Sexual Risk Behaviour Among Men with Multiple, Concurrent Female Sexual Partners in an Informal Settlement on the Outskirts of Cape Town

According to this document, identifying and understanding sub-groups of people who are more vulnerable to and more likely to transmit HIV is essential for improving the effectiveness of HIV prevention efforts. This study therefore set out to develop a robust surveillance system to measure key risk behaviours and HIV prevalence among adult men who have multiple, concurrent female sexual partners, and who live in an urban, informal community on the outskirts of Cape Town. Using respondent-driven sampling (RDS) to recruit men, the findings provide evidence that men living in urban, informal communities and who have multiple concurrent female sexual partners use condoms inconsistently, have high levels of transactional sex and intimate partner violence (IPV), and visit shebeens or taverns (where alcohol consumption is high) to acquire new sexual partners.

According to this document, men with more than one, usually younger, female, sexual partners make up a hard-to-reach, high-risk sub-population. This is largely due to them not being captured through conventional HIV surveillance methods. Traditionally-used surveillance systems, such as household surveys are designed to track HIV infection in the general population and are unable to capture high-risk groups in sufficient quantities to make accurate conclusions about them.

For this study, called Project ooPeto (buddies), men were recruited using the Respondent Driven Sampling (RDS) method, which, as stated in the document, has been extensively and successfully used globally among other hard-to-reach populations (such as injecting drug users, men who have sex with men, and commercial sex workers). 20 “seeds” (initial participants) who met the criteria for the study were selected. While some seeds and recruits did not use all their recruitment coupons, the study generated up to 13 successive recruitment waves, comprising a sample of 421 men. Every participant was interviewed, a blood sample taken for anonymous HIV testing (linked to every participant’s recruitment coupon number), and VCT offered.

Findings

• HIV prevalence was 12.3%. More than one third of men reported symptoms of STIs in the year prior to the study.
• Men reported a range of 2-39 sexual partners in the 3 months prior to the survey, with an average of 6 and a median of 5.
• 98% reported having concurrent sexual relationships during the same period.
• Most men (83.3%) indicated that their friends would approve if they had sex with women who were not their steady partners or wives and 86.1% indicated that their friends could approve if they changed girlfriends often.
• 46% of participants thought that their main partners had sex with them because they expected or had received some form of material goods; 82% thought this was the case for their casual partners; and 90.6% thought it of their once-off partners.
• Just over 50% of men reported physical or sexual IPV with their main partners in the year prior to the study and 41% reported physical or sexual IPV with their casual or once-off partners during this time.
• Shebeens or taverns were most commonly cited as places where men met with friends for recreation (31.2% and 54.4% respectively). Most men (81.8%) reported drinking more than five beers, ciders or tots of alcohol during these visits. About 74% indicated that they had met a new sexual partner at shebeens or taverns over the past 30 days.
• 95% of participants indicated that they would attend meetings if they were given the opportunity to talk about relationships and sexual behaviour with a male facilitator once a week (for 10 weeks) with a group of other men.

Recommendations
The study recommends that this high-risk group would benefit from specifically-targeted HIV prevention interventions which address partner concurrency, inconsistent condom use, excessive alcohol consumption, and intimate partner violence. It states that individually-targeted and small, peer group interventions aiming to support self-defined behavioural change and shift social norms may be appropriate for this population. Venues other than formal education and health care institutions must be utilised for HIV preventive messaging such as as venues used for recreation, like shebeens and taverns. The success of the RDS methodology also demonstrated that men in high-risk categories could be successfully accessed through their social networks. Because these men were willing to participate in sexual health programmes, RDS may also be employed as a valid entry point into this high-risk sub-population for planning, designing, implementing and evaluating targeted HIV preventive methods.