HIV risk perception and behavior among medically and traditionally circumcised males in South Africa

Abstract Background In South Africa, voluntary medical male circumcision (VMMC) has recently been implemented as a strategy for reducing the risk of heterosexual HIV acquisition among men. However, there is some concern that VMMC may lead to low risk perception and more risky sexual behavior. This study investigated HIV risk perception and risk behaviors among men who have undergone either VMMC or traditional male circumcision (TMC) compared to those that had not been circumcised. Methods Data collected from the 2012 South African national population-based household survey for males aged 15 years and older were analyzed using bivariate and multivariate multinomial logistic regression, and relative risk ratios (RRRs) with 95 % confidence interval (CI) were used to assess factors associated with each type of circumcision relative no circumcision. Results Of the 11,086 males that indicated that they were circumcised or not, 19.5 % (95 % CI: 17.9–21.4) were medically circumcised, 27.2 % (95 % CI: 24.7–29.8) were traditionally circumcised and 53.3 % (95 % CI: 50.9–55.6) were not circumcised. In the final multivariate models, relative to uncircumcised males, males who reported VMMC were significantly more likely to have had more than two sexual partners (RRR = 1.67, p = 0.009), and males who reported TMC were significantly less likely to be low risk alcohol users (RRR = 0.72, p < 0.001). Conclusion There is a need to strengthen and improve the quality of the counselling component of VMMC with the focus on education about the real and present risk for HIV infection associated with multiple sexual partners and alcohol abuse following circumcision

Perceptions about the acceptability and prevalence of HIV testing and factors influencing them in different communities in South Africa

HIV counselling and testing (HCT) is considered important because it is an entry point to a comprehensive continuum of care for HIV/AIDS. The South African Department of Health launched an HCT campaign in April 2010, and this reached 13,269,746 people by June 2011, of which 16% tested HIV positive and 400,000 of those were initiated into antiretroviral treatment. The overall objective of this project was to gain insight into the general perceptions about HIV testing in the different South African communities. Factors influencing testing in these communities were also explored. Discussions with twelve focus groups (FG) of 8–12 participants each were  conducted with male and female participants recruited from both urban formal and informal communities in Cape Town and Durban. Participants included four racial groups represented by different age groups as follows: adolescents (12–17 years), youth (18–24 years) and adults (25 years and older). Data were analyzed using thematic coding. Among the key themes that emerged from the findings were the inaccurate perception of risk, fear of testing HIV positive, stigma and discrimination. Participants from both African and Indian FGs reported being less likely to do self-initiated HIV testing and counselling, while those from the FG consisting of young whites were more likely to learn about their HIV status through blood donations and campus HIV testing campaigns. Most FGs said they were likely to test if they understood the testing process better and also if the results are kept confidential. The present findings reiterate the importance of spreading positive messages and ensuring confidentiality for HIV testing in a society where there is still some stigma associated with people living with HIV/AIDS. This can partly be accomplished by the continuation of the national HCT campaign, which has been a considerable success in the fight against HIV/AIDS in South Africa during the past two years.Keywords: HIV Counselling and Testing, perceptions, stigma, discrimination and confidentiality, South AfricaLe conseil et le de´pistage (CDV) du VIH sont conside´re´s importants pour les programmes de soins du VIH/SIDA. Le ministe`re sudafricain de la Sante´ a lance´ une campagne de CDV en avril 2010, et a atteint 13 269 746 personnes en juin 2011, dont 16% ont e´te´ identifie´s se´ropositifs, et dont 400,000 ont commence´ le traitement antire´troviral. L’objectif global de ce projet e´tait de mieux comprendre les perceptions ge´ne´rales sur le de´pistage du VIH dans les diffe´rentes communaute´s sud-africaines. Les facteurs influenc¸ant la participation au de´pistage du VIH ont e´te´ aussi e´tudie´s. Douze groupes de discussion (GDD), consistant de huit a` douze hommes et femmes, ont e´te´ forme´s. Les participants e´taient recrute´s dans les localite´s urbaines formelles et informelles a` Cape-Town et a` Durban. Les groupes e´taient repartie en quatre sur base d’ethnicite´, repre´sentant diffe´rents groupes d’aˆge: les adolescents (12–17 ans), les jeunes (18–24 ans) et les adultes (25 ans et plus). Les donne´es ont e´te´ analyse´es en utilisant un codage the´matique. La  perception errone´e du risque, la peur du de´pistage du VIH, la stigmatisation et la discrimination e´taient parmi les principaux the`mes qui ont e´merge´. Les participants africains et indiens ont de´clare´ d’eˆtre moins dispose´s a` se faire tester pour le VIH a` propre initiative, tandis que les jeunes blancs e´taient dispose´s a` connaıˆtre leur statut VIH graˆce aux dons de sang et aux campagnes universitaires de de´pistage du VIH. La plupart des participants des DDG ont dit qu’ils e´taient dispose´s a` se laisser tester s’ils avaient une meilleure compre´hension du processus de de´pistage, et s’ils e´taient convaincus de sa confidentialite´. Les re´sultats de cette recherche ont re´ite´re´ l’importance de la diffusion de messages positifs et de la confidentialite´ des re´sultats le de´pistage du VIH dans une socie´te´ ou` il y a encore un stigmate associe´ au VIH. Cela peut eˆtre accompli en partie par la poursuite de la campagne nationale de CDV, qui a e´te´ un succe`s conside´rable dans la lutte contre le VIH/SIDA en Afrique du Sud au cours des deux dernie`res anne´es.Mots cle´s: Le conseil et le depistage du VIH, Perceptions, stigmate, discrimination, confidentialite, Afrique du Su

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Sexual violence and HIV

This Chapter aims to provide a comprehensive synopsis and, in some instances, a critique of recent research conducted in the field of HIV/AIDS and sexual violence focusing specifically on children's vulnerability and the consequences of the HIV/AIDS and violence nexus. In South Africa, sexual violence is aimed at the most vulnerable members of society, namely children, increasing their risk of HIV infection. Sexual violence and coercion amongst children and adolescents may increase susceptibility to HIV insofar as non-consensual sex is associated with increased genital trauma and coital injuries, the likelihood of anal penetration, the vulnerability especially of adolescent girls and the age difference between partners. Research studies have shown that HIV infection rates among adolescents are on average five times higher among girls than among boys. This can be attributed to sexual violence perpetrated on children which includes: sexual abuse of children, forced sex, sexual abuse of people with mental and physical disabilities as well as sexual exploitation. Child trafficking has also been found to be another grave phenomenon that places children at risk of sexual violence and in turn increases their risk of becoming infected with HIV. Although there have been efforts to protect children through interventions, policies and the use of laws such as the Children's Act, it is recommended that much more needs to be done to enforce and implement these policies and laws to ensure that the agencies whose responsibility it is to protect children, are functional.

Community perceptions and understanding of the risk factors that affect children who are sexually abused

Paper presented at the AIDS Impact Conference, Gaborone, Botswana, 22-25 Septembe

Dual protection, contraceptive use, HIV status and risk among a national sample of South African women

The aim of this study was to investigate dual protection, contraceptive use, HIV status risk among a national sample of South African women. The final sample included only female participants (N=4675) who reported to have had sexual intercourse in the past 12 months aged 15 to 49 years. Results indicate that almost one thirds (31.7%) of the participants indicate that they were protected from both pregnancy and sexually transmitted infections the last time they had sexual intercourse, 18.6% using dual methods compared to the 6.8% who were found to use both barrier and hormonal methods and 13.1% using a condom alone; 40.9% were protected from pregnancy only through the use of a non-barrier contraceptive, while 46% of the participants used no method at all. In multivariate analysis younger age, higher education, African black, not married and high HIV risk perception were associated with dual method use. Dual method use is low in this population and the use of contraceptive methods that offer protection against pregnancy and STIs/HIV is encouraged.Key words: Dual protection, contraceptive use, HIV status, HIV risk, South African wome

The implementation of healthy relationships in the OR Tambo district in the Eastern Cape, South Africa 2007-2011

Paper presented to the Community Advisory Board Members of Marang Positive Prevention, Mthatha, OR Tambo, Eastern Cape, 27 Septembe

Dual protection, contraceptive use, HIV status and risk among a national sample of South African women

The aim of this study was to investigate dual protection, contraceptive use, HIV status risk among a national sample of South African women. The final sample included only female participants (N=4675) who reported to have had sexual intercourse in the past 12 months aged 15 to 49 years. Results indicate that almost one thirds (31.7%) of the participants indicate that they were protected from both pregnancy and sexually transmitted infections the last time they had sexual intercourse, 18.6% using dual methods compared to the 6.8% who were found to use both barrier and hormonal methods and 13.1% using a condom alone; 40.9% were protected from pregnancy only through the use of a non-barrier contraceptive, while 46% of the participants used no method at all. In multivariate analysis younger age, higher education, African black, not married and high HIV risk perception were associated with dual method use. Dual method use is low in this population and the use of contraceptive methods that offer protection against pregnancy and STIs/HIV is encouraged.

Covariates of condom use in South Africa: findings from a national population-based survey in 2008

Condom use has increased significantly over the past decade among all adult age groups in South Africa, and it is widely believed to have played a major role in the recent significant decline in HIV incidence in the country, especially among young people. This study investigated the demographic, behavioural and psychosocial correlates of condom use at last sex among a national random probability sample of sexually experienced respondents aged 15 years and older (n = 7817, 42.9% males and 57.1% females) using data from the 2008 South African national HIV population-based household survey. Multivariate logistic regression analyses revealed that for both sexes, being aged 15-24 years and 25-49 years old, Black African, never married and unemployed were significantly associated with condom use at last sex. In addition, for males, condom use was associated with having had two or more sexual partners, whereas for females it was associated with living in urban formal, urban informal and rural informal areas, and having been in a current relationship for less than a year. Based on these findings, it was concluded that there is a need to further promote condom use especially among the subgroups of people with lower rates of condom use in order to reduce their risk of HIV infection.