Correlates of self-reported substance use among men who have sex with men in South Africa Open Access

Mackey, Carolyn A (Spring 2019)

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Background: The global burden of HIV is disproportionately large among men who have sex with men (MSM). Among South African MSM, HIV prevalence has been reported as high as 50%. There is sparse research focused on substance use and its relation to HIV risk among this group. The burden of substance use is high, and its relationship to risky sexual behavior among South African MSM is prominent. However, there is very little research examining the association between substance use and HIV among South African MSM.

Methods: The Sibanye Health Project was a pilot combination HIV prevention trial with MSM living in Cape Town and Port Elizabeth, South Africa from February 2015 to September 2016. Using enrollment baseline survey data and baseline HIV clinical testing, we conducted bivariate and multivariate logistic regression analyses to examine the relationship of substance use with HIV, stigmatization, and risky sexual behaviors.

Results: We found substantial prevalence of any drug use (27%), frequent drug use (15%), and heavy alcohol use (21%). Self-reported drug use was less likely in participants who tested HIV-positive at baseline (OR=0.45, CI=0.24, 0.85). Drug use was more likely among those who engaged in transactional sex (OR=2.65, CI=1.25, 5.62). Those who reported stigmatizing events were less frequent drug users (OR=0.41, CI=0.18, 0.95). Frequent drug use was less common in participants who had more than 2 male sex partners in the past year (OR=0.38, CI=0.15, 0.98), but was more common among heavy alcohol users (OR=2.66, CI=1.40, 5.05).

Conclusions: Our findings indicate that those who are living with HIV may be adopting risk-reduction strategies, like reduction in drug use, to prevent HIV transmission. Further, transactional sex and drug use is strongly correlated, but only half of those participating in transactional sex are drug users; socioeconomic factors may play a role in non-drug using transactional sex. Social isolation of MSM due to stigmatization may contribute to less frequent drug use among those who are stigmatized. To ensure appropriate risk identification and intervention strategies against HIV, it is imperative to continue to examine the relationship between substance use and HIV among MSM in South Africa.

Table of Contents

Introduction                                       1


Methods                                              5


Results                                                9


Discussion                                         11


References                                         19


Tables                                                 23


Figures                                               32

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