Top

Published in:

01-08-2010 | Original Paper

The Associations of Voluntary Counseling and Testing Acceptance and the Perceived Likelihood of Being HIV-Infected Among Men with Multiple Sex Partners in a South African Township

Authors: Lisa Johnston, Heidi O’Bra, Mickey Chopra, Cathy Mathews, Loraine Townsend, Keith Sabin, Mark Tomlinson, Carl Kendall

Published in: AIDS and Behavior | Issue 4/2010

Abstract

This paper examines the socio-demographic factors and sexual risk behaviors (condom use, number of sexual partners, STI symptoms) associated with voluntary counselling and testing (VCT) acceptance and self-perceived risk of being HIV-infected among black men with multiple and younger sex partners in a South African township outside of Cape Town. Using respondent driven sampling, we interviewed 421 men, of whom 409 (97.3%) consented to provide a dried blood spot, 12.3% were HIVinfected (95% confidence intervals [CI.] 8.3, 16.9) and 47.2% (CI. 41.1, 53.6) accepted on site VCT. Twenty six percent (CI. 20.2, 30.7) reported having an HIV test in the past year. Few men perceived themselves as very likely to be infected with HIV (15.6%; CI. 10.4, 20.5). VCT acceptance was significantly associated with being older, married or living with a partner, having higher education, having four to six partners in the past three months and testing HIV positive. Self-perceived likelihood of being HIV infected was significantly associated with low condom use and having seven or more partners in the past three months, and testing HIV positive. These findings indicate that men correctly understand that engaging in certain HIV risk behaviors increases the likelihood of HIV-infection. However, those who perceive themselves at high risk of having HIV do not seek testing. Further investigation into the psychological and cultural barriers to reducing risky sexual behaviors and accessing VCT and other HIV services is recommended.

A ‘casual partner’ is a woman with whom the man has sexual relations on an infrequent but ongoing basis; a ‘one-off’ partner is a woman with whom the man had sex on one occasion only.

Akwara, P. A., Madise, N. J., & Hinde, A. (2003). Perception of risk of HIV/AIDS and sexual behavior in Kenya. Journal of Biosocial Science, 35, 385–411.CrossRefPubMed

Benatar, S. R. (2004). Health care reform and the crisis of HIV and AIDS in South Africa. The New England Journal of Medicine, 351, 1.CrossRef

Birdsall, K., Hajiyiannis, H., Nkosi, Z., & Parker, W. (2004). Voluntary counseling and testing in South Africa: Analysis of calls to the national AIDS helpline. Center for AIDS development, research and evaluation. Pretoria, South Africa. Retrieved from http://www.cadre.org.za/pdf/pdf/CANVCT.pdf. Accessed 1 October 2007.

Coovadia, H. M. (2000). Access to voluntary counseling and testing for HIV in developing countries. Annals New York Academy of Sciences, 918, 57–63.CrossRef

Cleland, J. (1995). Risk perception and behavioral change. In J. Cleland, & B. Ferry (Eds.), Sexual behaviors and AIDS in the developing world (pp. 157–192). London: Taylor and Francis Ltd.

Department of Health. (2005). National HIV and syphilis antenatal sero-prevalence survey in South Africa. Department of Health, Cape Town, South Africa.

De Zoysa, I., Phillips, K. A., Kamenga, M. C., O’Reilly, K. R., Sweat, M. D., White, R. A., et al. (1995). Role of HIV counseling and testing in changing risk behaviour in developing countries. AIDS, 9(Suppl. A), 95–101.

Dorrington, R. E., Bradshaw, D., Johnson, L., & Budlender, D. (2004). The Demographic impact of HIV/AIDS in South Africa. National Indicators for 2004. Cape Town: Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa. Retrieved from http://www.mrc.ac.za/bod/demographic.pdf. Accessed 6 October 2007.

Dunkle, K. L., Jewkes, R., Nduna, M., Jama, N, Levin, J., Sikweyiya, Y., & Koss, M. P. (2007). Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: Prevalence, predictors, and associations with gender-based violence. Social Science & Medicine, 65(6), 1235–1248. CrossRef

Glick, P. (2005). Scaling up HIV voluntary counseling and testing in Africa: What can evaluation studies tell us about potential prevention impacts? Evaluation Review, 29, 331.CrossRefPubMed

Glick, P., & Sahn, D. (2004). Changes in HIV/AIDS knowledge and testing behavior in Africa: How much and for whom? Cornell University Food and Nutrition Policy Program working paper 173. Ithaca, NY: Cornell University. Retrieved from http://www.cfnpp.cornell.edu/info/wp173.html. Accessed 1 October 2007.

Hallett, T. B., Gregson, S., Lewis, J. J. C., Lopman, B. A., & Garnett, G. P. (2007). Behavior change in generalised HIV epidemics: Impact of reducing cross-generational sex and delaying age as sexual debut. Journal of Sexually transmitted injections, 83, 50–54.CrossRef

Halperin, D. T., & Epstein, H. (2004). Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: Implications for prevention. The Lancet, 364, 4–6.CrossRef

Heckathorn, D. (2007). Extensions of respondent driven sampling: Analysing continuous variables and controlling for differential recruitment. Sociological Methodology, 37(1), 151–207.CrossRef

Heckathorn, D. (1997). Respondent driven sampling: a new approach to the study of hidden populations. Social Problems, 44(2), 174–199.CrossRef

Heckathorn, D. (2002). Respondent driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems, 49(1), 11–34.CrossRef

Hutchinson, P. L., & Mahlalela, X. (2006). Utilization of voluntary counseling and testing services in the Eastern Cape, South Africa. AIDS Care, 18(5), 446–455.CrossRefPubMed

IRIN Plus News. (2005). South Africa: men falling through the cracks. 25 July. Retrieved from http://www.aegis.com/news/irin/2005/IR050766.html. Accessed 1 October 2007.

Jewkes, R., Levin, J., & Penn-Kekanac, L. A. (2003). Gender inequalities, intimate partner violence and HIV preventive practices: Findings of a South African cross-sectional study. Social Science & Medicine, 56(1), 125–134.CrossRef

Kalichman, S. C., & Simbayi, L. C. (2003). HIV testing attitudes, AIDS stigma, and voluntary HIV counseling and testing in a black township in Cape Twon, South Africa. Sexually Transmitted Infections, 79, 442–447.CrossRefPubMed

Kelly, R. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Wabwire-Mangen, F., Lutalo, T., & Wawer, M. J. (2003). Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. Journal of Acquired Immune Deficiency Syndromes, 32, 446–451.CrossRefPubMed

Killewo, J. Z. J., Kwesigabo, G., Comoro, C., Lugalla, J., Mhalu, F. S., Biberfeld, G., Wall, S., & Sandström, A. (1998). Acceptability of voluntary HIV testing with counseling in a rural village in Kagera, Tanzania. AIDS Care, 10(4), 431–439.CrossRefPubMed

Levack, B. A. (2005). Understanding men’s low utilization of HIV voluntary counseling and testing and men’s role in efforts to prevent mother-to-child HIV transmission in Soweto, South Africa. Thesis (M.P.H.)—University of Washington.

Luke, N. (2003). Age and economic asymmetries in the sexual relationships of adolescent girls in Sub-Saharan Africa. Studies in Family Planning, 34(2), 67–86.CrossRefPubMed

Luke, N. (2005). Confronting the ‘Sugar Daddy’ stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. International Family Planning Perspectives, 31(1), 6–14.CrossRefPubMed

Mabunda, G. (2006). Voluntary HIV counseling and testing: knowledge and practices in a rural South African village. Journal of Transcultural Nursing, 17(1), 23–29.CrossRefPubMed

Marks, G., Crepaz, N., Senterfitt, J. W., & Janssen, R. S. (2005). Meta-analysis of high-risk sexual behaviour in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes, 39, 446–453.CrossRefPubMed

MSF- Médecins Sans Frontières. (2003). Providing HIV services including antiretroviral therapy at primary health care clinics in resource poor settings: the experience from Khayelitsha. School of Public Health and Family Medicine, University of Cape Town, South Africa. Retrieved from https://www.aerzte-ohne-grenzen.de/obj/_scripts/msf_download_pdf.php?id=1759&filename=khayelitsha1000.pdf. Accessed 12 September 2007.

MSF-Médecins Sans Frontières. (2004). Exploring HIV risk perception in a context antiretroviral treatment: Results from a household survey, September 2003 to March 2004, Khayelitsha, Cape Town. Médecins Sans Frontières and School of Public Health and Family Medicine, University of Cape Town, South Africa.

Pettifor, A. E., Rees, H. V., Steffenson, A., Hlongwa-Madikizela, L., MacPhail, C., & Vermaak, K. (2004) HIV and sexual behaviour among young South Africans: a national survey of 15–24 year olds. Johannesburg: Reproductive Health Research Unit. Retrieved from http://www.lovelife.org.za/corporate/research/national_survey_RHRU.pdf. Accessed 10 September 2007.

SA Census data. (2005). A population profile of Khayelitsha: socio-economic information from the 2001 census. SA Census data Information and Knowledge Management from Statistics. Retrieved from http://web.capetown.gov.za/eDocuments/A_Population_Profile_of_Khayelitsha_1052006142120_359.pdf. Accessed 10 September 2007.

Statistics South Africa. (2001). City of Cape Town-Census 2001-Khayelitsha. Retrieved from http://www.capetown.gov.za/censusInfo/Census2001-new/Suburbs/Khayelitsha.htm. Accessed 25 May 2006.

Salganik, M. J. (2006). Variance estimation, design effects, and sample size calculations for Respondent-Driven Sampling. Journal of Urban Health, 83(Suppl 7), 98–112.CrossRef

Salganik, M. J., & Heckathorn, D. D. (2004). Sampling and estimation in hidden populations using Respondent-Driven Sampling. Sociological Methodology, 34, 193–239.CrossRef

Sethosa, E., & Peltzer, K. (2005). Evaluation of HIV counselling and testing, self-disclosure, social support and sexual behaviour change among a rural sample of HIV reactive patients in South Africa. Curationis: The South African Journal of Nursing, 28, 29–41.

Shaikh, N., Abdullah, F., Lombard, C. J., Smit, L., Bradshaw, D., & Makubalo, L. (2006). Masking through averages—Intraprovincial heterogeneity in HIV prevalence within the Western Cape. South African Medical Journal, 96, 538–543.PubMed

Shisana, O., Rehle, T., Simbayi, L. C., Parker, W., Zuma, K., Bhana, A., Connolly, C., Jooste, S., & Pillay. V. (2005). South African national HIV prevalence, HIV incidence, behaviour and communication survey, 2005. Cape Town South Africa: Human Sciences Research Council. Retrieved from http://www.hsrcpress.ac.za/product.php?productid=2134. Accessed 10 September 2007.

Shisana, O., & Simbayi, L. (2002). Nelson Mandela/HSRC study of HIV/AIDS: South African national HIV prevalence, behavioral risks and mass media, household survey 2002. Cape Town South Africa: Human Sciences Research Council. Retrieved from www.hsrcpress.ac.za/product.php?productid=2009. Accessed 12 September 2007.

Southern African Development Community. (2006). Multiple sex partners driving HIV. 16 August 2006. Government Communications. Retrieved from http://www.southafrica.info/public_services/citizens/health/aids-160806.htm. Accessed 10 September 2007.

Statistics of South Africa. (2005). Census 2001: Primary tables Western Cape: Census ‘96 and 2001 compared. Statistics South Africa. Pretoria, South Africa. P.107. [Report No. 03-02-13 (2001)].

Sweat, M., Gregorich, S., Snagiwa, G., Furlonge, C., Balmer, D., Kamenga, C., Grinstead, O., & Coates, T. (2000). Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV-1 in the United Republic of Tanzania and Kenya. The Lancet, 356, 113–121.CrossRef

UNAIDS. (2004). 2004 Report on the global HIV/AIDS epidemic. Geneva: Switzerland. Retrieved from http://www.unaids.org/bangkok2004/GAR2004_html/GAR2004_00_en.htm. Accessed 9 September 2007.

Voluntary HIV-1 Counseling and Testing Efficacy Study Group. (2000). Efficacy of voluntary HIV-1 counseling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: A randomized trial. The Lancet, 356, 103–112.CrossRef

Volz, E., & Heckathorn, D. D. (2007). Probability based estimation theory for Respondent Driven Sampling. Journal of Official Statistics, (In Press).

Weinhardt, L. S., Carey, M. P., Johnson, B. T., & Bickham, N. L. (1999). Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. American Journal of Public Health, 89(9), 1397–1405.CrossRefPubMed

Wellings, K., Collumbien, M., Slaymaker, E., Singh, S., Hodges, Z., Patel, D., & Bajos, N. (2006). Sexual behaviour in context: A global perspective. The Lancet, 368, 1706–1727.CrossRef

WHO-World Health Organization. (2003). Antiretroviral therapy in primary health care: experience of the Khayelitsha programme in South Africa: case study. Geneva, Switzerland. Retrieved from http://www.who.int/hiv/amds/case8.pdf. Accessed 2 September 2007.

WHO-World Health Organization. (2004). Coverage of selected services for HIV/AIDS prevention, care and support in low and middle income countries in 2003; June 2004 Policy Project, Washington, DC. Reference Number: ISBN 1-59560-001-9. Retrieved from http://www.who.int/hiv/pub/prev_care/coverage/en/. Accessed 10 September 2007.

WHO-World Health Organization. (2007). Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva, Switzerland. Retrieved from http://www.who.int/hiv/pub/guidelines/pitc2007/en/. Accessed 1 November 2007.

Zachariah, R., Spielmann, M. P., Harries, A. D., Buhendwa, L., & Chingi, C. (2003). Motives, sexual behaviors and risk factors associated with HIV in individuals seeking voluntary counseling and testing in a rural district of Malawi. Tropical Doctor, 33, 88–91.PubMed

Title: The Associations of Voluntary Counseling and Testing Acceptance and the Perceived Likelihood of Being HIV-Infected Among Men with Multiple Sex Partners in a South African Township
Authors: Lisa Johnston
Heidi O’Bra
Mickey Chopra
Cathy Mathews
Loraine Townsend
Keith Sabin
Mark Tomlinson
Carl Kendall
Publication date: 01-08-2010
Publisher: Springer US
Published in: AIDS and Behavior / Issue 4/2010
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI: https://doi.org/10.1007/s10461-008-9362-8

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Associations of Voluntary Counseling and Testing Acceptance and the Perceived Likelihood of Being HIV-Infected Among Men with Multiple Sex Partners in a South African Township

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2010

Importance of Dose Timing to Achieving Undetectable Viral Loads

High HIV Prevalence, Suboptimal HIV Testing, and Low Knowledge of HIV-Positive Serostatus Among Injection Drug Users in St. Petersburg, Russia

The Relationships Between States’ DUI Penalties and HIV-Positive Adults’ Drinking Behaviors

Affective Correlates of Stimulant Use and Adherence to Anti-retroviral Therapy Among HIV-positive Methamphetamine Users

Smoking Among HIV Positive New Yorkers: Prevalence, Frequency, and Opportunities for Cessation

Two-Year Follow-Up of Sexual Behavior Among HIV-Uninfected Household Members of Adults Taking Antiretroviral Therapy in Uganda: No Evidence of Disinhibition

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page