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

For men, our multiple regression analyses showed that sexual assault and rape myth acceptance, along with substance use, were significantly related to cumulative risks for HIV transmission, pointing toward several avenues for risk-reduction interventions with men. Information and education campaigns are currently underway in South Africa to raise awareness of the link between sexual violence and STI/HIV, combining these issues under a common rubric of sexual health. Behavioral interventions that target men for STI/HIV risk reduction are also becoming more common in South Africa (Morrell, 2002). Given the independent association of substance use to sexual risks, efforts to prevent HIV transmission by focusing on men may be most efficient when targeting men who drink alcohol and use other drugs. Because men often control much of what happens in the sexual relationships, significant advances in reducing STI/HIV risks in South Africa may result from targeting men.

In contrast, our findings for women suggest few inroads for STI/HIV prevention by targeting women. Although we found that women were at substantial risk for STI/HIV, women's risks were only associated with lower education and history of alcohol use in this study. Women endorsed the view that women are subordinate and passive in their relationships with men and that women are often to blame for rape. Nevertheless, these attitudes were not independently associated with STI/HIV risks. We speculate that women's risks for STI/HIV are the product of partner characteristics in male-dominated relationships. Women who are victims of, or threatened with, violence are often unable to negotiate life-saving strategies in HIV prevention (Heise & Elias, 1995), and so the design and implementation of risk-reduction interventions focused on men may prove successful in ultimately reducing HIV risks for women.

These findings are limited by the study measures relying on self-reports of sensitive and private behaviors. In particular, results for admitting to having sexually violated a person or having been sexually assaulted must be considered conservative, as it is likely that these behaviors were under-reported. It is worth noting that the relationship between sexual coercion and risk of STI/HIV could be more prominent than is indicated by the current data. In addition, self-reports of substance use and sexual behaviors should be considered lower-bound estimates. Although our measures of gender attitudes and rape myths have been used in international research, and the items we selected were based on previous qualitative studies of men and women in South Africa, the scales themselves showed item heterogeneity, as indicated by low to moderate internal consistency and have not yet been validated in the South African context. Also, the amount of variance accounted for in our analyses was small, leaving much of the variance unexplained. Our study is also limited by its focus on STI clinic patients, reducing the generalizability of the findings to other populations. Our focus on STI clinic patients likely biased the study results by over-representing men and women who engage in considerable risk behaviors and are at some of the highest risks for HIV infection. Further research is needed to confirm these results before allowing for generalizability. Nevertheless, it is clear from our results that gender-tailored STI/HIV risk reduction interventions are urgently needed in South Africa.