Race-related differences in rates of HIV testing and infection in South African MSM
Background: Men who have sex with men (MSM) have largely been ignored in research and prevention in the South African AIDS epidemic, which is dominated by heterosexual transmission. The seroprevalence among MSM in South Africa is unknown. To focus prevention strategies and further research, it is important to know which MSM have been tested and what their HIV status is.
Methods: A sample of 1021 Black, Coloured, Indian, and White MSM reported on their testing and HIV status in self-administered surveys conducted in Gauteng, KwaZulu-Natal and Western Cape. We identified correlates of their testing behavior and self-reported HIV status.
Results: The majority of the MSM (71.7%) reported ever having been tested for HIV, about a third of whom were tested in the preceding year. Bivariately, younger age, being Black, lower level of education and socioeconomic status, and living in KwaZulu-Natal were negatively associated with having been tested. Being White and living in Western Cape were positively associated with having been tested. In a multiple logistic regression younger and Black MSM were significantly less like to have been tested (Adjusted OR=0.97, 95% CI=0.95-0.99 and Adjusted OR=0.42, 95% CI=0.26-0.67). Among the 732 MSM who reported having been tested, 13.9% said to be HIV positive. A positive serostatus was more likely among 25-40 years old men compared with younger men (16.1% versus 9.2%). Self-reported HIV status was not associated with race (12% of White MSM were HIV+), level of education, socioeconomic status and whether men reported exclusively homosexual or bisexual attraction.
Conclusions: HIV testing rates among South African MSM vary significantly in relation to socio-demographic factors such that men with more vulnerable social positions are at a disadvantage. The high HIV prevalence among White MSM is dissimilar to the situation in the general South African population in which White persons are much less affected than Black persons.
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