual risk-taking among men who have sex with men in Cape Town and Port Elizabeth, South Africa. CULTURE, HEALTH & SEXUALITY 2015; 18:509-23. [PMID: 26569376 PMCID: PMC4930490 DOI: 10.1080/13691058.2015.1096419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Despite the high prevalence of HIV among men who have sex with men in South Africa, very little is known about their lived realities, including their social and sexual networks. Given the influence of social network structure on sexual risk behaviours, a better understanding of the social contexts of men who have sex with men is essential for informing the design of HIV programming and messaging. This study explored social network connectivity, an understudied network attribute, examining self-reported connectivity between friends, family and sex partners. Data were collected in Cape Town and Port Elizabeth, South Africa, from 78 men who have sex with men who participated in in-depth interviews that included a social network mapping component. Five social network types emerged from the content analysis of these social network maps based on the level of connectivity between family, friends and sex partners, and ranged from disconnected to densely connected networks. The ways in which participants reported sexual risk-taking differed across the five network types, revealing diversity in social network profiles. HIV programming and messaging for this population can greatly benefit from recognising the diversity in lived realities and social connections between men who have sex with men.
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Affiliation(s)
- Alex de Voux
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Phaswana-Mafuya
- HIV/AIDS/STI and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa
| | - Aaron Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, USA
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, USA
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Implementation of couples' voluntary HIV counseling and testing services in Durban, South Africa. BMC Public Health 2015; 15:601. [PMID: 26136116 PMCID: PMC4489128 DOI: 10.1186/s12889-015-1959-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/22/2015] [Indexed: 01/21/2023] Open
Abstract
Background Couples’ voluntary HIV counseling and testing (CVCT) is an evidence-based intervention that significantly reduces HIV incidence in couples. Despite the high prevalence of HIV and HIV couple serodiscordance in South Africa, there are few CVCT services. Methods From February-June 2013, The Rwanda Zambia HIV Research Group provided support, training, and technical assistance for local counselors and promoters to pilot CVCT services in five hospital-based clinics in Durban, South Africa. Client-level data (age, gender, years cohabiting, pregnancy status, previous testing, antiretroviral treatment (ART) status, neighborhood, and test site) collected as a component of routine CVCT service operation is presented stratified by couple serostatus. Results Twenty counselors and 28 promoters completed training. Of 907 couples (1,814 individuals) that underwent CVCT, prevalence of HIV was 41.8 % and prevalence of HIV serodiscordance was 29.5 % (19.3 % M-F+, 10.3 % M + F-). Most participants were 25–34 years of age, and this group had the highest prevalence. Previous individual HIV testing was low (50 % for men, 63 % for women). Only 4 % of couples reported previous CVCT. Most (75 %) HIV+ partners were not on ART, and HIV+ individuals in discordant couples were more likely to be on ART than those in concordant positive couples. Pregnancy among HIV+ women was not associated with previous HIV testing or ART use. Conclusions Implementation of standard CVCT services was found to be feasible in Durban. The burden of HIV and couple serodiscordance in Durban was extremely high. CVCT would greatly benefit couples in Durban as an HIV prevention strategy.
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Dijkstra M, van der Elst EM, Micheni M, Gichuru E, Musyoki H, Duby Z, Lange JMA, Graham SM, Sanders EJ. Emerging themes for sensitivity training modules of African healthcare workers attending to men who have sex with men: a systematic review. Int Health 2015; 7:151-62. [PMID: 25596188 PMCID: PMC4427535 DOI: 10.1093/inthealth/ihu101] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 01/08/2023] Open
Abstract
Sensitivity training of front-line African health care workers (HCWs) attending to men who have sex with men (MSM) is actively promoted through national HIV prevention programming in Kenya. Over 970 Kenyan-based HCWs have completed an eight-modular online training free of charge (http://www.marps-africa.org) since its creation in 2011. Before updating these modules, we performed a systematic review of published literature of MSM studies conducted in sub-Saharan Africa (sSA) in the period 2011-2014, to investigate if recent studies provided: important new knowledge currently not addressed in existing online modules; contested information of existing module topics; or added depth to topics covered already. We used learning objectives of the eight existing modules to categorise data from the literature. If data could not be categorised, new modules were suggested. Our review identified 142 MSM studies with data from sSA, including 34 studies requiring module updates, one study contesting current content, and 107 studies reinforcing existing module content. ART adherence and community engagement were identified as new modules. Recent MSM studies conducted in sSA provided new knowledge, contested existing information, and identified new areas of MSM service needs currently unaddressed in the online training.
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Affiliation(s)
- Maartje Dijkstra
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Elise M van der Elst
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Murugi Micheni
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Evanson Gichuru
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme, P.O. Box 19361-00202, Nairobi, Kenya
| | - Zoe Duby
- Desmond Tutu HIV Foundation, Anzio Road, Observatory 7705, Cape Town, South Africa
| | - Joep M A Lange
- Amsterdam Institute for Global Health Development, University of Amsterdam, P.O. Box 22700 1100 DE, Amsterdam, The Netherlands Department of Global Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700 1100 DE, Amsterdam, The Netherlands
| | - Susan M Graham
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya University of Washington, Seattle, WA 98195, USA
| | - Eduard J Sanders
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya Department of Global Health, Academic Medical Centre, University of Amsterdam, P.O. Box 22700 1100 DE, Amsterdam, The Netherlands Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7BN, UK
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Lane T, Osmand T, Marr A, Shade SB, Dunkle K, Sandfort T, Struthers H, Kegeles S, McIntyre JA. The Mpumalanga Men's Study (MPMS): results of a baseline biological and behavioral HIV surveillance survey in two MSM communities in South Africa. PLoS One 2014; 9:e111063. [PMID: 25401785 PMCID: PMC4234301 DOI: 10.1371/journal.pone.0111063] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
The Mpumalanga Men's Study (MPMS) is the assessment of the Project Boithato HIV prevention intervention for South African MSM. Boithato aims to increase consistent condom use, regular testing for HIV-negative MSM, and linkage to care for HIV-positive MSM. The MPMS baseline examined HIV prevalence and associated risk behaviors, and testing, care, and treatment behaviors among MSM in Gert Sibande and Ehlanzeni districts in Mpumalanga province, South Africa in order to effectively target intervention activities. We recruited 307 MSM in Gert Sibande and 298 in Ehlanzeni through respondent-driven sampling (RDS) between September 2012-March 2013. RDS-adjusted HIV prevalence estimates are 28.3% (95% CI 21.1%–35.3%) in Gert Sibande, and 13.7% (95% CI 9.1%–19.6%) in Ehlanzeni. Prevalence is significantly higher among MSM over age 25 [57.8% (95% CI 43.1%–72.9%) vs. 17.9% (95% CI 10.6%–23.9%), P<0.001 in Gert Sibande; 34.5% (95%CI 20.5%–56.0%) vs. 9.1% (95% CI 4.6%–13.9%), P<0.001 in Ehlanzeni]. In Gert Sibande, prevalence is higher among self-identified gay and transgender MSM vs. other MSM [39.3% (95%CI, 28.3%–47.9%), P<0.01], inconsistent condom users [38.1% (18.1%–64.2%), P<0.05], those with a current regular male partner [35.0% (27.1%–46.4%), P<0.05], and those with lifetime experience of intimate partner violence with men [40.4%, (95%CI 28.9%–50.9%), P<0.05]. Prevalence of previous HIV testing was 65.8% (95%CI 58.8%–74.0%) in Gert Sibande, and 69.3% (95%CI 61.9%–76.8%) in Ehlanzeni. Regular HIV testing was uncommon [(34.6%, (95%CI 27.9%–41.4%) in Gert Sibande; 31.0% (95%CI 24.9%–37.8%) in Ehlanzeni]. Among HIV-positive participants, few knew their status (28.1% in Gert Sibande and 14.5% in Ehlanzeni), or were appropriately linked to care (18.2% and 11.3%, respectively), or taking antiretroviral therapy (13.6% and 9.6% respectively). MPMS results demonstrate the importance of implementing interventions for MSM to increase consistent condom use, regular HIV testing, and linkage and engagement in care for HIV-infected MSM.
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Affiliation(s)
- Tim Lane
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Thomas Osmand
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Alexander Marr
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Starley B. Shade
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - Kristin Dunkle
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Theodorus Sandfort
- HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States of America
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Susan Kegeles
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, United States of America
| | - James A. McIntyre
- Anova Health Institute, Johannesburg, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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14
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Siegler AJ, Sullivan PS, de Voux A, Phaswana-Mafuya N, Bekker LG, Baral SD, Winskell K, Kose Z, Wirtz AL, Brown B, Stephenson R. Exploring repeat HIV testing among men who have sex with men in Cape Town and Port Elizabeth, South Africa. AIDS Care 2014; 27:229-34. [PMID: 25134823 PMCID: PMC4286446 DOI: 10.1080/09540121.2014.947914] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite the high prevalence of HIV among men who have sex with men (MSM) - and the general adult population - in South Africa, there is little data regarding the extent to which MSM seek repeat testing for HIV. This study explores reported histories of HIV testing, and the rationales for test seeking, among a purposive sample of 34 MSM in two urban areas of South Africa. MSM participated in activity-based in-depth interviews that included a timeline element to facilitate discussion. Repeat HIV testing was limited among participants, with three-quarters having two or fewer lifetime HIV tests, and over one-third of the sample having one or fewer lifetime tests. For most repeat testers, the time gap between their HIV tests was greater than the one-year interval recommended by national guidelines. Analysis of the reasons for seeking HIV testing revealed several types of rationale. The reasons for a first HIV test were frequently one-time occurrences, such as a requirement prior to circumcision, or motivations likely satisfied by a single HIV test. For MSM who reported repeat testing at more timely intervals, the most common rationale was seeking test results with a sex partner. Results indicate a need to shift HIV test promotion messaging and programming for MSM in South Africa away from a one-off model to one that frames HIV testing as a repeated, routine health maintenance behavior.
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Affiliation(s)
- Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Alex de Voux
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Nancy Phaswana-Mafuya
- HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa
| | - Linda-Gail Bekker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stefan D. Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Zamakayise Kose
- HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Port Elizabeth, South Africa
| | - Andrea L. Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ben Brown
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rob Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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15
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Siegler AJ, Voux AD, Phaswana-Mafuya N, Bekker LG, Sullivan PS, Baral SD, Winskell K, Kose Z, Wirtz AL, Stephenson R. Elements of Condom-Use Decision Making among South African Men Who Have Sex with Men. J Int Assoc Provid AIDS Care 2014; 13:414-23. [PMID: 24935692 DOI: 10.1177/2325957414535979] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
South African men who have sex with men (MSM) are at increased risk for HIV infection, and male condoms are fundamental to HIV prevention programs. We explored condom use experiences through in-depth interviews with 34 South African MSM from Cape Town and Port Elizabeth. For data analysis, we generated a codebook and used the constant comparison method. Condom use reinforcing elements included use of alternative sexual strategies, having a high level of self-worth that was linked to protective behaviors, and use of ready-made condom negotiation scripts. Elements inhibiting condom use included perceiving substantial declines in sexual pleasure/performance, experiences of condom failure (possibly related to petroleum-based lubricant), and being in trusted relationships. Our findings suggest nuanced HIV prevention approaches such as bolstering condom negotiation skills based on successful tactics already in use. Further research is needed to address how to mitigate perceptions and experiences that condoms negatively impact sexual pleasure and performance.
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Affiliation(s)
- Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alex de Voux
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Phaswana-Mafuya
- HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Pretoria, Port Elizabeth, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stefan D Baral
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zamakayise Kose
- HIV/AIDS/STI/and TB (HAST), Human Sciences Research Council, Pretoria, Port Elizabeth, South Africa
| | - Andrea L Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rob Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Wei C, Muessig KE, Bien C, Yang L, Meng R, Han L, Yang M, Tucker JD. Strategies for promoting HIV testing uptake: willingness to receive couple-based and collective HIV testing among a cross-sectional online sample of men who have sex with men in China. Sex Transm Infect 2014; 90:469-74. [PMID: 24760266 DOI: 10.1136/sextrans-2013-051460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Low rates of HIV testing drive the rapidly growing HIV epidemic among men who have sex with men (MSM) in China. We examined the potential usefulness of couple-based and collective HIV testing strategies among Chinese MSM. METHODS A cross-sectional online survey was conducted among 1113 MSM in 2013. Multivariable logistic regression analyses were conducted to identify factors associated with willingness to receive couple-based and collective testing. RESULTS Acceptability of couple-based testing was very high among participants (86.1%), with a moderate level of interest in collective testing (43.2%). Being 'out' to others about one's sexual identity (adjusted OR (AOR)=1.48, 95% CI 1.01 to 2.17) and having ever had an HIV test (AOR=3.05, 95% CI 2.10 to 4.33) were associated with willingness to receive couple-based testing. Having multiple male anal sex partners in the past 3 months was associated with willingness to participate in collective testing (AOR=1.43, 95% CI 1.03 to 1.99). DISCUSSION Couple-based and collective HIV testing could help better control the HIV epidemic among Chinese MSM if implemented and promoted in a culturally competent manner.
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Affiliation(s)
- Chongyi Wei
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California-San Francisco, San Francisco, California, USA
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA University of North Carolina Project-China, Guangzhou, China
| | - Cedric Bien
- University of North Carolina Project-China, Guangzhou, China Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ligang Yang
- Guangdong Provincial Center for STI Control and Prevention, Guangzhou, China
| | - Roger Meng
- Guangtong-Lingnan MSM Community Support Center, Guangzhou, China
| | - Larry Han
- University of North Carolina Project-China, Guangzhou, China School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Min Yang
- University of North Carolina Project-China, Guangzhou, China School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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17
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Mitchell JW. Gay male couples' attitudes toward using couples-based voluntary HIV counseling and testing. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:161-71. [PMID: 24213623 PMCID: PMC4322901 DOI: 10.1007/s10508-013-0211-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Many men who have sex with men acquire HIV from their primary male partners while in a relationship. Studies with gay couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, couples-based voluntary HIV counseling and testing (CVCT) has become available to male couples throughout the U.S. However, HIV-negative couples' attitudes toward using CVCT and how their relationship characteristics may affect their use of CVCT remain largely unknown. This information is particularly relevant for organizations that offer CVCT. To assess couples' attitudes, and associated factors toward using CVCT, a cross-sectional study design was used with a novel Internet-based recruitment method to collect dyadic data from a national sample of 275 HIV-negative gay couples. Multivariate multilevel modeling was used to identify factors associated with differences between and within couples about their attitudes towards using CVCT. Findings revealed that couples were "somewhat" to "very likely" to use CVCT. More positive attitudes toward using CVCT were associated with couples who had higher levels of relationship satisfaction and commitment toward their sexual agreement and among those who had at least one partner having had sex outside of the relationship. Less positive attitude toward using CVCT was associated with couples who had higher levels of trust toward their partners being dependable. Differences within couples, including age between partners, whether sex had occurred outside of the relationship, and value toward a sexual agreement also affected their attitudes toward using CVCT. Providing additional testing methods may help HIV-negative gay couples better manage their HIV risk.
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Affiliation(s)
- Jason W Mitchell
- Risk Reduction and Health Promotion Programs, School of Nursing, University of Michigan, 400 N. Ingalls, Office 3343, Ann Arbor, MI, 48109, USA,
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Rendina HJ, Breslow AS, Grov C, Ventuneac A, Starks TJ, Parsons JT. Interest in couples-based voluntary HIV counseling and testing in a national U.S. sample of gay and bisexual men: the role of demographic and HIV risk factors. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:149-59. [PMID: 24277109 PMCID: PMC3891911 DOI: 10.1007/s10508-013-0226-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Main partnerships represent one context in which HIV transmission may occur that has been insufficiently addressed to date for gay and bisexual men, but few studies have focused on the acceptability of couples-based voluntary HIV counseling and testing (CVCT) for male couples in the U.S. Our aim in this study was to explore the acceptability of CVCT among a national U.S. sample of 1,532 gay and bisexual men surveyed online using a sexual networking site. We examined the role of demographic (i.e., geographic region, age, relationship status, sexual orientation, race/ethnicity) and HIV risk (i.e., substance use, number of sexual partners, unprotected anal intercourse, sexual role identity, and sexual compulsivity) factors that may be associated with CVCT among the full sample and among partnered men separately. We found that single men expressed higher interest in CVCT than partnered men and that greater age was more strongly associated with lower interest in CVCT for partnered men than for single men. The intersection of sexual orientation and race/ethnicity was also significantly associated with CVCT interest, with a higher proportion of Black bisexual men being interested than White bisexual men. These findings suggest that the uptake of CVCT may be less impacted by HIV risk factors than by demographic factors and that young gay and bisexual men of color-for whom rates of HIV continue to rise-may be the group with the highest levels of interest in CVCT.
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Affiliation(s)
- H. Jonathon Rendina
- Basic and Applied Social Psychology Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - Aaron S. Breslow
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - Christian Grov
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- Department of Health and Nutrition Sciences, Brooklyn College of the City University of New York, Brooklyn, NY, USA
- City University of New York School of Public Health at Hunter College, New York, NY, USA
| | - Ana Ventuneac
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
| | - Tyrel J. Starks
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- Department of Psychology, Pace University, New York, NY, USA
| | - Jeffrey T. Parsons
- Basic and Applied Social Psychology Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA
- The Center for HIV/AIDS Educational Studies & Training (CHEST), New York, NY, USA
- City University of New York School of Public Health at Hunter College, New York, NY, USA
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave., New York, NY 10065;
- Health Psychology and Clinical Sciences Doctoral Program, The Graduate Center of the City University of New York, New York, NY, USA
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Men at risk; a qualitative study on HIV risk, gender identity and violence among men who have sex with men who report high risk behavior in Kampala, Uganda. PLoS One 2013; 8:e82937. [PMID: 24358239 PMCID: PMC3866199 DOI: 10.1371/journal.pone.0082937] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 10/30/2013] [Indexed: 11/29/2022] Open
Abstract
In Uganda, men who have sex with men (MSM) are at high risk for HIV. Between May 2008 and February 2009 in Kampala, Uganda, we used respondent driven sampling (RDS) to recruit 295 MSM≥18 years who reported having had sex with another man in the preceding three months. The parent study conducted HIV and STI testing and collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. We conducted a nested qualitative sub-study with 16 men purposively sampled from among the survey participants based on responses to behavioral variables indicating higher risk for HIV infection. Sub-study participants were interviewed face-to-face. Domains of inquiry included sexual orientation, gender identity, condom use, stigma, discrimination, violence and health seeking behavior. Emergent themes included a description of sexual orientation/gender identity categories. All groups of men described conflicting feelings related to their sexual orientation and contextual issues that do not accept same-sex identities or behaviors and non-normative gender presentation. The emerging domains for facilitating condom use included: lack of trust in partner and fear of HIV infection. We discuss themes in the context of social and policy issues surrounding homosexuality and HIV prevention in Uganda that directly affect men's lives, risk and health-promoting behaviors.
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Abstract
New approaches to expanding HIV testing and effective treatment and the wider availability of rapid testing technology have created new opportunities for achieving national and global HIV testing goals. In spite of HIV testing expansion in many settings, growing evidence of the prevention benefits of HIV testing, and the development of new, cost-effective approaches to HIV testing service provision, formidable obstacles to HIV testing expansion persist. Inequitable testing coverage exists within and across countries. While the proportion of people with HIV aware of their status is about 80% in the U.S., the majority of HIV-infected persons in Africa are unaware of their status. Testing of most-at-risk populations, couples, children, and adolescents pose still unresolved policy and programmatic challenges. Future directions for HIV testing include rapid testing technology and detection of acute HIV infection, self-testing expansion, and partner notification. Expanded routine HIV screening and widespread testing is a public health imperative to reach national and international HIV prevention and treatment goals.
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Affiliation(s)
- Peter Cherutich
- National AIDS/STI Control Program, Ministry of Health, Nairobi, Kenya.
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Sullivan PS, White D, Rosenberg ES, Barnes J, Jones J, Dasgupta S, O'Hara B, Scales L, Salazar LF, Wingood G, DiClemente R, Wall KM, Hoff C, Gratzer B, Allen S, Stephenson R. Safety and acceptability of couples HIV testing and counseling for US men who have sex with men: a randomized prevention study. J Int Assoc Provid AIDS Care 2013; 13:135-44. [PMID: 23995295 DOI: 10.1177/2325957413500534] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We tested a couples HIV testing and counseling (CHTC) intervention with male couples in Atlanta by randomizing eligible couples to receive either CHTC or separate individual voluntary HIV counseling and testing (iVCT). To evaluate the acceptability and safety of CHTC, main outcomes were satisfaction with the intervention and the proportions of couples reporting intimate partner violence (IPV) and relationship dissolution after the service. The results indicated that the service was very acceptable to men (median 7-item index of satisfaction was 34 for CHTC and 35 for iVCT, P = .4). There was no difference in either incident IPV (22% versus 17% for CHTC and iVCT, respectively, P = .6) or relationship dissolution (42% versus 51% for CHTC and iVCT, respectively, P = .5). Based on the preliminary data, CHTC is safe for male couples, and it is equally acceptable to iVCT for men who have main partners.
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