The fallacy of intimacy: Sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa

Abstract

The objective of this study is to assess (1) whether beliefs about trust and condom use affect sexual risk behaviour, and (2) if beliefs about trust and condom use impact sexual risk behaviour directly or if this relationship is mediated by other determinants. The Information-MotivationBehavioural Skills model was used as a framework for the mediation analysis. A diverse cohort of three hundred 18-40 year old men who have sex with men (MSM) residing in Pretoria, South Africa, were recruited and surveyed for this project. Findings indicate that men who report a high frequency of past unprotected anal intercourse are more likely to believe that it is not necessary to use condoms with a trusted or steady partner regardless of their current partnership status. This fallacy of intimacy appears to affect sexual risk behaviour through intentions and attitudes regarding safer sex practices. Based on these findings, we recommend that more attention be given to gaining a better understanding of how beliefs about trust and condom use are formed and how they can be changed among MSM in South Africa.

Types of Female Partners Reported by Black Men Who Have Sex with Men and Women (MSMW) and Associations with Intercourse Frequency, Unprotected Sex and HIV and STI Prevalence

“…Hence, prevention strategies designed to reach behaviorally bisexual men and the women in primary partnerships with them may need to employ a broad reach [38]. Preventive measures are less likely to be adopted consistently by individuals in primary than in non-primary partnerships because the cost/benefit ratio of condom use and HIV testing tends to be viewed less favorably in the context of more serious relationships [39–41]. Nevertheless, at least one published intervention has successfully addressed this challenge directly through couples-based approaches [42].…”

HIV risk and prevention among men who have sex with men in rural South Africa

“…In terms of demographics, South African MSM older than 25 have consistently been found to have higher HIV infection rates than other MSM (Baral et al, 2011;Lane et al, 2011;Sandfort, Knox, Collier, Lane, & Reddy, 2015). Psychosocial factors contributing to HIV risk include: sexual self-identity (Lane et al, , 2014Rispel et al, 2011;Sandfort, Lane, Dolezal, & Reddy, 2015); experiences of stigma and homophobia (Arnold, Struthers, McIntyre, & Lane, 2013;Tucker et al, 2014); low self-efficacy for protective behaviours (Tucker et al, 2014); beliefs about trust and condom use in relationships (Knox, Yi, Reddy, Maimane, & Sandfort, 2010); being in a relationship with a regular partner (Arnold et al, 2013;Knox et al, 2010); and experiencing depression (Tucker et al, 2013). Behavioural risk factors for HIV infection identified in previous research include: transactional sex Nel, Yi, Sandfort, & Rich, 2013); high numbers of sexual partners Tucker et al, 2014); and alcohol and drug use Lane, Shade, McIntyre, & Morin, 2008;Parry et al, 2008;Sandfort, Yi, Knox, & Reddy, 2013).…”

Most at-risk populations: contextualising HIV prevention programmes targeting marginalised groups in Zanzibar, Tanzania

“…Additionally, the cost of drug treatment centres is too high for most users and those who are fortunate enough to complete a recovery programme, struggle with finding work due to incomplete education, criminal records and the reluctance of employers to hire individuals with a history of drug use. MSM are the most difficult group to reach because of legal, societal and religious sanctions against homosexuality in Zanzibar, which is also an issue in other African countries (Rispel and Metcalf 2009, Onyango-Ouma et al 2009, Knox et al 2010). These considerable challenges place marginal populations in a tenuous position in Zanzibari society, contributing to poor health outcomes with few social safety nets to address their needs.…”

“…Although epidemiological data indicate a high HIV/AIDS prevalence rate among MSM, Zanzibar and other African countries have limited information on MSM (Rispel and Metcalf 2009, Onyango-Ouma et al 2009, Seale 2009, Johnston et al 2010, Knox et al 2010, Tadele 2010. Barriers to fully understanding the sexual health of MSM include discrimination, stigma and the criminalisation of homosexuality.…”