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. 2025 Oct 1;100(2):89-96.
doi: 10.1097/QAI.0000000000003709.

Young Men's Experiences of Violence and Poverty and the Relationship With Sexually Transmissible HIV: A Cross-Sectional Study From Rural South Africa

Andrew Gibbs  1   2   3 , Esnat Chirwa  2 , Guy Harling  3   4 , Natsayi Chimbindi  3   4   5 , Jaco Dreyer  5 , Carina Herbst  5 , Nonhlanhla Okesola  5 , Ngundu Osee Behuhuma  5 , Nondumiso Mthiyane  3   5 , Kathy Baisley  5   6 , Thembelihle Zuma  3   4   5 , Theresa Smit  5 , Nuala McGrath  4   5   7 , Lorraine Sherr  8 , Janet Seeley  4   5   6 , Maryam Shahmanesh  3   4   5
Affiliations

Young Men's Experiences of Violence and Poverty and the Relationship With Sexually Transmissible HIV: A Cross-Sectional Study From Rural South Africa

Andrew Gibbs et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Young men are inadequately engaged in HIV prevention and treatment globally, including in South Africa, increasing the likelihood of them having sexually transmissible HIV (ie, living with HIV but with high viral loads). We sought to understand how men's experiences of poverty and violence affected transmissible HIV, directly or indirectly through mental health and substance misuse.

Setting: Rural communities in northern KwaZulu-Natal, South Africa.

Methods: Cross-sectional population-based sample (September 2018-June 2019), assessing transmissible HIV (living with HIV and viral load ≥400 copies/mL, compared with individuals either not living with HIV, or living with HIV and viral load <400 copies/mL) through dried blood spots, and sociodemographic data. Structural equation models (SEM) assessed direct and indirect pathways from food insecurity and violence experience to transmissible-HIV, with mediators common mental disorders, alcohol use, gender inequitable attitudes, and perceptions of low life chances.

Results: In total, 2,086 (ages 13-35 years) men and 8.6% (n = 178) men had transmissible HIV. There was no direct pathway from food insecurity, or violence experience, to transmissible HIV. Low perceptions of life chances mediated the relationship between food insecurity and transmissible HIV. In addition, increased poor mental health, through increased alcohol use, also mediated these relationships.

Conclusions: Transmissible HIV was common among young men. The analysis highlights the need to address the proximate "drivers" of low perceptions of life chances and substance misuse, and men's experiences of poverty and violence. Building multicomponent interventions that engage these multiple challenges is critical for improving HIV among young men.

Keywords: HIV/AIDS; gender; interpersonal violence; male; mental health; poverty.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Update of

References

    1. Colvin CJ. Strategies for engaging men in HIV services. Lancet HIV. 2019;6:e191–e200.
    1. Dovel K, Yeatman S, Watkins S, et al. Men's heightened risk of AIDS-related death: the legacy of gendered HIV testing and treatment strategies. AIDS. 2015;29:1123–1125.
    1. Grimsrud A, Ameyan W, Ayieko J, et al. Shifting the narrative: from “the missing men” to “we are missing the men”. J Int AIDS Soc. 2020;23(suppl 2):e25526.
    1. Cornell M, McIntyre J, Myer L. Men and antiretroviral therapy in Africa: our blind spot. Trop Med Int Health. 2011;16:828–829.
    1. UNAIDS. Blind Spot: reaching out to men and boys. Joint United Nations Programme on HIV/Aids, Geneva, Switzerland. 2017. https://www.unaids.org/sites/default/files/media_asset/blind_spot_en.pdf .

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