Abstract #196  -  Tracking HIV risk behaviour and prevalence over time among players in Cape Town, South Africa
Authors:   Presenting Author:   Mrs Loraine Townsend - Medical Research Council
Additional Authors:  Dr Alan Flisher, Dr Cathy Mathews, Dr  Mickey Chopra, Ms Yanga Zembe,
Aim: The South African government’s HIV & AIDS and STI Strategic Plan for South Africa 2007-2011 aims to reduce the number of new HIV infections by 50%. In order to do this monitoring, research, and surveillance is one of the priority areas identified by the NSP. Regular HIV behavioural and biological surveillance among groups of people most at risk for HIV is therefore urgently needed to provide information about the characteristics of these groups, and the behaviours that make them more susceptible to HIV infection and therefore transmission than other groups. The aim of this paper is to report on results from two integrated bio-behavioural surveillance surveys conducted in 2006 and 2008 among a hard-to-reach, high-risk population of ‘players’: heterosexual men who have multiple, concurrent sexual partners.
Method / Issue: In 2006 and 2008 Respondent Driven Sampling was used to recruit men into an integrated bio-behavioural surveillance survey assessing HIV prevalence and associated risk factors. Eligible men lived, worked or socialised in a urban, informal settlement on the outskirts of Cape Town and reported having had 2 or more female sexual partners in the three months prior to the survey (n=421 in 2006 and n=425 in 2008). Upon providing written consent, participants completed a behavioural assessment questionnaire and provided an anonymous dried blood spot. Unique recruitment coupon numbers linked responses on the behavioural questionnaire and HIV test results to each participant.
Results / Comments: The two samples were not significantly different in terms of age, education level, and marital status. However, compared to men in the 2006 sample, those in the 2008 sample were less likely to be employed. Although higher in 2008, HIV prevalence was not significantly different between the two samples (12.3%; OR 8.3-16.9 in 2006 vs 14.4%; OR 9.7-20.6 in 2008). There was a significant decrease in the mean number of sexual partners in the 3 months prior to the surveys (6.9 in 2006 vs 5.8 in 2008: p<0.01). Compared to men in the 2006 sample, those in the 2008 sample were more likely to have always used condoms with their main sexual partners (i.e. steady partners or wives) (10.7%; OR 6.9-15.6 vs 22.9%; OR 16.3-30.2); to to have used a condom at last sex with casual sexual partners (i.e. regular, secret partners) (35.9%; OR 29.9-44.2 vs 75.1%; OR 67.4-81.7) and their one-time sexual partners (i.e. partner with whom they had sex once and never again) (42.4% OR 33.9-50.0 vs 69.0%; OR 59.6-80.1); and to have consumed alcohol at less risky levels (i.e. 5 or more alcoholic drinks on most occasions) (81.7% OR 75.7-87.5 vs 56.9%; OR 49.4-64.5).
Discussion: Results from the two surveys in this high-risk population indicate that HIV risk behaviours have declined over time whereas there has been little change in HIV prevalence. People who have concurrent sexual partners are believed to be key drivers of the HIV epidemic in sub-Saharan Africa and regular surveillance of associated risk behaviours and HIV prevalence in this population has important implications for tracking trends over time, and for monitoring the impact of HIV prevention efforts.
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