Community norms for HIV risk behaviors among men in a South African township

Abstract

We investigated alcohol-related sexual risk behavior from the perspective of social norms theory. Adults (N = 895, 62% men) residing in a South African township completed street-intercept surveys that assessed risk and protective behaviors (e.g., multiple partners, drinking before sex, meeting sex partners in shebeens, condom use) and corresponding norms. Men consistently overestimated the actual frequency of risky behaviors, as reported by the sample, and underestimated the frequency of condom use. Relative to actual attitudes, men believed that other men were more approving of risk behavior and less approving of condom use. Both behavioral and attitudinal norms predicted the respondents' self-reported risk behavior. These findings indicate that correcting inaccurate norms in HIV-risk reduction efforts is worthwhile.Sub-Saharan Africa is in the midst of an HIV/AIDS epidemic. Southern Africa is home to two-thirds of people living with HIV/AIDS in the world; although only 10% of the world's population lives in southern Africa, more than 85% of the world's AIDS-related deaths have occurred in this region (UNAIDS, 2006). In the Republic of South Africa, 7.9% of men and 13.6% of women are infected with HIV (Shisana, et al., 2009). Like elsewhere in the world, the AIDS epidemic in South Africa is linked, in part, to substance use. Alcohol serving establishments are often the very places that link drinking with risks for HIV infection. Informal alcohol serving establishments, such as small bars and private homes where alcoholic beverages are sold and served which are popularly known as shebeens are often places where sex partners meet (Morojele, et al., 2004). Research conducted in South Africa suggests a close association between patronizing shebeens and engaging in HIV risk behaviors such as unprotected sex and concurrent partners (Kalichman, Simbayi, Vermaakk, Jooste, & Cain, 2008;Morojele, et al., 2006). Shebeens sometimes provide venues for sex between new or casual partners (Morojele, et al., 2006). The co-occurrence of these behavioral risk factors suggests the importance of social determinants of health behaviors, including social norms.Social norms play an explanatory role in theories of health behavior in general (Godin & Kok, 1996) and HIV risk behavior in particular (Albarracin, Johnson, Fishbein, & Muellerleile, 2001;Auerbach, Parkhurst, Caceres, & Keller, 2009). Perceived norms are a form of internalized social influence (Oostveen, Knibbe, & de Vries, 1996). Norms predict behavioral intentions and behavior in part because they signal what will be accepted/ approved by the group; failure to conform to social norms invites disapproval and/or social sanction (Cialdini & Trost, 1998 Distinction has been made between behavioral (descriptive) and attitudinal (injunctive) norms (Cialdini, Reno, & Kallgren, 1990). Behavioral norms refer to perceptions of how the group behaves, and attitudinal norms refer to perceptions of what the group finds acceptable. Although conceptually similar, these two types of ...

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Community-Level HIV Stigma as a Driver for HIV Transmission Risk Behaviors and Sexually Transmitted Diseases in Sierra Leone: A Population-Based Study

“…20–22 By condemning HIV-infected people, people who are uninfected or not aware of their HIV status are more likely to feel protected and less likely to engage in risk-reduction strategies. 17 As a result, instrumental fears about casual transmission, negative attitudes toward people living with HIV, and anticipated stigma are associated, at the individual level, with HIV transmission risk behaviors and failure to link to HIV treatment.…”

Collective Efficacy and HIV Prevention in South African Townships

“…Further examination could also determine whether those who endorsed collective efficacy believe their own behaviors are not contributing to the risk of their community and the responsibility to prevent HIV belongs to others who are perceived to be practicing riskier behaviors. This is supported by the finding that perceptions of what others do are often exaggerated in a more risky direction (Carey et al, 2011). These associations warrant further exploration to understand the mechanisms by which social norms influence the community’s collective capability to prevent HIV.…”

“…With respect to HIV risk behavior, attitudinal norms refer to whether others approve of HIV risk or protective behaviors whereas behavioral norms refer to the perception about how others act. In South African townships, Carey et al (2011) found that men overestimated how many peers approved of and engaged in risky behaviors. Further, permissive attitudinal and behavioral norms with regard to HIV risk behaviors were associated with higher self-reported risk behavior among men.…”