5.4. Results of bivariate associations
5.4.2. Socio-demographic characteristics by PrEP adoption intention
Therefore, understanding the relationships between risk behaviour and perceived HIV infection could offer insights into understanding PrEP adoption intention. The results of the correlational analysis are presented in Table 8 above. The table was collated to synthesize the results of the tests done on common overarching categories. In the results below, the researcher attempted to test whether an association between sexual and HIV testing behaviours such as frequency of HIV testing, the multiplicity of male sexual partners as well as the frequency of condom use with male sexual partners and perceived risk of contracting HIV.
Ratio Statistic was, used instead of the Chi-Square Statistic to make conclusions about Associations. From these results, it is evident that the Chi-Square Test of Associations was violated i.e. cells (64.3%) have expected a count less than 5. Therefore, the Likelihood Ratio,asymptotic significance (2-sided) result of (0.272) was used as a reference point for making conclusions regarding associations.
Since this value (0.272) is larger than the significance level, one may conclude that there is no association between the level of education attained and intention to adopt PrEP daily to prevent HIV.
The second variable of socio-demographic characteristics is Age, in the below results, the researcher attempted to test whether there was an association between age and intention to adopt PrEP daily to prevent HIV. It is apparent from Table 10 that the chi-square test of associations was violated i.e. cells (60.0%) have expected a count less than 5, therefore, the Likelihood Ratio (0.429) was used as a reference point for making conclusions regarding associations. Since this value (0.429) is larger than our significance level of <0.05, we conclude that the chi-square test did not show any association between age and intention to adopt PrEP daily to prevent HIV. Therefore, it cannot be inferred that the age of BMSM in Msunduzi can be used to assume a prone to adopting PrEP for HIV transmission. The present results seem to be consistent with other research by Brooks et al., (2015), which had a similar stratified sample that contained a majority of young BMSM (between 18-29 years) and found that there was no bivariate statistical association been socio- demographic characteristics and PrEP adoption intention.
The third socio-demographic characteristic variable of interest that is depicted in the Table 10 is personal income. The data which is in line with the subgroup comparison in the previous section of this chapter reveals that respondents were primarily of lower social economic status (SES) with (72.6%) having a very low income of <R1000 per month. The test to establish an association between personal income and intention to adopt PrEP to mitigate HIV infection revealed that the Chi-Square Test of Associations was violated i.e. cells (40.0%) have expected a count less than 5. Therefore, the Likelihood Ratio (0.036) was used as a reference point for making conclusions regarding associations. Since this result is significant at the p= <0.05 level, one may conclude that there was a significant positive correlation between personal income and intention to adopt PrEP daily to prevent HIV. This denotes that there is an association between these two variables. The
Cramer’s V test statistic result below (see page 130) indicates that although the association is prevalent, it is not as strong association with the statistic value (0.015) = < 0.060 level for strong associations.
Table 10: Crosstabulation of Socio-Demographic Characteristics by PrEP Adoption Intention
Socio-demographic Characteristics by PrEP Adoption Intention Crosstabulation – Bivariate Analysis
Variables for Analysis (Variables, Actual Calculations)
Chi - Square Test Results (Overall Considerations)
Socio-Demographic Characteristics
Would you willing be to take PrEP daily to prevent HIV transmissions?
Likelihood Ratio
Yes No Total α Value df Asymptotic
Significance (2-sided) Level Education
Attained
Primary Education (Grade 7)
3 0 3
(100.0%) (0.0%) (100.0%)
Secondary Education (Matric)
57 4 61
(93.4%) (6.6%) (100.0%)
Diploma 18 3 21
(85.7%) (14.3%) (100.0%)
Bachelor’s Degree 13 4 17
(76.5%) (23.5%) (100.0%) Postgraduate Diploma
or Honours
10 2 1
(83.3%) (16.7%) (100.0%)
Masters or Doctorate 1 1 2
(50.0%) (50.0%) (50.0%)
None 4 0 4
(100.0%) (0.0%) (100.0%)
Total 106 14 120 4
7.566 6 0.272
(88.3%) (11.7%) (100.0%) (40%)
Age 18-23 34 6 40
(85.0%) (15.0%) (100.0%)
24-29 43 6 49
(87.8%) (12.2%) (100.0%)
30-35 26 1 27
(96.3%) (3.7%) (100.0%)
36-40 2 1 3
(66.7%) (33.3%) 100.0%
>41 1 0 1 (100.0%) (0.0%) (100.0%)
Total 106 14 120 6
3.831 4 0.429
(88.3%) (11.7%) (100.0%) (60%) Personal
Income
<R1000 76 6 82
(92.7%) (7.3%) (100.0%)
R1001-R5000 8 1 9
(88.9%) (11.1%) (100.0%)
R5001-R10000 7 0 7
(100.0%) (0.0%) (100.0%)
R10001-R15000 4 3 7
(57.1%) (42.9%) (100.0%)
>R1500 11 4 15
(73.3%) (26.7%) (100.0%)
Total 106 14 120 4
10.289 4 <0.036*
(88.3%) (11.7%) (100.0%) (40%) Sexual Orientation Gay
Count
57 7 64
(89.1%) (10.9%) (100.0%) Bisexual
Count
15 2 17
(88.2%) (11.8%) (100.0%) Straight
Count
27 3 30
(90.0%) (10.0%) (100.0%)
Curious 7 2 9
(77.8%) (22.2%) (100.0%)
Total 106 14 120 3
0.914 3 0.822
(88.3%) (11.7%) (100.0%) (37.5%)
Sexual Role Insertive (Top) 48 8 56
(85.7%) (14.3%) (100.0%)
Receptive (Bottom) 29 3 32
(90.6%) (9.4%) (100.0%)
Both (Versatile) 27 3 30
(90.0%) (10.0%) (100.0%)
Oral 2 0 2
(100.0%) (0.0%) (100.0%)
Table 11: Cramer’s V Symmetric Measures Results
A close analysis reveals that PrEP adoption intention is significant amongst MSM with a low income with (92.7%) reporting an income of <R1000 monthly, followed by those with R1001- R5000 accounting (88.9%) and those on the higher end of the income bracket <R15001 also reflecting an (88.3%) adoption intention.
This correlation does not reflect what previous studies have reported on. In their study of BMSM in Los Angeles, which had a sample of lower socio-economic status (SES), Brooks et al. (2015) revealed no association between any socio-demographic characteristics and PrEP adoption intention. In their study exploring access among Black and Latino MSM, Lelutiu-Weinberger and Golub (2016) learnt that a lower SES resulted in a not being medically ensured, which many BLMSM viewed as a barrier to adoption. This is supported by an assortment of studies which highlighted high cost as a barrier to adoption.
Therefore, it is surprising to see an association between MSM with lower SES in this sample and the intention to adopt PrEP. Although this association is established here, these data must be interpreted with caution because the sample is skewed towards individuals in the lower income bracket <R1000, because of high unemployment rates amongst this sample. Therefore, these results may not be representative of the general population of BMSM in Msunduzi Local Municipality without necessary unemployment figures to corroborate these levels of unemployment affecting the income levels. It is difficult to explain this result, however, a possible explanation for this can be linked to the role that the Gay and Lesbian Network (GLN) plays as a preventative health provision source for most BMSM in the area. As highlighted in the above section, the GLN is viewed as a valuable source of information and preventative methods, therefore, it could be suggested that BMSM with lower an SES would rely on the accessing PrEP from the GLN, in the same way, that current
Total 106 14 120 4 1.105 3 0.776
(88.3%) (11.7%) (100.0%) (50.0%)
Symmetric Measures
Value
Approximate Significance
Nominal by Nominal Phi .320 .015
Cramer's V .320 .015
N of Valid Cases 120
preventative methods are provided (for free). Although this has not been tested and will be explored more in the interviews. This could explain the conviction to adopt PrEP among low-income level individuals.
The next test for association depicted in Table 10 is sexual orientation. The researcher attempted to test whether there was an association between sexual orientation and intention to adopt PrEP daily to prevent HIV transmissions. The above results illustrate that the Chi-Square Test of associations was violated i.e. cells (37.5%) have expected a count less than 5. Therefore, the Likelihood Ratio (0.822) was used as a reference point for making conclusions regarding associations. Since this value (0.822) is larger than our significance level, one can conclude that there is no association between sexual orientation and intention to adopt PrEP daily to prevent HIV transmission. Following, this the researcher attempted to test whether an association between an individual’s sexual role and intention to adopt PrEP daily to prevent HIV transmissions.
The above results illustrate that the Chi-Square Test of associations was violated i.e. cells (50.0%) have expected a count less than 5. Therefore, the Likelihood Ratio (0.766) was used as a reference point for making conclusions regarding associations. Since this value (0.766) is larger than our significance level, one can conclude that there is no association between an individual’s sexual role and intention to adopt PrEP daily to prevent HIV transmission. Together, the results observed in this study mirror those, of the study by Brooks et al. (2015) mentioned earlier which examined socio-demographic characteristics such a sexual orientation and established no statistical association between these and PrEP adoption intention.
In conclusion, it is evident that most socio-demographic characteristics amongst BMSM in Msunduzi Local Municipality do not predict the intention to adopt PrEP, with the exclusion of personal income. Therefore, it is important to identify what informs this association even though most BMSM have indicated that high-cost would be a barrier to adoption. Therefore, the association identified here give cues for consideration of cost and the attainability of PrEP for low-income BMSM in the Municipality. Interview data are presented in Chapter 6 have the potential to better illuminate the intended hopes for accessibility of PrEP especially, for BMSM with a lower SES in the Municipality.