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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

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.


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