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RESEARCH ARTICLE

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: earl.burrell@ucla.edu

Sexual Health 7(2) 149-153 https://doi.org/10.1071/SH09090
Submitted: 24 August 2009  Accepted: 23 February 2010   Published: 14 May 2010

Abstract

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.


Acknowledgements

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.


References


[1] Williamson C,  Engelbrecht S,  Lambrick M,  van Rensberg EJ,  Wood R,  Rybicki EP, et al. HIV-1 subtypes in different risk groups in South Africa. Lancet 1995; 346 782.
CrossRef | CAS | PubMed |

[2] Wood R,  O’Keefe EA,  Maartens G. The changing pattern of transmission and clinical presentation of HIV infection in the Western Cape region of South Africa 1984–95. South African J Epidemiol Infect 1996; 11 96–8.


[3] van Harmelen J,  Wood R,  Lambrick M,  Rybicki EP,  Williamson AL,  Williamson C. An association between HIV-1 subtype and mode of transmission in Cape Town, South Africa. AIDS 1997; 11 81–7.
CrossRef | CAS | PubMed |

[4] UNAIDS. 2008 Report on the global Aids epidemic. Geneva: UNAIDS; 2008. Available online at: http://data.unaids.org/pub/GlobalReport/2008/jc1510_2008_global_report_pp29_62_en.pdf [verified 29 June 2009].

[5] Louw R. Advancing human rights through constitutional protection for gays and lesbians in South Africa. J Homosex 2005; 48 141–62.
CrossRef | PubMed |

[6] Hargreaves JR , Stevens G , Makhuraj A , Morison L , Porter JDH , Watts C et al Preliminary estimates of the acceptability of oral fluid collection, and the sensitivity, specificity and reproducibility of ELISA analysis of oral fluid samples for detection of antibodies to HIV from the IMAGE study in South Africa. South African AIDS Conference, Durban: August 3–6, 2003.

[7] Flores SA,  Mansergh G,  Marks G,  Guzman R,  Colfax G. Gay identity-related factors and sexual risk among men who have sex with men in San Francisco. AIDS Educ Prev 2009; 21 91–103.
CrossRef | PubMed |

[8] Relf MV,  Huang B,  Campbell J,  Catania J. Gay identity, interpersonal violence, and HIV risk behaviors: an empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men. J Assoc Nurses AIDS Care 2004; 15 14–26.
CrossRef | PubMed |

[9] Baral S,  Sifakis F,  Cleghorn F,  Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000–2006: a systematic review. PLoS Med 2007; 4 e339.
CrossRef | PubMed |

[10] HSRC. South African national HIV prevalence, incidence, behaviour and communication survey. Cape Town: HSRC Press. Available online at: http://www.hsrc.ac.za/Document-3238.phtml [verified 29 June 2009].

[11] Cohen MS. Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis. Lancet 1998; 351 S5–S7.
CrossRef |

[12] Fleming DT,  Wasserheit JN. From epidemiological synergy to public health policy: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect 1999; 75 3–17.
CrossRef | CAS | PubMed |

[13] National Institutes of Health. Consensus statement online. Interventions to prevent HIV risk behaviors 1997. Available online at: http://consensus.nih.gov/1997/1997PreventHIVRisk104html.htm [verified 17 March 2010].

[14] Stolte IG,  Coutinho RA. Risk behaviour and sexually transmitted diseases are on the rise in gay men, but what is happening with HIV? Curr Opin Infect Dis 2002; 15 37–41.
PubMed |

[15] Bacon O,  Lum P,  Hahn J,  Evans J,  Davidson P,  Moss A, et al. Commercial sex work and risk of HIV infection among young drug-injecting men who have sex with men in San Francisco. Sex Transm Dis 2006; 33 228–34.
CrossRef | PubMed |

[16] Estcourt CS,  Marks C,  Rohrsheim R,  Johnson AM,  Donovan B,  Mindel A. HIV, sexually transmitted infections, and risk behaviors in male commercial sex workers in Sydney. Sex Transm Infect 2000; 76 294–8.
CrossRef | CAS | PubMed |

[17] Rietmeijer CA,  Wolitski RJ,  Fishbein M,  Corby NH,  Cohn DL. Sex hustling, injection drug use, and nongay identification by men who have sex with men. Associations with high-risk sexual behaviors and condom use. Sex Transm Dis 1998; 25 353–60.
CrossRef | CAS | PubMed |

[18] Weber AE,  Craib KJ,  Chan K,  Martindalea S,  Millera ML,  Schechtera MT, et al. Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. Int J Epidemiol 2001; 30 1449–54.
CrossRef | CAS | PubMed |

[19] Fernández MI,  Perrino T,  Royal S,  Ghany D,  Bowen GS. To test or not to test: are Hispanic men at highest risk for HIV getting tested? AIDS Care 2002; 14 375–84.
CrossRef | PubMed |

[20] MacKellar DA,  Valleroy LA,  Secura GM,  Bartholow BN,  McFarland W,  Shehan D, et al. Repeat HIV testing, risk behaviors, and HIV seroconversion among young men who have sex with men: a call to monitor and improve the practice of prevention. J Acquir Immune Defic Syndr 2002; 29 76–85.
PubMed |

[21] Norton J,  Elford J,  Sherr L,  Miller R,  Johnson MA. Repeat HIV testers at a London same-day testing clinic. AIDS 1997; 11 773–81.
CAS | PubMed |

[22] Chen SY,  Gibson S,  Weide D,  McFarland W. Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men, San Francisco. J Acquir Immune Defic Syndr 2003; 33 166–70.
CrossRef | PubMed |

[23] Read TR,  Hocking J,  Sinnott V,  Hellard M. Risk factors for incident HIV infection in men having sex with men: a case-control study. Sex Health 2007; 4 35–9.
CrossRef | PubMed |

[24] van Kesteren NM,  Hospers HJ,  Kok G. Sexual risk behavior among HIV-positive men who have sex with men: a literature review. Patient Educ Couns 2007; 65 5–20.
CrossRef | PubMed |

[25] Snowden J,  Raymond HF,  McFarland W. Prevalence of seroadaptive behaviors of men who have sex with men, San Francisco, 2004 Sex Transm Infect 2009; 85 469–76.
CrossRef | CAS | PubMed |



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