Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence

We explored the prevalence and predictors of transactional sex with casual partners and main girlfriends among 1288 men aged 15-26 from 70 villages in the rural Eastern Cape province of South Africa. Data were collected through face-to-face interviews with young men enroling in the Stepping Stones HIV prevention trial. A total of 17.7% of participants reported giving material resources or money to casual sex partners and 6.6% received resources from a casual partner. Transactionally motivated relationships with main girlfriends were more balanced between giving (14.9%) and getting (14.3%). We constructed multivariable models to identify the predictors for giving and for getting material resources in casual and in main relationships. Each model resulted in remarkably similar predictors. All four types of exchange were associated with higher socio-economic status, more adverse childhood experiences, more lifetime sexual partners, and alcohol use. Men who were more resistant to peer pressure to have sex were less likely to report transactional sex with casual partners, and men who reported more equitable gender attitudes were less likely to report main partnerships underpinned by exchange. The most consistent predictors of all four types of transaction were perpetration of intimate partner violence and rape against women other than a main partner. The strong and consistent association between perpetration of gender-based violence and both giving and getting material goods from female partners suggests that transactional sex in both main and casual relationships should be viewed within a broader continuum of men's exercise of gendered power and control. HIV prevention interventions need to explicitly address transactional sex in the context of ideas about masculinity, which place a high emphasis on heterosexual success with, and control of, women.     

Breakage is the norm: use of condoms and lubrication in anal sex among Black South African men who have sex with men

Abstract

This paper explores condom use and lubrication practices among Black men who have sex with men in South African townships. Results are from 81 in-depth individual interviews conducted among a purposive sample from four townships surrounding Pretoria as part of a larger qualitative study. Awareness that condoms should be used to have safer anal sex was ubiquitous. Fewer men reported that lubricants should be used to facilitate anal intercourse. Partner pressure and partner distrust were the most common barriers cited for not using condoms and lubricants. Knowledge about condom-lubricant compatibility was rare. Condom problems were a norm, with widespread expectations of condom failure. Men’s subjectivities – their perceptions of and preferences for specific brands, types and flavours of condoms and lubricants – influenced engagement with such safer-sex technologies. However, what was available in these settings was often neither what men needed nor preferred. Findings show the need to enhance access to appropriate and comprehensive: safer-sex supplies, health services and health education, and underline the importance of efforts to develop targeted programmes relevant to experiences of men who have sex with men in the South African context.     

Substance use,gender inequity,violence and sexual risk among couples in Cape Town

Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.     

Intimate partner violence among women veterans by sexual orientation

National estimates suggest intimate partner violence (IPV) rates are equal or higher among lesbian, bisexual, or questioning (LBQ)-identified women than heterosexual-identified women. Women veterans are a population at high risk for IPV, yet the occurrence of lifetime and past-year IPV experiences by sexual orientation have not been examined in this population. Lifetime and past-year IPV experiences and current IPV-related posttraumatic stress disorder (PTSD) symptoms were assessed with validated screening measures as part of a 2014 web-based national survey of women veterans. Among 403 respondents, 9.7% (n = 39) identified as LBQ, and 90.3% (n = 364) identified as heterosexual. When controlling for age, LBQ-identified women veterans were significantly more likely to report lifetime sexual and physical IPV and lifetime intimate partner stalking. In the past year, LBQ-identified veterans were twice as likely to endorse emotional mistreatment and physical IPV, and three times more likely to endorse sexual IPV, than were heterosexual-identified women veterans. However, sexual orientation was unrelated to IPV-related PTSD symptoms, when controlling for age, race, and number IPV forms experienced. IPV is prevalent among LBQ-identified women veterans, suggesting the need to understand the potentially unique contextual factors and health-care needs of this group.     

Masculinity and HIV disclosure among heterosexual South African men: implications for HIV/AIDS intervention

Relationships and constructions of masculinity are central to understanding the process of male HIV disclosure, which is an important step towards accessing HIV-related services. Data from in-depth interviews and focus-group discussions with 23 HIV-positive, self-identified heterosexual, Black South African men were used to explore the disclosure process and how this process was negotiated in the context of constructions of masculinity. Of these men, 20 had disclosed to one or more persons, with partners and siblings being the preferred confidants. Disclosure was dependent on the acceptance of HIV status, perceived support and healthy relationships with others, HIV counselling and participation in educational and training activities. Non-disclosure was explained as a result of stigma, fear of rejection, discrimination, a lack of healthy relationships with others and lack of access to suitable disclosure strategies. Negative perceptions of HIV and hegemonic conceptions of masculinity hindered men from disclosing and seeking health services. Many men, however, managed to renegotiate their masculine identities to become responsible, knowledgeable HIV-positive individuals, protecting their families and becoming community educators. Findings suggest the need to consider gendered, contextual, skills-building/income-generating and guided interventions to promote male HIV disclosure and service uptake.     

Unwanted sexual experiences among young men in four sub-Saharan African countries: prevalence and context

Unwanted sexual experiences are most frequently examined from the woman's perspective, yet these experiences happen to men as well. Part of the reason for the paucity of studies on coerced sexual experiences among men is the difficulty in gathering information about such experiences. This study examines the prevalence of unwanted sexual experiences at sexual debut as well as ever among young men aged 12–19 years old in Burkina Faso, Ghana, Malawi and Uganda. The data come from nationally-representative surveys and in-depth interviews with approximately 50 young men in each country gathered around 2004. Between 4 and 12% of young men stated that they were ‘not willing at all’ at sexual debut and between 3 and 6% said that they had ever experienced unwanted sex. Narratives from in-depth interviews give insights into the context surrounding men's unwanted sexual experiences. The sometimes conflicting information provided by the respondents serve to confound rather than illuminate the contexts within which these unwanted sexual experiences occurred, demonstrating that coercion for young men looks extremely different than coercion for young women, spurring us to improve our measures of sexual coercion among men.     

The relational dynamics of hegemonic masculinity among South African men and women in the context of HIV

In South Africa, the frequent positioning of men's sexual behaviours as a prime driver of the HIV epidemic has generated much interest in men's sexuality. However, the relational nature of dominant male norms that exacerbate the risk of HIV transmission is inadequately understood. This study used sexual biographies to explore how men and women negotiate gendered norms and how this affects their sexual and reproductive health (SRH). A total of 50 sexual-history interviews and 10 focus group discussions were conducted with men, and 25 sexual-history interviews with women, with participants sampled from three age categories (ages 18–24, 25–55 and 55+years), a range of cultural and racial backgrounds and urban and rural sites across five provinces in South Africa. The narratives illustrate that men and women's SRH is largely dependent on the type and quality of their relationships. Men's sexuality was regularly depicted as being detached from intimacy and uncontrollable, which was premised as being opposite from and/or superior to women's sexuality and could justify men's high-risk sexual behaviours. Yet many participants also supported gender equitable relationships and endorsed accountable and healthy SRH behaviours. The narratives reveal that HIV-risky dominant male norms should be addressed relationally for the sake of better SRH outcomes.     

Proposing love on the way to school: mobility,sexuality and youth transitions in South Africa

Young people's daily mobility in sub-Saharan Africa remains largely invisible and under-researched. Drawing on qualitative and quantitative data from the Child Mobility Project in South Africa, we show how young people's daily journeys (to school and other places) shape, and are shaped by, the possibility of sexual encounters. Young women are seen to be at risk of sexual violence as they travel around their neighbourhoods and fears of sexual violence and transgressive relationships lead to controls over their mobility, with potentially negative consequences for education and social opportunities. However, mobility can also present opportunities for welcomed sexual encounters and experimentation, which are seen as part of growing up. We discuss the implications for young women's ability to negotiate safe routes to adulthood.     

A social network typology and sexual risk-taking among men who have sex with men in Cape Town and Port Elizabeth,South Africa

Despite the high prevalence of HIV among men who have sex with men in South Africa, very little is known about their lived realities, including their social and sexual networks. Given the influence of social network structure on sexual risk behaviours, a better understanding of the social contexts of men who have sex with men is essential for informing the design of HIV programming and messaging. This study explored social network connectivity, an understudied network attribute, examining self-reported connectivity between friends, family and sex partners. Data were collected in Cape Town and Port Elizabeth, South Africa, from 78 men who have sex with men who participated in in-depth interviews that included a social network mapping component. Five social network types emerged from the content analysis of these social network maps based on the level of connectivity between family, friends and sex partners, and ranged from disconnected to densely connected networks. The ways in which participants reported sexual risk-taking differed across the five network types, revealing diversity in social network profiles. HIV programming and messaging for this population can greatly benefit from recognising the diversity in lived realities and social connections between men who have sex with men.     

Intimate partner violence and postpartum emotional distress among South African women: Moderating effects of resilience and vulnerability factors

ABSTRACT

In this study we aimed to identify factors that condition (i.e. buffer or exacerbate) the impact of exposure to intimate partner violence (IPV) on postpartum emotional distress among South African women. Hypothesised buffering factors included: socioeconomic status, family social support, and religiosity. Hypothesised exacerbating factors included: baseline distress, HIV status, and childhood abuse. Longitudinal analyses examined interactions between putative buffering and exacerbating factors and exposure to physical or sexual IPV, assessed during pregnancy (T1), as predictors of emotional distress, measured at 14 weeks (T2) and 9 months postpartum (T3). Consistent with hypotheses, at both T2 and T3 the impact of IPV exposure on emotional distress was significantly stronger among women who reported greater baseline distress and weaker among women of greater socioeconomic status. At T3, an interaction emerged with HIV status; the impact of IPV exposure on emotional distress was stronger for women who were diagnosed as HIV-positive during pregnancy. Findings support the need for targeted mental health promotion interventions for IPV-exposed women who are newly diagnosed with HIV and/or report high levels of emotional distress during pregnancy. Although more research is needed, findings also suggest that strengthening socioeconomic supports for IPV-exposed women may buffer impacts on postpartum mental health.     

Peer network influence on intimate partner violence perpetration among urban Tanzanian men

Male perpetration of intimate partner violence (IPV) against women in Tanzania is widespread. Theory and empirical evidence suggest peer networks may play an important role in shaping IPV perpetration, although research on this topic in sub-Saharan Africa is limited. Grounded in social learning theory, social influence theory, and the theory of gender and power, the purpose of this study was to examine whether and how peer networks influence men’s perpetration of IPV in Dar es Salaam, Tanzania. We conducted in-depth interviews (n = 40) with a sub-sample of 20 men enrolled in the control condition of an ongoing cluster-randomised controlled trial. We purposively sampled participants who previously reported perpetrating physical IPV. To analyse the data, we generated narrative summaries and conducted thematic and interpretative coding. We saw no evidence that men self-selected into peer networks with certain values or behaviours. Rather, men described several mechanisms through which their peers influenced the perpetration of IPV, including: (1) the internalisation of peer network norms, (2) pressure to conform to peer network norms and (3) the direct involvement of peers in shaping couple power dynamics. Our findings suggest that peer networks influence men’s perpetration of IPV and should be targeted in future programmes and interventions.     

Experiences of racism,sexual objectification and alcohol use among gay and bisexual men of colour

ABSTRACT

Objective: Previous research has shown that experiences of racial discrimination and sexual objectification are associated with health risk behaviours among gay and bisexual men of colour. However, little is known about whether racial discrimination and sexual objectification are associated with alcohol use among this population. This community-based study examined the association between racial discrimination, sexual objectification and alcohol use in a sample of 369 gay and bisexual men of colour (Black/African/Caribbean, Latino/Latin American, South Asian, and East and Southeast Asian) in Toronto.

Design: Data were drawn from an online survey designed to examine issues of racism, homophobia, health and well-being among gay and bisexual men of colour in Toronto. Regression analysis assessed the relationship between scores on the Racism and Life Experiences Scale, Sexual Objectification Scale, and the CAGE questionnaire (a screen for alcohol use disorder).

Results: Multivariable logistic regression analyses revealed that experiences of racism and sexual objectification are significantly and positively associated with a screening for alcohol use disorder. The interactions between Latino/Latin American race/ethnicity and experience of sexual objectification were also positively associated with a screening for alcohol use disorder.

Conclusions: Health professionals should consider the role of racial discrimination and sexual objectification within the context of risk and treatment for alcohol use disorders, harm reduction, and HIV prevention for gay and bisexual men of colour.     

Intimate partner violence in the Balkans: the example of Albania

Our aim was to describe the prevalence and associated factors of intimate partner violence in postcommunist countries of South East Europe (SEE). Review of recent reports regarding intimate partner violence in SEE countries as documented in the official Web sites of the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), Minnesota Advocates for Human Rights, Centers for Disease Control, and Medline. In Belgrade, Serbia and Montenegro, the prevalence of physical violence against women has been reported as 69.8%. In a reproductive health survey conducted in 1997 in Moldova, 22% of the women interviewed reported they had been abused by a partner or former partner at some time in their lives. More than 31% of female university students in Macedonia have reported that they had been victims of physical or psychological violence. Data from Albania indicate that spousal physical violence is one of the highest reported internationally. In Tirana, the Albanian capital city, the prevalence of past-year physical intimate partner violence was reported by 37% of women interviewed. The most empowered Albanian women were most likely to experience physical abuse and the least powerful men and those of rural origin were most likely to perpetrate spousal violence. Notwithstanding the lack of well-documented data and the questionability of extent to which the reported results are comparable among different SEE countries, the evidence suggests that intimate partner violence is an important public health problem in transitional countries of SEE. Information on intimate partner abuse can provide valuable clues to primary care and community care practitioners about the health status of female populations.     

男男性接触者性伴网络特征与HIV传播

目的了解男男性接触者（MSM）性伴网络特征,探讨人类免疫缺陷病毒/性传播疾病（HIV/STDs）从该人群向普通人群传播的途径,为开展HIV/STDs的预防与控制提供依据.方法以同性恋酒吧为研究现场,以其中男男性接触者为对象进行匿名问卷调查.调查内容包括社会人口学特征、HIV/STDs感染状况、性伴类型及数量等.结果某市酒吧中MSM的HIV和STDs感染报告率分别为3.4%和10.3%;多性伴现象在MSM中普遍存在,且性伴类型广泛.在最近2个月中,50.0%的MSM有同性偶然性伴,17.8%有同性商业性伴,63.8%目前有同性固定性伴.曾有过异性性伴者为55.7%.拥有3种类型性伴者为19.5%,4种类型性伴者为12.6%.拥有不同类型性伴的MSM亚群之间相互关联,核心亚群为拥有异性性伴和拥有同性商业性伴亚群.结论 MSM以多维的性伴网络相互连接,不仅在MSM人群内部具有HIV/STDs的多向传播通道,而且已经形成了向普通人群传播的桥梁.     

Intimate partner violence among men and women--South Carolina, 1998

Few studies provide population-based estimates of intimate partner violence (IPV) for men and women, especially at the state level. IPV may result in adverse health effects for victims and perpetrators (1-3). To estimate the lifetime incidence of IPV by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population-based random-digit-dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.     

Gay men and intimate partner violence: a gender analysis

Though intimate partner violence (IPV) is predominately understood as a women's health issue most often emerging within heterosexual relationships, there is increasing recognition of the existence of male victims of IPV. In this qualitative study we explored connections between masculinities and IPV among gay men. The findings show how recognising IPV was based on an array of participant experiences, including the emotional, physical and sexual abuse inflicted by their partner, which in turn led to three processes. Normalising and concealing violence referred to the participants’ complicity in accepting violence as part of their relationship and their reluctance to disclose that they were victims of IPV. Realising a way out included the participants’ understandings that the triggers for, and patterns of, IPV would best be quelled by leaving the relationship. Nurturing recovery detailed the strategies employed by participants to mend and sustain their wellbeing in the aftermath of leaving an abusive relationship. In terms of masculinities and men's health research, the findings reveal the limits of idealising hegemonic masculinities and gender relations as heterosexual, while highlighting a plurality of gay masculinities and the need for IPV support services that bridge the divide between male and female as well as between homosexual and heterosexual.     

Intimate partner violence, depression, and PTSD among pregnant Latina women

PURPOSE We undertook a study to describe factors related to depression and posttraumatic stress disorder (PTSD) among pregnant Latinas who were or were not exposed to intimate partner violence.METHODS We interviewed 210 pregnant Latinas attending prenatal clinics located in Los Angeles, California. Latinas who did and did not have histories of intimate partner violence were recruited. We then assessed the women for strengths, adverse social behavioral circumstances, posttraumatic stress disorder (PTSD), and depression.RESULTS Significantly more women exposed to intimate partner violence scored at or above the cutoff point for depression than women who were not (41% vs 18.6%; P<.001). Significantly more women exposed to intimate partner violence scored at or above the cutoff point for PTSD than women who were not (16% vs 7.6%; P <.001). Lack of mastery, which measures feelings of being in control of forces that affect life (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.84), a history of trauma not associated with intimate partner violence (OR, 1.33; 95% CI, 1.08–1.63), and exposure to intimate partner violence (OR, 2.43; 95% CI, 1.16–5.11) were associated with depression after adjusting for age, language of interview, and site effects. Stress (OR, 1.72; 95% CI, 1.34–2.2) and a history of trauma (OR, 1.45; 95% CI, 1.03–2.04) were independently associated with PTSD, whereas higher income was associated with decreased risk of PTSD (OR, 0.10; 95% CI, 0.02–0.63), after adjusting for age, language of interview, and site effects.CONCLUSIONS Intimate partner violence was significantly associated with depression and PTSD but was associated with depression only after controlling for other factors in the multivariate model. The risk for depression declined with greater mastery but increased with a history of trauma or exposure to intimate partner violence. Stress, a history of trauma not associated with intimate partner violence, and lower income were all independently associated with increased risk for PTSD.     

Experience of intimate partner violence among women and men attending general practices in Dublin,Ireland: A cross-sectional survey

This cross-sectional study examined women's and men's reported experience of intimate partner violence in general practice in the greater Dublin region. A high prevalence of reported experience of controlling behaviour and violent incidents was found. Although the reported prevalence of both was higher in men, women were more likely to have reported fear of a partner and a severe level of violence.

Conclusion: The findings demonstrate that intimate partner violence is a major problem among the men and women surveyed.