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Sexual risk behaviours and HIV-1 prevalence among urban men who have sex with men in Cape Town, South Africa

Earl Burrell A E F , Daniella Mark A , Robert Grant D , Robin Wood A B C and Linda-Gail Bekker A B C
+ Author Affiliations
- Author Affiliations

A Desmond Tutu HIV Centre, University of Cape Town, Cape Town 7705, South Africa.

B Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa.

C Department of Medicine, University of Cape Town, Cape Town 7925, South Africa.

D Gladstone Institute of Virology and Immunology, University of California, San Francisco, CA 94121, USA.

E Present address: UCLA School of Public Health, Los Angeles, CA 90095, USA.

F Corresponding author. Email:

Sexual Health 7(2) 149-153
Submitted: 24 August 2009  Accepted: 23 February 2010   Published: 14 May 2010


Background: Distinct homosexual and heterosexual HIV epidemics have previously been recognised in South Africa. However, linked HIV prevalence and self-reported sexual risk behaviour data have not been reported for men who have sex with men (MSM) in Cape Town since 1986. Methods: We conducted a cross-sectional, anonymous, venue-based HIV risk behaviour and prevalence study of 542 self-identified MSM in greater Cape Town using a self-administered risk questionnaire and the OraSure® testing device to asses HIV-1 prevalence. Results: This sample had an overall HIV prevalence of 10.4% (56/539). We found that self-identifying as gay, homosexual or queer (adjusted odds ratio (AOR) 4.5, 95% confidence interval (CI) 1.0–20.0) and reporting ever having had a sexually transmissible infection diagnosis (AOR 4.3, 95% CI: 2.3–8.3) were significantly predictive of testing HIV-1 positive, while reporting unprotected anal intercourse with a known HIV-negative partner (AOR 0.4, 95% CI: 0.2–0.9) was significantly protective. Conclusion: These data suggest a mature epidemic with consistent high-risk taking among MSM in Cape Town, and significant associations of select self-reported risk behaviours and HIV-1 serostatus. There is a need for continued and robust HIV surveillance along with detailed risk behaviour trends over time to inform the development of targeted risk-reduction interventions for this population.

Additional keywords: cross-sectional study, gay, homosexual.


We would like to thank the study participants and acknowledge the effort of the health workers involved in the recruitment of study participants, as well as the LGBT business community in Cape Town for their support of this project. This study was funded by the Gladstone Institute of Virology and Immunology.


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