Prevalence and HIV-related correlates of same-gender sexual behaviour among men and boys in rural South Africa

Published: July 21, 2010

R.J. Jolly1, S. Fergus2, A. Jeeves3

1Queen’s University, Department of English, Kingston, Canada, 2Queens’ University, School of Kinesiology and Health Studies, Kingston, Canada, 3Queen’s University, Department of History, Kingston, Canada

Background: Recent work suggests that sub-Saharan African men who have sex with men (MSM) are an overlooked population at enhanced HIV risk. Yet, few studies have investigated the prevalence of same-gender partners among rural African men, or have examined how HIV-related characteristics among MSM may differ from those among non-MSM.
Methods: Using area-based, quasi-probability sampling to maximize generalizability, and an audio, computer-assisted self-interviewing (ACASI) system to minimize social desirability bias, we surveyed 451 males (mean age = 22.0) in rural KwaZulu-Natal, asking about the genders of their sexual partners over the previous two months. We then compared participants with one or more male partners to those without a male partner on demographics, socioeconomics, perpetration of gender-based violence, and gender role attitudes.
Results: Of the participants who had sex in the previous two months, 15% reported having at least one male partner. Of those, almost half reported also having a female partner. As compared to non-MSM, MSM were 55% more likely (p< .05) to practice traditional religion, 54% more likely (p< .05) to have left the area to look for work in the previous year, and more than twice as likely (p< .05) to report having perpetrated sexual violence against any female in the previous year. Finally, MSM exhibited higher scores on a measure of gender role confusion (p< .05).
Conclusions: Our study suggests that, despite strict cultural taboos, some men in rural South Africa are having sex with other men. Further, MSM may be different from non-MSM on a number of characteristics related to HIV prevention and transmission for both men and women. Researchers should consider using ACASI or similar systems with general populations in sub-Saharan Africa to capture same-gender sexual behaviour. The results of such studies may be useful for improving services for an overlooked yet important group.

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