COUPLES-BASED VOLUNTARY HIV COUNSELING AND TESTING FOR MSM IN SOUTH AFRICA 公开

Rentsch, Christopher (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/2z10wq60c?locale=zh
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Abstract

Couples-based voluntary HIV counseling and testing (CVCT) allows
couples to receive their HIV test results together and has been demonstrated to
be effective in reducing HIV transmission, increasing and sustaining condom
use, and reducing sexual risk-taking among at-risk heterosexual couples.
However, the acceptability of CVCT among MSM has yet to be evaluated in an
African setting. This thesis utilizes a mixed-methods approach to determine if
CVCT would be a viable option for an HIV testing service among MSM in South
Africa, and how the service would need to be structured in order to attract the
most MSM in this setting. Using online advertisements, quantitative data were
collected from 486 MSM, who were 18 years of age or older with a current
residence in South Africa and had at least one male sex partner in the previous 12
months. The analysis examined associations between individual characteristics
and willingness to utilize CVCT services. Concurrently, seven focus group
discussions and twenty-nine in-depth interviews were used to investigate the
attitudes toward CVCT among MSM in Cape Town, South Africa. The
willingness to utilize CVCT services was compellingly high (89%). The results
from the focus groups and interviews further exhibit nearly universal acceptance
of CVCT. Participants were particularly attracted to the counseling components
of the service, stating that these would allow for the couple to increase their
commitment and to explore methods of how to effectively reduce their risk of
acquiring or transmitting HIV in the presence of a trained counselor. Several
studies show the discontent MSM currently have with public and government
clinics offering HIV testing services, which may be a large factor of the low
awareness of sero-status among MSM in South Africa. Having the knowledge of
a partner's sero-status is possibly one of the most effective strategies to reduce
the risk of HIV infection due to the elimination of risk that comes from assuming
or guessing a partner's sero-status. These results suggest CVCT would be highly
welcomed and could work to fill the significant lack of services acceptable by
and accessible to MSM in South Africa.

Table of Contents

TABLE OF CONTENTS


PREAMBLE 1
CHAPTER 1: INTRODUCTION 3
PROJECT BACKGROUND 4
AIMS AND OBJECTIVES 6
COUNTRY CONTEXT: SOUTH AFRICA 6
RESEARCH SETTING 12
SUMMARY 13
CHAPTER 2: REVIEW OF THE LITERATURE 15
EPIDEMIOLOGY OF HIV AMONG MSM 16
HIGH-RISK SEXUAL BEHAVIORS AND HIV STATUS AMONG MSM 21
AWARENESS OF HIV STATUS 25
POTENTIAL FOR CVCT 29
CHAPTER 3: QUANTITATIVE MANUSCRIPT 33
ABSTRACT 35
INTRODUCTION 36
METHODS 38
RESULTS 40
DISCUSSION 41
CONCLUSIONS 42
CHAPTER 4: QUALITATIVE MANUSCRIPT 46
ABSTRACT 48
INTRODUCTION 49
METHODS 52
RESULTS 54
DISCUSSION 68
CONCLUSIONS 73
CHAPTER 5: IMPLICATIONS AND FUTURE DIRECTIONS 77
APPENDICES 85
APPENDIX 1: EMORY UNIVERSITY IRB DOCUMENTATION 86
APPENDIX 2: WITS UNIVERSITY ETHICS COMMITTEE CLEARANCE 88
APPENDIX 3: FOCUS GROUP AND INTERVIEW GUIDE 89
REFERENCES 91

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