Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and Risk Factors for HIV Infection Among Heterosexual Men Recruited from Socializing Venues in Rural KwaZulu-Natal, South Africa

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

Abstract

Young heterosexual men have low uptake of HIV prevention and treatment services and represent an important key population that may require novel strategies. We recruited 1271 heterosexual men, 12 years and older from socializing venues such as “shebeens”, transport hubs, “spaza” shops, and community centers in rural KwaZulu-Natal, South Africa. Participants completed a questionnaire and were tested for HIV serostatus. Generalized estimating equations (GEE) with exchangeable covariance structure estimated factors independently associated with prevalent HIV infection. Median age was 25 years [Interquartile range (IQR) 21–29]. HIV prevalence was 15.5% [95% confidence interval (CI) 11.0–21.9] and increased significantly by age. Factors associated with higher odds of HIV infection were being 25 years and older [adjusted odds ratio (aOR) 4.82, 95% CI 3.47–6.69; p < 0.001), not completing high school (aOR 1.60, 95% CI 1.39–1.85; p < 0.001), not using condoms at first sex (aOR 1.43, 95% CI 1.20–1.70; p < 0.001), consuming alcohol (aOR 1.63, 95% CI 1.15–2.31; p = 0.006) or substances (aOR 1.37, 95% CI 1.31–1.44; p < 0.001), and absence of medical circumcision (aOR 2.05, 95% CI 1.71–2.44; p < 0.001). Risk was lower among those testing for HIV in last 12 months (aOR 0.54, 95% CI 0.36–0.80; p = 0.002). Greater effort is needed to implement innovative programs within settings that are easily accessible and where heterosexual men are likely to be.

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

Abbreviations

aOR:

Adjusted odds ratio

BREC:

University of KwaZulu-Natal Biomedical Research Ethics Committee

CI:

Confidence interval

GEE:

Generalized estimating equations

GPS:

Global positioning system

HIV:

Human immunodeficiency virus

IQR:

Interquartile range

PDA:

Personal digital assistant

PID:

Participant identification number

QIC:

Quasi-likelihood information under the independence model criterion

References

  1. Joint United Nations Programme on HIV/AIDS (UNAIDS): South Africa: UNAIDS. 2018; https://www.unaids.org/en/regionscountries/countries/southafrica accessed 10 October 2019.

  2. Shisana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Labadarios D, Onoya D: South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. 2014; (http://www.hsrc.ac.za/en/research-outputs/view/6871 accessed 17 June 2020.

  3. Kharsany AB, Cawood C, Khanyile D, Lewis L, Grobler A, Puren A, Govender K, George G, Beckett S, Samsunder N. Community-based HIV prevalence in KwaZulu-Natal, South Africa: results of a cross-sectional household survey. Lancet HIV. 2018;5(8):e427–37.

    Article  Google Scholar 

  4. Simbayi L, Zuma K, Zungu N, Moyo S, Marinda E, Jooste S, Mabaso M, Ramlagan S, North A, van Zyl J, et al.: South African National HIV Prevalence, Incidence, Behaviour And Communication Survey, 2017 HSRC Press, Cape Town 2019. https://www.hsrcpress.ac.za/books/south-african-national-hiv-prevalence-incidence-behaviour-and-communication-survey-2017: Accessed 15 May 2019.

  5. de Oliveira T, Kharsany AB, Graf T, Cawood C, Khanyile D, Grobler A, Puren A, Madurai S, Baxter C, Karim QA, et al. Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study. Lancet HIV. 2017;4(1):e41–50.

    Article  Google Scholar 

  6. Akullian A, Bershteyn A, Klein D, Vandormael A, Bärnighausen T, Tanser F. Sexual partnership age pairings and risk of HIV acquisition in rural South Africa. AIDS. 2017;31(12):1755.

    Article  Google Scholar 

  7. Kharsany ABM, Cawood C, Lewis L, Yende-Zuma N, Khanyile D, Puren A, Madurai S, Baxter C, George G, Govender K, et al. Trends in HIV prevention, treatment, and incidence in a hyperendemic area of KwaZulu-Natal, South Africa. JAMA Netw Open. 2019;2(11):e1914378.

    Article  Google Scholar 

  8. Venkatesh KK, Madiba P, De Bruyn G, Lurie MN, Coates TJ, Gray GE. Who gets tested for HIV in a South African urban township? Implications for test and treat and gender-based prevention interventions. J Acquir Immune Defic Syndr. 2011;56(2):151.

    Article  Google Scholar 

  9. Beauclair R, Hens N, Delva W. Concurrent partnerships in Cape Town, South Africa: race and sex differences in prevalence and duration of overlap. J Int AIDS Soc. 2015;18:19372.

    Article  Google Scholar 

  10. Joint United Nations Programme on HIV/AIDS (UNAIDS). Working with men for HIV prevention and care. 2001 (http://data.unaids.org/publications/irc-pub02/jc543-workingwithmen_en.pdf Accessed 12 November 2019.

  11. Sisonke Gender Justice Network: Building male involvement in SRHR: A basic model for male involvement in Sexual and Reproductive Health and Rights. 2012; http://menengage.org/wp-content/uploads/2014/01/Sonke-Gender-Justice-Model-for-Male-Involvement-in-SRHR.pdf Accessed 1 July 2020.

  12. Chikovore J, Gillespie N, McGrath N, Orne-Gliemann J. Men, masculinity, and engagement with treatment as prevention in KwaZulu-Natal, South Africa. AIDS Care. 2016;28(Suppl 3):74–82.

    Article  Google Scholar 

  13. Joint United Nations Programme on HIV/AIDS (UNAIDS): Male engagement in the HIV response—a Platform for Action. 2016; https://www.unaids.org/sites/default/files/media_asset/JC2848_en.pdf Accessed 17 October 2019.

  14. Stern E, Rau A, Cooper D. Sexual and reproductive health perceptions and practices as revealed in the sexual history narratives of South African men living in a time of HIV/AIDS. SAHARA-J. 2014;11(1):233–44.

    Article  Google Scholar 

  15. Young LE, Michaels S, Jonas A, Khanna AS, Skaathun B, Morgan E, Schneider JA. uConnect study team: sex behaviors as social cues motivating social venue patronage among young black men who have sex with men. AIDS Behav. 2017;21(10):2924–34.

    Article  Google Scholar 

  16. Velloza J, Watt MH, Abler L, Skinner D, Kalichman SC, Dennis AC, Sikkema KJ. HIV-risk behaviors and social support among men and women attending alcohol-serving venues in South Africa: implications for HIV prevention. AIDS Behav. 2017;21(Suppl 2):144–54.

    Article  Google Scholar 

  17. Abdool Karim Q, Kharsany AB, Frohlich JA, Werner L, Mashego M, Mlotshwa M, Madlala BT, Ntombela F, Abdool Karim SS. Stabilizing HIV prevalence masks high HIV incidence rates amongst rural and urban women in KwaZulu-Natal, South Africa. Int J Epidemiol. 2010;40(4):922–30.

    Article  Google Scholar 

  18. Eaton LA, Kalichman S. Risk compensation in HIV prevention: implications for vaccines, microbicides, and other biomedical HIV prevention technologies. Curr HIV/AIDS Rep. 2007;4(4):165–72.

    Article  Google Scholar 

  19. Kalichman SC, Cherry C, Amaral CM, Swetzes C, Eaton L, Macy R, Grebler T, Kalichman MO. Adherence to antiretroviral therapy and HIV transmission risks: implications for test-and-treat approaches to HIV prevention. AIDS Patient Care STDS. 2010;24(5):271–7.

    Article  Google Scholar 

  20. Kalichman S, Mathews C, Kalichman M, Eaton LA, Nkoko K. Male circumcision for HIV prevention: Awareness, risk compensation, and risk perceptions among South African women. Glob Public Health. 2018;13(11):1682–90.

    Article  Google Scholar 

  21. Pettifor AE, Levandowski BA, Macphail C, Padian NS, Cohen MS, Rees HV. Keep them in school: the importance of education as a protective factor against HIV infection among young South African women. Int J Epidemiol. 2008;37:1266–73.

    Article  Google Scholar 

  22. Hendriksen ES, Pettifor A, Lee S-J, Coates TJ, Rees HV. Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey. Am J Public Health. 2007;97(7):1241–8.

    Article  Google Scholar 

  23. Shafii T, Stovel K, Holmes K. Association between condom use at sexual debut and subsequent sexual trajectories: a longitudinal study using biomarkers. Am J Public Health. 2007;97(6):1090–5.

    Article  Google Scholar 

  24. World Health Organization (WHO): Global status report on alcohol and health 2018. 2019; https://www.who.int/substance_abuse/publications/global_alcohol_report/en/ accessed 17 June 2020.

  25. Peltzer K, Davids A, Njuho P. Alcohol use and problem drinking in South Africa: findings from a national population-based survey. Afr J Psychiatry. 2011;14(1):147.

    Article  Google Scholar 

  26. Fritz K, Morojele N, Kalichman S. Alcohol: the forgotten drug in HIV/AIDS. Lancet. 2010;376(9739):398–400.

    Article  Google Scholar 

  27. Panday S, Makiwane M, Ranchod C, Letsoalo T. Teenage pregnancy in South Africa - with a specific focus on school-going learners. 2009; http://www.hsrc.ac.za/en/research-data/view/4542  Accessed 17 June 2020.

  28. Setlalentoa B, Pisa P, Thekisho G, Ryke E, Du Loots T. The social aspects of alcohol misuse/abuse in South Africa. S Afr J Clin Nutr. 2010;23(sup2):11–5.

    Article  Google Scholar 

  29. Liu Y, Qian HZ, Ruan Y, Wu P, Osborn CY, Jia Y, Yin L, Lu H, He X, Shao Y, et al. Frequent HIV testing: impact on HIV risk among Chinese men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(4):452–61.

    Article  Google Scholar 

  30. Scott-Sheldon LA, Carey MP, Carey KB, Cain D, Simbayi LC, Mehlomakhulu V, Kalichman SC. HIV testing is associated with increased knowledge and reductions in sexual risk behaviours among men in Cape Town, South Africa. Afr J AIDS Res. 2013;12(4):195–201.

    Article  Google Scholar 

  31. Montague C, Ngcobo N, Mahlase G, Frohlich J, Pillay C, Yende-Zuma N, Humphries H, Dellar R, Naidoo K, Karim QA. Implementation of adolescent-friendly voluntary medical male circumcision using a school based recruitment program in rural KwaZulu-Natal, South Africa. PLoS ONE. 2014;9(5):e96468.

    Article  Google Scholar 

  32. South African National Department of Health.: Implementation of the Universal Test and Treat Strategy for HIV Positive patients and differentiated care for stable patients. 2016; http://www.sahivsoc.org/Files/22%208%2016%20Circular%20UTT%20%20%20Decongestion%20CCMT%20Directorate%20(2).pdf Accessed 24 February 2019.

  33. Kharsany AB, Frohlich JA, Yende-Zuma N, Mahlase G, Samsunder N, Dellar RC, Zuma-Mkhonza M, Karim SSA, Karim QA. Trends in HIV prevalence in pregnant women in rural South Africa. J Acquir Immune Defic Syndr. 2015;70(3):289.

    Article  Google Scholar 

  34. Hankins C. Male circumcision: implications for women as sexual partners and parents. Reprod Health Matters. 2007;15(29):62–7.

    Article  Google Scholar 

  35. Nagelkerke NJ, Moses S, de Vlas SJ, Bailey RC. Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa. BMC Infect Dis. 2007;7(1):16.

    Article  Google Scholar 

  36. Seeley J, Watts CH, Kippax S, Russell S, Heise L, Whiteside A. Addressing the structural drivers of HIV: a luxury or necessity for programmes? J Int AIDS Soc. 2012;15(Suppl 1):1–4.

    CAS  PubMed  Google Scholar 

  37. Cluver LD, Orkin FM, Meinck F, Boyes ME, Sherr L. Structural drivers and social protection: mechanisms of HIV risk and HIV prevention for South African adolescents. J Int AIDS Soc. 2016;19(1):20646.

    Article  Google Scholar 

  38. Auerbach JD, Parkhurst JO, Caceres CF. Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations. Glob Public Health. 2011;6(Suppl 3):S293-309.

    Article  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank all the participants for their time and commitment to study participation. To all the traditional and municipal leadership for their support with the study. The Provincial Department of Health and uMgungundlovu District office, the local primary health care clinics for management of follow-up care and support for participants referrals. To all the study staff, laboratory and primary health care clinic staff for study related procedures and follow-up care. Our sincere thanks to Mr Mesuli Mhlongo for his invaluable assistance.

Funding

The study was made possible through The Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), Office of the Director and National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health: R01HD083343 (Multi-PI: Kharsany and Kohler). Further funding support was provided to N. Ntombela from the University Capacity Development Programme from the College of Health Sciences by the University of KwaZulu-Natal. REF:207525096. N. Ntombela, A. Soogun and ABM. Kharsany received support from the South African Department of Science and Innovation and the National Research Foundation’s Centre of Excellence in HIV Prevention (Grant 96354). The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the funding agencies.

Author information

Author notes

  1. Nonzwakazi P. Ntombela and Ayesha B. M. Kharsany are Joint first authors.

Authors and Affiliations

  1. Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa

    Nonzwakazi P. Ntombela, Ayesha B. M. Kharsany, Adenike Soogun, Nonhlanhla Yende-Zuma & Lyle R. McKinnon

  2. School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

    Ayesha B. M. Kharsany

  3. Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, USA

    Hans-Peter Kohler

  4. Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada

    Lyle R. McKinnon

  5. CAPRISA, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, 2nd Floor, Congella, Private Bag X7, 4013, Durban, South Africa

    Ayesha B. M. Kharsany

Authors
  1. Nonzwakazi P. Ntombela
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayesha B. M. Kharsany
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adenike Soogun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nonhlanhla Yende-Zuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans-Peter Kohler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lyle R. McKinnon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ABMK, LRM and HP-K conceptualised the study. NN contributed to overall field supervision, data collection and wrote the first draft of the manuscript. NN and AS contributed to data cleaning and analysis. AS and NY-Z were overall responsible for the statistical analysis. ABMK, LRM and NN contributed to designing, analysis and scientific integrity review of the manuscript. All authors contributed to the critical review and approval of the final version of the manuscript.

Corresponding author

Correspondence to Ayesha B. M. Kharsany.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Electronic supplementary material 1 (DOCX 22 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ntombela, N.P., Kharsany, A.B.M., Soogun, A. et al. Prevalence and Risk Factors for HIV Infection Among Heterosexual Men Recruited from Socializing Venues in Rural KwaZulu-Natal, South Africa. AIDS Behav 25, 3528–3537 (2021). https://doi.org/10.1007/s10461-021-03182-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-021-03182-3

Keywords

Search

Navigation