Conspiracy beliefs about HIV, attitudes towards condoms and treatment and HIV-related preventive behaviors among men who have sex with men in Tshwane (Pretoria), South Africa
W. Tun1, S. Kellerman2, S. Maime3, Z. Fipaza4, M. Sheehy1, L. Vu1, D. Nel3
1Population Council, HIV and AIDS Program, Washington, United States, 2Management Sciences for Health (MSH), Arlington, United States, 3OUT LGBT WELL-BEING, Pretoria, South Africa, 4Population Council – S. Africa Office, Johannesburg, South Africa
Background: South Africans have received messages about HIV origin, treatment and prevention that contradict evidence-based information and may negatively impact HIV preventive behaviors.
Methods: A cross-sectional survey was conducted with 339 men who have sex with men (MSM) recruited through respondent-driven sampling in Tshwane. Eligibility criteria included being ≥18 years old and having sex with another man in the last 6 months. Face-to-face interviews assessed HIV knowledge, attitudes towards condoms and HIV treatment, HIV-related conspiracy beliefs (i.e., people are being experimented on with new HIV treatments; HIV is man-made), and HIV testing and sexual history.
Results: Two-thirds of the MSM sample was < 26 years old, 91% was black, 86% was single, one-third had >12 years schooling, and 74% self-identified as homosexual. Eighty-five percent reported a male sex partner in the past two months, of whom 50% reported ≥2 male sex partners and 27% reported unprotected anal intercourse (UAI). Three-fourths had ever tested for HIV. Over 90% had correct knowledge about HIV transmission. However, 19% subscribed to at least 3 of 12 conspiracy beliefs, and 11% reported being less careful about HIV because of better HIV treatments. MSM who had never tested for HIV were more likely to report being less careful about HIV because of better treatments (AOR: 3.7; 95% CI: 1.6-8.4) and slightly more likely to subscribe to conspiracy beliefs (AOR: 1.8; 95% CI: 0.9-3.7). MSM who reported UAI were more likely to hold negative condom attitudes (AOR: 2.1; 95% CI: 1.1-3.8), be engaged in sex work (AOR: 2.7; 95% CI: 1.2-6.2), and slightly more likely to mistrust government condoms (AOR: 1.8; 95% CI: 1.0-3.3).
Conclusions: Negative condom attitudes, mistrust in government condoms, and misunderstanding about HIV treatment can be barriers to condom use and HIV testing among South African MSM. Media campaigns and peer education may improve HIV-related norms and attitudes.