Social vulnerability and HIV testing among MSM in South Africa
J. Knox1, T. Sandfort1,2, H. Yi2, V. Reddy3, S. Maimane4
1Columbia University Mailman School of Public Health, Sociomedical Sciences, New York, United States, 2Columbia University and New York State Psych. Institute, HIV Center for Clinical and Behavioral Studies, New York, United States, 3University of KwaZulu-Natal South Africa, Policy Analysis and Capacity Enhancement Unit, Pretoria, South Africa, 4OUT LGBT Well-Being, Pretoria, South Africa
Background: While the importance of HIV testing in stopping the HIV/AIDS epidemic is increasingly acknowledged, little is known about HIV testing practices among MSM in South Africa. This study explored whether social vulnerability is associated with HIV testing among MSM, as it is among the general population.
Methods: A community-based survey was conducted with 300 MSM in Pretoria in 2008 using a quota-sampling method stratified by age, race, and township. Social vulnerability was assessed using measures of
(1) demographic characteristics: race, residential status, employment, education, income;
(2) social determinants: sexual-orientation related discrimination, social support; and
(3) indicators of sexual minority stress: concealment of sexual orientation, internalized homophobia.
Results: Two thirds of the participants had ever tested for HIV (67.7%); 64.0% of those in the past year (43.3% of the total sample). These men had tested an average of 4.1 times (SD = 5.1). Bivariately, all demographic characteristics were related to ever and recently having tested for HIV at p < .10. In multivariate models, at p < .05, being White was the only variable associated with both ever having tested for HIV (adjusted-OR = 2.36, 95% CI: 1.22-4.57) and having tested in the past year (AOR = 3.71, 95% CI: 2.09-6.58). Social support was associated with ever having tested for HIV (AOR = 1.41, 95% CI: 1.02-1.96) and internalized homophobia was associated with having tested in the past year (AOR = 0.71, 95% CI: 0.55-0.91).
Conclusions: In South Africa, being Black reduces MSM’s likelihood of having tested for HIV. Having strong social support increased one’s likelihood of ever having tested, but internalized shame of one’s sexual orientation reduced the likelihood of having tested recently. Scaling up HIV testing services in South Africa would profit from strengthening MSM communities, especially among Black MSM, resulting in stronger social support and reduced levels of internalized homophobia.