HIV/AIDS Misinformation and Beliefs Among Men Who Have Sex with Men in Pretoria, South Africa
In South Africa, the Council investigated the extent of HIV misinformation and beliefs among men who have sex with men, the factors that may influence HIV misinformation and mistrust, and the impact HIV misinformation and mistrust have on HIV preventive behaviors.
South Africans often have been the recipients of misinformation and mixed messages about the origins, treatment, and prevention of HIV. With messages from high-profile public figures contradicting evidence-based information from HIV researchers and the medical community, it is hard for the average South African to glean accurate HIV prevention information. The long-term goal of this study was to better understand the extent of mistrust in evidence-based HIV information and implications for HIV programs among men who have sex with men (MSM) in South Africa. Highly marginalized groups, including MSM, often are hit hardest by medical misinformation because of their lack of exposure to credible health information sources and access to health care.
The specific aims of this project were to:
- determine population-based prevalence estimates of HIV misinformation and beliefs, mistrust in medical providers and institutions, and HIV-related sexual risk behaviors among MSM;
- identify factors associated with HIV misinformation and mistrust; and
- determine the effect of HIV misinformation and mistrust on HIV preventive behaviors, utilization of HIV-related services, and willingness to participate in HIV treatment/vaccine trials.
As secondary objectives, we also sought to: (1) determine levels of internalized homophobia (i.e., self-shame about being attracted to other men) and factors associated with internalized homophobia; and (2) identify factors associated with self-reported symptoms of sexually transmitted infections (STIs).
A cross-sectional survey was conducted using respondent-driven sampling (RDS) to recruit MSM aged 18 years and older who engaged in oral or anal sex with another male within the past six months and who live in and around Pretoria. RDS is an adaptation of chain-referral sampling where members of the target population refer other members in their network to participate in the study. A total of 324 MSM were recruited from February to August 2009.
The study was conducted by the Population Council in collaboration with a local NGO, OUT LGBT Well-Being.
(Click on the Details tab above to view key study findings and implications.)
Key study findings:
- A fairly high proportion of MSM in Pretoria endorse conspiracy beliefs, particularly those related to HIV information being withheld from the public and to people being used as experimental subjects with HIV treatments and in HIV research.
- Risky sexual behaviors persist at somewhat high levels, with 20 percent of MSM having unprotected anal sex in the past two months and 39 percent having multiple sex partners. However, endorsement of conspiracy beliefs was not found to be correlated with inconsistent condom use.
- Approximately 30 percent of these men have never been tested for HIV. Endorsement of conspiracy beliefs was found to be associated with not testing for HIV. MSM who believe in conspiracy beliefs were 2.4 times less likely to have been tested for HIV.
- Nearly one in five (18%) of MSM reported symptoms of STIs in the previous 12 months. Forced sex was most strongly associated with reported STI symptoms (AOR 5.2; 95% CI 1.9–13.9).
- Fairly high levels of internalized homophobia were found among MSM (e.g., "Wanting to have sex with another man is a personal shortcoming.").
- 10–15 percent reported "often/very often" having feelings of internalized homophobia.
- Over 20 percent reported "sometimes" having feelings of internalized homophobia.
- MSM who self-identify as bisexual were more likely to endorse HIV conspiracy beliefs and experience internalized homophobia.
Program implications:
- HIV testing promotion campaigns should address conspiracy beliefs.
- There is a need to train HIV counselors to probe for same-sex behaviors and to provide nonjudgmental services.
- There is a need for strategies to reach non-gay–identified men.
- Programs should incorporate mental health issues, such as counseling for internalized homophobia.
- STI screening and/or presumptive treatment should continue to be part of postexposure prophylaxis (PEP) programs for MSM victims of sexual assault; men need to know that PEP is available for them as well.
HIV-related conspiracy beliefs and its relationships with HIV testing and unprotected sex among men who have sex with men in Tshwane (Pretoria), South Africa (abstract)
Tun,Waimar; Kellerman,Scott E.; Maime,Senkhu; Fipaza,Zukiswa; Sheehy,Meredith; Vu,Lung; Nel,Dawie
AIDS Care 24(4): 459-467
Publication date: 2012
Levels and correlates of internalized homophobia among men who have sex with men in Pretoria, South Africa (abstract)
Vu,Lung; Tun,Waimar; Sheehy,Meredith; Nel,Dawie
AIDS and Behavior 16(3): 717-723
Publication date: 2012
Project Stats
Location: South Africa (Pretoria)
Program(s):
HIV and AIDS
Topic(s):
Men who have sex with men
Duration: 9/2008 - 8/2009
Population Council researchers:
Meredith Sheehy
Waimar Tun
Non-Council collaborators:
Dawie Nel (OUT LGBT Well-Being, Pretoria)
Senkhu Maimane (OUT LGBT Well-Being, Pretoria)
Donors:
Foundation for AIDS Research
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