Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in Cape Town, South Africa

Journal of Sex Research, Nov, 2005 by Seth C. Kalichman, Leickness C. Simbayi, Michelle Kaufman, Demetria Cherry Cain, Chauncey, Sean Jooste, Vuyisile Mathiti

Rape myth acceptance. The rape myth acceptance measure consisted of six items adapted from the Rape Myth Acceptance Scale (Burt, 1980). Items used in this study are presented in the results section. The rape myth acceptance items have been used in international research (e.g., Nayak, Byrne, Martin, & Abraham, 2003), and they reflect beliefs revealed in qualitative research with South African men (Wood & Jewkes, 2001). Items on the rape myth measure were responded to on 4-point scales, from 1 (Disagree) to 4 (Agree), and the instrument was marginally internally consistent, alpha = .70.

Sexual behaviors. To assess current sexual behaviors, participants were asked how many male and female sex partners they had in the past three months. In addition, participants reported the number of times that they engaged in vaginal and anal intercourse with and without condoms during that time period. Participants also indicated whether they had engaged in sexual activity in the past three months that involved direct contact with blood. Because sexual contact during menstruation may increase a risk of HIV infection for men and women (Lazzarin, Saracco, Musicco, & Nicolosi, 1991), as may genital bleeding during intercourse (Seidlin, Vogler, Lee, Lee, & Dubin, 1993), we thought it was appropriate to include questions relating to sexual activity involving direct blood contact. We collected responses on a range representing the number of partners and number of acts occurring in the preceding three months. In addition, we asked participants if they had ever exchanged sex for money or a place to stay and whether they had ever had a sex partner they believed had injected illegal drugs.

Participants also reported whether they had ever been diagnosed with an STI. History of genital ulcers was assessed by asking participants whether they had ever experienced an open sore on their genitals. We also asked whether participants were currently experiencing STI symptoms.

Substance use. To assess lifetime history of substance use, participants indicated whether they had ever used alcohol, dagga (marijuana), or mandrax (a sedative).

AIDS-related knowledge. An 11-item test assessed HIV risk and prevention-related knowledge. Items were adapted from a measure reported by Carey and Schroder (2002) and previously used in South African research (Kalichman & Simbayi, 2003). The items reflected information about HIV transmission, condom use, and AIDS-related knowledge. Participants responded to each item by checking "Yes," "No," or "Don't Know." The AIDS knowledge test was scored for the number of correct responses, with "Don't Know" responses scored as incorrect; the proportion of correct responses was calculated. The AIDS knowledge test demonstrated heterogeneity among items, alpha = .65, suggesting a representation of multiple aspects of AIDS knowledge.

Procedure

Participants were recruited to complete an anonymous survey of sexual behavior and health. Potential participants were referred to the study recruiter by their doctor or nurse following their clinical services; 90% of patients referred to the study agreed to complete surveys. Sampling occurred during all hours of clinic operation over a three-month period. We limited participant enrollment to no more than 12 individuals per day to assure a range of participants recruited over time. All persons who agreed to complete the survey were able to self-administer the measures with minimal assistance. Participants received 15 South African Rand ($3 U.S.) as compensation.