Prevalence of consensual male-male sex and sexual violence, and associations with HIV in South Africa: a population-based cross-sectional study

In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual beh...

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Bibliographic Details
Published in:PLoS medicine 2013-06, Vol.10 (6), p.e1001472-e1001472
Main Authors: Dunkle, Kristin L, Jewkes, Rachel K, Murdock, Daniel W, Sikweyiya, Yandisa, Morrell, Robert
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adolescent
Adult
AIDS
Crime Victims - statistics & numerical data
Cross-Sectional Studies
Demography
Female
Gay couples
Health aspects
HIV
HIV Infections - epidemiology
HIV Seropositivity - epidemiology
Homosexuality, Male - statistics & numerical data
Households
Human immunodeficiency virus
Humans
Logistic Models
Male
Medicine
Men
Middle Aged
Multivariate Analysis
Prevalence
Prevalence studies (Epidemiology)
Sex Offenses - statistics & numerical data
Sexual abuse
Sexual behavior
Sexual Behavior - statistics & numerical data
Sexual intercourse
Social and Behavioral Sciences
South Africa - epidemiology
Studies
Young Adult
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Summary:In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male-male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus. In a cross-sectional study conducted in 2008, men aged 18-49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male-male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26-12.3), and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22-7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24-7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58; 95% CI 1.17-10.9). In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male-female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been com
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001472