5.3. Descriptive Analysis
5.3.2. Sexual behaviours and sexual risk taking of BMSM in the Msunduzi Local Municipality
catalyst for better understanding the sexual risk behaviours of MSM in the Msunduzi Local Municipality and how this informs their perceptions and attitudes towards PrEP.
an insertive sexual role to maintain social standing and masculine expressions that may be linked to their heterosexual relationships with females (Moskowitz, Rieger and Roloff, 2008). Whereas, gay-identified individuals and particularly those who are out are assigned to a more receptive role which is linked to a more feminine identification or even a versatile sexual role preference (Moskowitz et al., 2008). This notion is evident when analysing sexual orientation, figures presented in Table 2 (see page 98) in relation to sexual role preference in Table 3 below. When quantified, straight, bisexual and curious identified MSM in this sample closely link to the suggestion made above about sexual role preference based on sexual identity.
Therefore, the results of this study support the notions presented on sexual identification and sexual role preference.
The section of the questionnaire whose results are presented in Table 3 required respondents to provide information on their sexual behaviours to establish if there was a correlation between actual risk activity and perceived risk of HIV transmission. This was done to assess if the BMSM in the sample consider themselves to be susceptible to HIV incidence, which is referred to as perceived susceptibility in the HBM (Sharma and Romas, 2012). Essentially to establish, if the perceived susceptibility to HIV that BMSM may experience is an influencing factor for their sexual behaviours and their attitudes towards the adoption of PrEP. It is apparent from the data in Table 3 that firstly, very few respondents reported not being aware of their HIV status.
There is no significant lateral difference between the two groups across the various categories. Most respondents who reported an awareness of the HIV status had recently had an HIV test with (55.0%) reporting being tested less than 3 months ago, followed by those having test 3-6 months ago, and 6-12 months and a small group of (10.0%) reporting having an HIV test over a year ago. It can be suggested that the confidence to report awareness of HIV status is linked to recently testing for HIV. This is further exhibited by the respondents who reported being unaware of their HIV status, (55.5%) of which reported having a test 6-12 months ago, which indicates that the more time has elapsed since an HIV test the higher the uncertainty with regards to one’s HIV status. It can, therefore, be suggested that there is a close relationship between the recent occurrence of the test and the perceived awareness of HIV status. What these findings revealed
is a reported prevalence of testing amongst BMSM. This is in support of earlier research by Sandfort et al.
(2008) who asserted that HIV testing amongst MSM was more prevalent than in the general population.
Granting that there is a high perceived HIV status awareness, the data revealed that there was a pattern of multiple male sexual partners amongst respondents with the average of 1-5 sexual partners per BMSM over a 12-month period across both the HIV status aware (83.0%) and HIV status unaware (55.5%) individuals.
There was an average number reporting a higher rate of male sexual partners and there were a few HIV aware respondents (5.0%) reporting 11-15 male sexual partners in the past 12 months. Although the categorised number of sexual partners is not excessively high, but multi-partner risks can be assumed to exist amongst this population. It can also be argued that HIV risk behaviour in the form of multiple sexual partners is positively affected by an awareness of the HIV status. This number could have been larger as revealed in other local and continental studies (Baral et al., 2009; Merrigan et al., 2011).
Table 3: Sexual behaviours and sexual risk taking BMSM in Msunduzi Local Municipality
Sexual Behaviour and Sexual Risk Taking HIV Status Awareness (n=100)
Not Aware of HIV status (n=9)
Frequency Percent (%) Frequency Percent (%) Sexual Role
Insertive 43 (43.0) 7 (77.7)
Receptive (Bottom) 27 (27.0) 2 (22.2)
Both (Versatile) 28 (28.0) 0 (0.0)
Oral 2 (2.0) 0 0.0
Last HIV Test
<3 months ago, 55 (55.0) 3 (33.3)
3–6 months ago, 21 (21.0) 1 (11.1)
6–12 months ago, 14 (14.0) 5 (55.5)
>1 year ago, 10 (10.0) 0 (0.0)
Male Sexual Partner in the past 12 months
Yes 94 (94.0) 8 (88.8)
No 6 (6.0) 1 (11.1)
Number of Male Sexual Partners in the past 12 months
None 5 (5.0) 1 (11.1)
1–5 83 (83.0) 5 (55.5)
6–10 5 (5.0) 2 (22.2)
11–15 5 (5.0) 1 (11.1)
>15 2 (2.0) 0 (0.0)
Condom Use with Male Sexual Partner
Always 51 (51.0) 7 (77.7)
Very Often 19 (19.0) 1 (11.1)
Occasionally 14 (14.0) 1 (11.1)
Rarely 10 (10.0) .0 (0.0)
What is interesting in these results is that although many HIV status aware respondents were reporting consistent condom use (51.0%), they were concurrently reporting frequent condomless sex with their male sexual partners (46.0%). This evidence is an inconsistency of effort and elevated risky sexual behaviour. A close assessment of Table 3 reveals that most HIV status aware respondents indicated multiple partners in the past 12 months, confirming an average of 1-5 sexual partners over this period. An area requiring further interrogation is the close relation in the high number of respondents reporting condomless sex 1-5 times over the same 12 months’ period. This brings to the fore questions of whether these MSM are practising safe sex even though they report being aware of their HIV status or are they taking part in risky sexual behaviour.
Table 3: Continued
Sexual Behaviour and Sexual Risk HIV Status
Awareness (n=110)
Not Aware of HIV status
(n=10)
Frequency Percent (%) Frequency Percent (%) Condom Use with Male Sexual Partner
Always 51 (51.0) 7 (77.7)
Very Often 19 (19.0) 1 (11.1)
Occasionally 14 (14.0) 1 (11.1)
Rarely 10 (10.0) .0 (0.0)
Condomless Anal Intercourse in past 12 months
1–5 times 46 (46.0) 4 (44.0)
6–10 times 11 (11.0) .0 (0)
11–15 times 4 (4.0) .0 (0)
>15 times 10 (10.0) .0 (0)
Never 29 (29.0) 5 (55.0)
Perceived Risk of Contracting HIV
High 39 (39.0) 2 (22.2)
Moderate 36 (36.0) 5 (55.5)
Low 20 (20.0) 2 (22.2)
Non-existent 5 (5.0) .0 (0)
This table is quite revealing in several ways. Firstly, it exposes that respondents who are unaware of their HIV status do not exhibit a difference in behaviour than their HIV status aware counterparts. This is because a similar behaviour trajectory can be identified amongst this group of BMSM. Secondly, there is a disconnect between the self-reported safe behaviours such as regular condom use and the number of times that these respondents have condomless sex. Thirdly, although many of these respondents (63.6%) report having confidence in the adequacy and efficacy of the HIV prevention methods available to them, their reported behaviour indicates that they are not using these methods, with a high percentage reporting not using a condom on average 1-5 times during the previous 12 months. Finally, most HIV status aware respondents reported a perceived risk to HIV transmission with close risk relation between those who reported high perceived risk (39.0%) and those with perceived moderate risk (36.0%). The same trajectory could be identified amongst HIV unaware respondents. The present findings seem to be consistent with other previous research which found that Tanzanian MSM perceived their risk of HIV infection to be higher due to risky sexual behaviours (Dahoma et al., 2011).
Furthermore, what these findings reveal is that awareness of HIV status does not influence the risk behaviour of respondents with a majority still reporting multiple sexual partners and multiple incidences of condomless sex, all underscoring their perceived risk to HIV transmission. What HIV unaware respondents revealed is that they were prone to the less frequent HIV testing, a higher number of multiple sexual partners, frequent condomless sex and a moderate perceived risk to HIV infection. What can be deduced from these above results is that there is no significant correlation between the behaviours of HIV aware and unaware individuals. The respondents partook in risk behaviour considering their perceived risk to HIV transmission, therefore, their self-reported perceived susceptibility to HIV transmission does not influence their behaviours.
Conversely, these risky sexual behaviours may be the driving force for their perceived susceptibility. It is still to be revealed if the promise of PrEP as an additional HIV preventative method, and particularly its uptake will be influenced by this sexual risk taking by BMSM in the Msunduzi Local Municipality.