Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa

Bibliographic Data

ID4593676
AuthorsAbigail M Hatcher (0000-0002-4150-1405, University of California, San Francisco, corresponding author), A Gibbs (0000-0003-2812-5377, South African Medical Research Council), Ruari‐santiago Mcbride (0000-0001-8012-0675, University of the Witwatersrand), Ruari-Santiago Mcbride, Dumisani Rebombo (Sonke Gender Justice), Mzwakhe Khumalo (Sonke Gender Justice), Nicola Christofides (0000-0002-3559-6401, University of the Witwatersrand), Nicola J Christofides
Year2022
Volume295
Pages112637
Publication date2022-02-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2019.112637
OpenAlexW2981515291
LanguageEN
Citations received39
References cited55

Men whose sexual behaviors place them at risk of HIV often exhibit a "cluster" of risky behaviors, including alcohol misuse and violence against women. Called the "Substance Abuse, Violence and AIDS (SAVA) syndemic," this intersecting set of issues is poorly understood among heterosexual men in sub-Saharan Africa. We conducted a baseline survey with a cohort of men in an informal, peri-urban settlement near Johannesburg during the period of Jan - Aug 2016. Audio-assisted, self-completed questionnaires on tablets measured an index of risky sex (inconsistent condom use, multiple and risky partnerships, transactional sex), recent physical or sexual violence against women (using the Multicountry Study instrument), alcohol misuse (Alcohol Use Disorders Tool), and gender attitudes (Gender Equitable Men's Scale). We used linear and logistic regression to test for syndemic interaction on multiplicative and additive probability scales. We used structural equation modeling to test whether assumptions around serially causal epidemics hold true in these data. Of 2,454 men, 91.8% reported engaging in one or more types of risky sex. Similarly, a high number of participants reported one or more SAVA conditions (1783, 71.6%). After controlling for socio-demographics, higher scores on the risky sex index were independently predicted by men's recent violence use, problem drinking, and inequitable gender views. Those men reporting partner violence perpetration, problem drinking, and inequitable gender views had more than 12-fold greater odds of risky sex compared to counterparts with no syndemic conditions. A three-way interaction of alcohol use, gender inequitable views, and IPV perpetration was associated with a 16 percent relative increase in risky sex. On the additive scale, significant two-way interactions existed between alcohol use and gender inequitable views, and between gender inequitable views and IPV perpetration. A structural equation model illustrated that gender norms predict violence, which in turn predict alcohol misuse, increasing both IPV perpetration and risky sex. These data are consistent with a syndemic model of HIV risk among heterosexual men. Projects that target a single condition may have limited success, given that alcohol, gender norms, and violence are co-occurring, with interactions that produce greater odds of HIV risky behaviors. Targeting the intersections between these syndemic conditions may help prevent HIV among heterosexual men in peri-urban African settings

Domestic violence · Environmental health · Human immunodeficiency virus (HIV · Poison control · Sociology · Suicide prevention · Syndemic · Adolescent Sexual and Reproductive Health · Demography · Intimate Partner and Family Violence · Medicine · Psychology · Sex work and related issues · Virology