Skip to main content

Advertisement

SpringerLink
Log in

HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

While men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those already infected know their status. Effectively promoting frequent HIV testing—of increasing importance with the expanding accessibility of antiretroviral treatment—requires an understanding of the testing practices in this population. To understand men’s HIV testing practices, including their behavior, experiences, and perceptions, we conducted in-depth interviews with 81 black South African MSM (ages 20–39), purposively recruited from four townships. Many men in the sample had tested for HIV. While ever having tested seemed to facilitate repeat testing, men still expressed a high level of discomfort with testing. It was common to test after having engaged in risky behavior, thus increasing anxiety about testing that was already present. Fear that they might test HIV positive caused some men to avoid testing until they were clearly sick, and others to avoid testing completely. HIV testing may increase in this population if it becomes a routine practice, instead of being driven by anxiety-inducing incidents. Mobilization through social support might facilitate frequent testing while education about current treatment options is needed.

Resumen

Aunque la población de hombres que tienen sexo con hombres (HSH) en África corre un alto riesgo de infección del VIH, pocos de ellos que ya están infectados con el virus conocen su diagnóstico. Promover exitosamente el uso de la prueba del VIH frecuente y regularmente—una práctica de creciente importancia con la mayor disponibilidad de los tratamientos antiretrovirales—requiere un entendimiento de las prácticas de esta población en relación a la prueba. Para entender las prácticas de la prueba del VIH en hombres, incluyendo sus comportamientos, experiencias y percepciones, llevamos a cabo entrevistas en profundidad con 81 HSH negros sudafricanos de 20 a 39 años de edad, intencionalmente reclutados de cuatro localidades (townships). Al parecer, muchos de los hombres se habían hecho la prueba. Aunque el hecho de haberse hecho la prueba parece facilitar la repetición de esta, los hombres expresaron altos niveles de incomodidad. Fue común hacerse la prueba después de haber tenido conductas de riesgo, así aumentando la ansiedad sobre la prueba ya existente. El temor de tener un resultado de VIH-positivo causó que algunos hombres postergaran la prueba hasta que estuvieran claramente enfermos y a otros que evitaran someterse a ella por completo. Convertir a la prueba de VIH en una práctica rutinaria, en vez de un acto estimulado por incidentes coyunturales y altamente preocupantes, probablemente incrementará el uso de la prueba entre esta población. Una movilización a través del apoyo social podría facilitar el uso frecuente de la prueba.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Beyrer C, Baral SD, Walker D, Wirtz AL, Johns B, Sifakis F. The expanding epidemics of HIV Type 1 among men who have sex with men in low- and middle-income countries: diversity and consistency. Epidemiol Rev. 2010;32(1):137–51.

    Article  PubMed  Google Scholar 

  2. Vuylsteke B, Semde G, Sika L, Crucitti T, Ettiegne Traore V, Buve A, et al. High prevalence of HIV and sexually transmitted infections among male sex workers in Abidjan, Cote d’Ivoire: need for services tailored to their needs. Sex Transm Infect. 2012;88(4):288–93.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Rispel LC, Metcalf CA, Cloete A, Reddy V, Lombard C. HIV prevalence and risk practices among men who have sex with men in two South African cities. J Acquir Immune Defic Syndr. 2011;57(1):69–76.

    Article  PubMed  Google Scholar 

  4. Sanders EJ, Graham SM, Okuku HS, van der Elst EM, Muhaari A, Davies A, et al. HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS. 2007;21(18):2513–20.

    Article  PubMed  Google Scholar 

  5. Baral S, Sifakis F, Cleghorn F, Beyrer C. Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries 2000-2006: a systematic review. PLoS Med. 2007;4(12):e339.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Wade AS, Larmarange J, Diop AK, Diop O, Gueye K, Marra A, et al. Reduction in risk-taking behaviors among MSM in Senegal between 2004 and 2007 and prevalence of HIV and other STIs. ELIHoS Project, ANRS 12139. AIDS Care. 2010;22(4):409–14.

    Article  PubMed  Google Scholar 

  7. Merrigan M, Azeez A, Afolabi B, Chabikuli ON, Onyekwena O, Eluwa G, et al. HIV prevalence and risk behaviours among men having sex with men in Nigeria. Sex Transm Infect. 2011;87(1):65–70.

    Article  PubMed  Google Scholar 

  8. Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, et al. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men’s Study. AIDS Behav. 2009;15(3):626–34.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Wade AS, Kane CT, Diallo PAN, Diop AK, Gueye K, Mboup S, et al. HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS. 2005;19(18):2133–40.

    Article  PubMed  Google Scholar 

  10. Burrell E, Mark D, Grant R, Wood R, Bekker LG. Sexual risk behaviours and HIV-1 prevalence among urban men who have sex with men in Cape Town, South Africa. Sex Health. 2010;7(2):149–53.

    Article  PubMed  Google Scholar 

  11. Dahoma M, Johnston LG, Holman A, Miller LA, Mussa M, Othman A, et al. HIV and related risk behavior among men who have sex with men in Zanzibar, Tanzania: results of a behavioral surveillance survey. AIDS Behav. 2011;15(1):186–92.

    Article  PubMed  Google Scholar 

  12. Baral S, Burrell E, Scheibe A, Brown B, Beyrer C, Bekker LG. HIV risk and associations of HIV infection among men who have sex with men in Peri-Urban Cape Town, South Africa. BMC Public Health. 2011;11:766.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Price MA, Rida W, Mwangome M, Mutua G, Middelkoop K, Roux S, et al. Identifying at-risk populations in Kenya and South Africa: HIV incidence in cohorts of men who report sex with men, sex workers, and youth. J Acquir Immune Defic Syndr. 2012;59(2):185–93.

    Article  PubMed  Google Scholar 

  14. Sanders EJ, Okuku HS, Smith AD, Mwangome M, Wahome E, Fegan G, et al. High HIV-1 incidence, correlates of HIV-1 acquisition, and high viral loads following seroconversion among men who have sex with men in Coastal Kenya. AIDS. 2012;27(3):437–46.

    Article  Google Scholar 

  15. Lane T, Raymond HF, Dladla S, Rasethe J, Struthers H, McFarland W, et al. High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto Men’s Study. AIDS Behav. 2011;15(3):626–34.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Burrell E, Mark D, Grant R, Wood R, Bekker LG. Sexual risk behaviours and HIV-1 prevalence among urban men who have sex with men in Cape Town, South Africa. Sex Health. 2010;7(2):149–53.

    Article  PubMed  Google Scholar 

  17. Rispel L, Metcalf C, Cloete A, Reddy V, Twonsend L, Zembe Y. The Johannesburg/eThekwini Men’s Study (JEMS): a rapid assessment of the HIV epidemic among men who have sex with men (MSM) in South Africa. Johannesburg: University of Witwatersrand; 2009.

    Google Scholar 

  18. Rispel LC, Metcalf CA. Breaking the silence: South African HIV policies and the needs of men who have sex with men. Reprod Health Matter. 2009;17(33):133–42.

    Article  Google Scholar 

  19. Knox J, Sandfort T, Yi H, Reddy V, Maimane S. Social vulnerability and HIV testing among South African men who have sex with men. Int J STD AIDS. 2011;22:709–13.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Scott-Sheldon LAJ, Carey MP, Carey KB, Cain D, Vermaak R, Mthembu J, et al. Impact of HIV testing on sexual health communication in South Africa. Sex Transm Infect. 2011;87(3):242–7.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Imrie J, McDonald N. HIV testing in men who have sex with men: are we ready to take the next HIV testing test? Sex Transm Infect. 2009;85:487–8.

    Article  PubMed  Google Scholar 

  22. Marks G, Crepaz N, Janssen RS. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006;20(10):1447–50.

    Article  PubMed  Google Scholar 

  23. Dombrowski JC, Harrington R, Golden M. Evidence for the long-term stability of HIV transmission–associated sexual behavior after HIV diagnosis. Sex Transm Dis. 2013;40:41–5.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Fox J, White PJ, Macdonald N, Weber J, McClure M, Fidler S, et al. Reductions in HIV transmission risk behaviour following diagnosis of primary HIV infection: a cohort of high-risk men who have sex with men. HIV Med. 2009;10(7):432–8.

    Article  PubMed  Google Scholar 

  25. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.

    Article  PubMed  Google Scholar 

  26. Vallabhaneni S, McConnell JJ, Loeb L, Hartogensis W, Hecht FM, Grant RM, et al. Changes in seroadaptive practices from before to after diagnosis of recent HIV infection among men who have sex with men. PLoS ONE. 2013;8(2):e55397.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Hull MW, Wu Z, Montaner JS. Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention. Curr Opin HIV AIDS. 2012;7(6):579–86.

    Article  PubMed  Google Scholar 

  28. Lucas A, Armbruster B. The cost-effectiveness of expanded HIV screening in the United States. AIDS. 2013;27(5):795–801.

    Article  PubMed  Google Scholar 

  29. Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment—United States. MMWR. 2011;60(47):1618–23.

    Google Scholar 

  30. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.

    Article  PubMed  Google Scholar 

  31. Holtgrave D. Evidence-Based Efforts to Prevent HIV Infection: an Overview of Current Status and Future Challenges. Clin Infect Dis. 2007;45(Supplement 4):S293–9.

    Article  PubMed  Google Scholar 

  32. Folch C, Marks G, Esteve A, Zaragoza K, Munoz R, Casabona J. Factors associated with unprotected sexual intercourse with steady male, casual male, and female partners among men who have sex with men in Barcelona, Spain. AIDS Educ Prev: Off Publ Int Soc AIDS Educ. 2006;18(3):227–42.

    Article  Google Scholar 

  33. Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26(7):893–6.

    Article  PubMed  Google Scholar 

  34. Powers KA, Ghani AC, Miller WC, Hoffman IF, Pettifor AE, Kamanga G, et al. The role of acute and early HIV infection in the spread of HIV and implications for transmission prevention strategies in Lilongwe, Malawi: a modelling study. Lancet. 2011;378(9787):256–68.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Miller WC, Rosenberg NE, Rutstein SE, Powers KA. Role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):277–82.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Henard S, Jeanmaire E, Nguyen Y, Yazdanpanah Y, Cheret A, Hoen B, et al. Is total community viral load a robust predictive marker of the efficacy of the TasP strategy? J Acquir Immune Defic Syndr. 2012;61(3):400–2.

    Article  PubMed  Google Scholar 

  37. Das M, Chu PL, Santos GM, Scheer S, Vittinghoff E, McFarland W, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS ONE. 2010;5(6):e11068.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. New Engl J Med. 2011;365(6):493–505.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. April MD, Walensky RP, Chang Y, et al. HIV testing rates and outcomes in a South African community, 2001–2006: implications for expanded screening policies. J Acquir Immune Defic Syndr. 2009;51:310–6.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Knox J, Sandfort T, Yi H, Reddy V, Maimane S. Social vulnerability and HIV testing among South African men who have sex with men. Int J STD AIDS. 2011;22(12):709–13.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Phillips AN, Cambiano V, Nakagawa F, Brown AE, Lampe F, Rodger A, et al. Increased HIV incidence in men who have sex with men despite high levels of ART-induced viral suppression: analysis of an extensively documented epidemic. PLoS ONE. 2013;8(2):e55312.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Wilson DP, Regan DG, Heymer KJ, Jin FY, Prestage GP, Grulich AE. Serosorting may increase the risk of HIV acquisition among men who have sex with men. Sex Transm Dis. 2010;37(1):13–7.

    Article  PubMed  Google Scholar 

  43. Williamson LM, Flowers P, Knussen C, Hart GJ. HIV testing trends among gay men in Scotland, UK (1996-2005): implications for HIV testing policies and prevention. Sex Transm Infect. 2009;85(7):550–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Stekler JD, Golden MR. Learning from the missed opportunities for HIV testing. Sex Transm Infect. 2009;85(1):2–3.

    Article  PubMed  Google Scholar 

  45. Burns F, Hart G. Increased HIV testing in men who have sex with men. Brit Med J. 2012;344(7850):11.

    Google Scholar 

  46. Oster AM, Miles IW, Le BC, DiNenno EA, Wiegand RE, Heffelfinger JD, et al. HIV testing among men who have sex with men — 21 cities, United States, 2008. MMWR. 2011;60(21):694–9.

    Google Scholar 

  47. Sorensen SW, Sansom SL, Brooks JT, Marks G, Begier EM, Buchacz K, et al. A mathematical model of comprehensive test-and-treat services and HIV incidence among men who have sex with men in the United States. PLoS ONE. 2012;7(2):e29098.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  48. Charlebois ED, Das M, Porco TC, Havlir DV. The Effect of Expanded Antiretroviral Treatment Strategies on the HIV Epidemic among Men Who Have Sex with Men in San Francisco. Clin Infect Dis. 2011;52(8):1046–9.

    Article  PubMed Central  PubMed  Google Scholar 

  49. South African National AIDS Council. National Strategic Plan on HIV, STIs and TB 2012-2016. Pretoria: SANAC; 2011.

    Google Scholar 

  50. Seeking J, Nattrass N. Class, race, and inequality in South Africa. Scottsville, South Africa: University of KwaZulu-Natal Press; 2005.

    Book  Google Scholar 

  51. Musheke M, Ntalasha H, Gari S, Mckenzie O, Bond V, Martin-Hilber A, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in Sub-Saharan Africa. BMC Public Health. 2013;13(1):220.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Gibbs G. Analyzing qualitative data. Los Angeles: Sage; 2007.

    Google Scholar 

  53. Rispel LC, Metcalf CA, Cloete A, Moorman J, Reddy V. You become afraid to tell them that you are gay: health service utilization by men who have sex with men in South African cities. J Public Health Policy. 2011;32:S137–51.

    Article  PubMed  Google Scholar 

  54. Nanin J, Osubu T, Walker J, Powell B, Powell D, Parsons J. “HIV is still real”: perceptions of HIV testing and HIV prevention among black men who have sex with men in New York City. Am J Mens Health. 2009;3(2):150–64.

    Article  PubMed  Google Scholar 

  55. Lane T, Mogale T, Struthers H, McIntyre J, Kegeles SM. “They see you as a different thing”: the experiences of men who have sex with men with healthcare workers in South African township communities. Sex Transm Infect. 2008;84(6):430–3.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Zablotska I, Holt M, de Wit J, McKechnie M, Mao L, Prestage G. Gay men who are not getting tested for HIV. AIDS Behav. 2012;16(7):1887–94.

    Article  CAS  PubMed  Google Scholar 

  57. Dowson L, Kober C, Perry N, Fisher M, Richardson D. Why some MSM present late for HIV testing: a qualitative analysis. AIDS Care. 2012;24(2):204–9.

    PubMed  Google Scholar 

  58. Flowers P, Knussen C, Li J, McDaid L. Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK. HIV Med. 2013;14(2):92–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  59. Nel JA, Yi H, Sandfort TG, Rich E. HIV-Untested Men Who Have Sex with Men in South Africa: The Perception of Not Being at Risk and Fear of Being Tested. AIDS Behav. 2012;17:1–9.

    Google Scholar 

  60. Lorenc T, Marrero-Guillamon I, Llewellyn A, Aggleton P, Cooper C, Lehmann A, et al. HIV testing among men who have sex with men (MSM): systematic review of qualitative evidence. Health Educ Res. 2011;26(5):834–46.

    Article  PubMed  Google Scholar 

  61. Pitpitan EV, Kalichman SC, Eaton LA, Cain D, Sikkema KJ, Skinner D, et al. AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town. South Africa. Ann Behav Med. 2012;43(3):362–71.

    Article  Google Scholar 

  62. Lauby J, Bond L, Eroğlu D, Batson H. Decisional Balance, Perceived Risk and HIV Testing Practices. AIDS Behav. 2006;10(1):83–92.

    Article  PubMed  Google Scholar 

  63. Flowers P, Church S. To test or not? HIV antibody testing amongst gay men. Cult Health Sex. 2002;4(1):43–65.

    Article  Google Scholar 

  64. Margolis AD, Joseph H, Belcher L, Hirshfield S, Chiasson MA. ‘Never testing for HIV’ among men who have sex with men recruited from a sexual networking website. United States. AIDS Behav. 2012;16(1):23–9.

    Article  Google Scholar 

  65. Gold RS, Karantzas G. Thought processes associated with reluctance in gay men to be tested for HIV. Int J STD AIDS. 2008;19(11):775–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by a grant from the National Institute of Mental Health (R01-MH083557; Principal Investigator: Theo Sandfort, Ph.D.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. The HIV Center for Clinical and Behavioral Studies is supported by a center grant from the National Institute of Mental Health, P30 MH43520 (Principal Investigator: Robert Remien, Ph.D.). We wish to thank OUT Well-being, the communities that partnered with us in conducting this research, and the study participants for their contributions. We also thank study staff at all participating institutions for their work and dedication.

Author information

Authors and Affiliations

  1. Department of Psychiatry, HIV Center for Clinical and Behavioral Studies, Columbia University, New York, NY, USA

    Theo G. M. Sandfort, Justin Knox & Kate L. Collier

  2. New York State Psychiatric Institute, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA

    Theo G. M. Sandfort, Justin Knox & Kate L. Collier

  3. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Justin Knox

  4. Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA

    Tim Lane

  5. Human and Social Development, Human Sciences Research Council, Durban, South Africa

    Vasu Reddy

  6. University of KwaZulu-Natal, Durban, South Africa

    Vasu Reddy

Authors
  1. Theo G. M. Sandfort
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin Knox
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kate L. Collier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tim Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vasu Reddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theo G. M. Sandfort.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sandfort, T.G.M., Knox, J., Collier, K.L. et al. HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART. AIDS Behav 19, 561–574 (2015). https://doi.org/10.1007/s10461-014-0843-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-014-0843-7

Keywords

Search

Navigation