Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study

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dc.contributor.authorDunkle, Kristin Len_ZA
dc.contributor.authorJewkes, Rachel Ken_ZA
dc.contributor.authorMurdock, Daniel Wen_ZA
dc.contributor.authorSikweyiya, Yandisaen_ZA
dc.contributor.authorMorrell, Roberten_ZA
dc.date.accessioned2016-01-11T06:49:20Z
dc.date.available2016-01-11T06:49:20Z
dc.date.issued2013en_ZA
dc.description.abstractBackground: In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male–male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus. Methods and Findings: In a cross-sectional study conducted in 2008, men aged 18–49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male–male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26–12.3), and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22–7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24–7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58; 95% CI 1.17–10.9). Conclusions: In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male–female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been common. These findings suggest that HIV prevention messages regarding male–male sex in South Africa should be mainstreamed with prevention messages for the general population, and sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence.en_ZA
dc.identifier.apacitationDunkle, K. L., Jewkes, R. K., Murdock, D. W., Sikweyiya, Y., & Morrell, R. (2013). Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study. <i>PLOS Medicince</i>, http://hdl.handle.net/11427/16231en_ZA
dc.identifier.chicagocitationDunkle, Kristin L, Rachel K Jewkes, Daniel W Murdock, Yandisa Sikweyiya, and Robert Morrell "Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study." <i>PLOS Medicince</i> (2013) http://hdl.handle.net/11427/16231en_ZA
dc.identifier.citationDunkle, K. L., Jewkes, R. K., Murdock, D. W., Sikweyiya, Y., & Morrell, R. (2013). Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study. PLoS medicine, 10(6), e1001472. doi:10.1371/journal.pmed.1001472en_ZA
dc.identifier.ris TY - Journal Article AU - Dunkle, Kristin L AU - Jewkes, Rachel K AU - Murdock, Daniel W AU - Sikweyiya, Yandisa AU - Morrell, Robert AB - Background: In sub-Saharan Africa the population prevalence of men who have sex with men (MSM) is unknown, as is the population prevalence of male-on-male sexual violence, and whether male-on-male sexual violence may relate to HIV risk. This paper describes lifetime prevalence of consensual male–male sexual behavior and male-on-male sexual violence (victimization and perpetration) in two South African provinces, socio-demographic factors associated with these experiences, and associations with HIV serostatus. Methods and Findings: In a cross-sectional study conducted in 2008, men aged 18–49 y from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces provided anonymous survey data and dried blood spots for HIV serostatus assessment. Interviews were completed in 1,737 of 2,298 (75.6%) of enumerated and eligible households. From these households, 1,705 men (97.1%) provided data on lifetime history of same-sex experiences, and 1,220 (70.2%) also provided dried blood spots for HIV testing. 5.4% (n = 92) of participants reported a lifetime history of any consensual sexual activity with another man; 9.6% (n = 164) reported any sexual victimization by a man, and 3.0% (n = 51) reported perpetrating sexual violence against another man. 85.0% (n = 79) of men with a history of consensual sex with men reported having a current female partner, and 27.7% (n = 26) reported having a current male partner. Of the latter, 80.6% (n = 21/26) also reported having a female partner. Men reporting a history of consensual male–male sexual behavior are more likely to have been a victim of male-on-male sexual violence (adjusted odds ratio [aOR] = 7.24; 95% CI 4.26–12.3), and to have perpetrated sexual violence against another man (aOR = 3.10; 95% CI 1.22–7.90). Men reporting consensual oral/anal sex with a man were more likely to be HIV+ than men with no such history (aOR = 3.11; 95% CI 1.24–7.80). Men who had raped a man were more likely to be HIV+ than non-perpetrators (aOR = 3.58; 95% CI 1.17–10.9). Conclusions: In this sample, one in 20 men (5.4%) reported lifetime consensual sexual contact with a man, while about one in ten (9.6%) reported experience of male-on-male sexual violence victimization. Men who reported having had sex with men were more likely to be HIV+, as were men who reported perpetrating sexual violence towards other men. Whilst there was no direct measure of male–female concurrency (having overlapping sexual relationships with men and women), the data suggest that this may have been common. These findings suggest that HIV prevention messages regarding male–male sex in South Africa should be mainstreamed with prevention messages for the general population, and sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence. DA - 2013 DB - OpenUCT DO - 10.1371/journal.pmed.1001472 DP - University of Cape Town J1 - PLOS Medicince LK - https://open.uct.ac.za PB - University of Cape Town PY - 2013 T1 - Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study TI - Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study UR - http://hdl.handle.net/11427/16231 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pmed.1001472en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16231
dc.identifier.vancouvercitationDunkle KL, Jewkes RK, Murdock DW, Sikweyiya Y, Morrell R. Prevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study. PLOS Medicince. 2013; http://hdl.handle.net/11427/16231.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentResearch Officeen_ZA
dc.publisher.facultyThe Enterpriseen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2013 Dunkle et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLOS Medicinceen_ZA
dc.source.urihttp://journals.plos.org/plosmedicineen_ZA
dc.subject.otherViolent crimeen_ZA
dc.subject.otherHuman sexual behavioren_ZA
dc.subject.otherHIVen_ZA
dc.subject.otherMen who have sex with menen_ZA
dc.subject.otherHIV preventionen_ZA
dc.subject.otherHIV epidemiologyen_ZA
dc.subject.otherAfricansen_ZA
dc.subject.otherRape and sexual assaulten_ZA
dc.titlePrevalence of consensual male–male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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