Forced sex and HIV infection among men who have sex with men (MSM) in South African townships: A complex relationship

Background: Although associations between sexual violence and HIV infection risk have been documented, little is known about this relationship. This study documents an association between sexual violence and HIV infection and psychosocial factors that explain this relationship among MSM in Tshwane, South Africa.

Methods:  Using respondent-driven sampling, 480 participants (18-44 years old) were recruited from Tshwane, South Africa to complete a computer-assisted, interviewer-administered survey and an HIV test.

Results: In this sample, 15% of participants reported to have ever experienced forced sex by a man after the age of 16. Participants with such experiences were more likely to be HIV positive (OR = 4.58, p < .001). Mediation analyses were used to explore the psychosocial factors that were statistically related to both and explain this relationship. Self-reported feminine gender presentation, gay-identity, internalized homophobia, number of lifetime male partners, lifetime transactional sex, and alcohol-use all mediated the relationship between ever forced sex and HIV status. Lifetime number of male partners was the strongest mediator of this relationship (reducing the regression coefficient by .16).

Conclusion: This is the first study to document pathways that link sexual violence and HIV risk among MSM in South Africa. The complexity of the relationship between sexual violence and HIV risk as suggested by the mediation analyses offer a new framework for the design of HIV prevention interventions. Targeting the mediating psychosocial variables that explain the relationship between sexual violence and HIV risk may not only effectively help prevent HIV infection but also reduce sexual violence.