An approach to targeting HIV prevention for MSM in Cape Town, South Africa

Published: July 21, 2010

An approach to targeting HIV prevention for MSM in Cape Town, South Africa

G. Jobson, G. De Swardt, K. Rebe, H. Struthers, J.A. McIntyre

ANOVA Health Institute, Johannesburg, South Africa

Background: Men-who-have-sex-with-men (MSM) in South Africa are a population that has been neglected in terms of HIV prevention interventions. In Cape Town, spatial and racial segregation imposed under apartheid continues to shape the social and sexual dynamics of MSM communities. While HIV risk behaviours are similar between ‘white’, ‘black’, and ‘coloured’ communities, the contexts in which they occur, and the social dynamics surrounding them differ. This study focused on the contexts and dynamics of HIV risk in the ‘black’ townships of Cape Town with a view to implementing HIV prevention interventions with explicit relevance to local MSM.

Methods: A qualitative approach was used to conduct this research. Sampling was purposive and aimed to recruit MSM with differing backgrounds and sexual identities. Key informant interviews (n=4) and focus group discussions (n=16) were conducted. Data were analysed using content analysis.

Results: Factors affecting HIV risk in this population were identified at three levels using a personal-proximal-distal framework. Important factors at a distal level (cultural and structural issues) included homophobic cultural norms and stigma, HIV-related stigma, and poverty. Proximal factors (interpersonal relationships and the immediate environment) included verbal abuse and violence, lack of safe social and sexual spaces, multiple partnerships, transactional sex, alcohol use, discrimination at health care facilities, and a lack of HIV prevention resources (including condoms and water-based lubricant). Personal factors (within the individual) included self esteem and whether individuals were openly gay or not.

Conclusions: Understanding the contexts and processes that affect HIV risk for specific MSM populations can assist in targeting HIV prevention that is appropriate, effective, and compelling. Analyses such as these can contribute to designing broader approaches to HIV prevention that encompass both the direct and indirect causes of risk behaviour.

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