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medRxiv
MEDRXIV
medRxiv
Cold Spring Harbor Laboratory

10.1101/2024.09.08.24313251
preprint
1
Article
eYoung men’s experiences of violence and poverty and the relationship to sexually transmissible HIV: a cross sectional study from rural South Africa
Gibbs Andrew http://orcid.org/0000-0003-2812-5377

Chirwa Esnat
Harling Guy http://orcid.org/0000-0001-6604-491X

Chimbindi Natsayi
Dreyer Jaco
Herbst Carina
Okesola Nonhlanhla
Behuhuma Osee
Mthiyane Nondumiso
Baisley Kathy
Zuma Thembelihle
Smit Theresa
McGrath Nuala
Sherr Lorraine
Seeley Janet
Shahmanesh Maryam
09 9 2024
2024.09.08.24313251https://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows reusers to copy and distribute the material in any medium or format in unadapted form only, for noncommercial purposes only, and only so long as attribution is given to the creator.
http://medrxiv.org/lookup/doi/10.1101/2024.09.08.24313251
nihpp-2024.09.08.24313251.pdf
Abstract

Background

Young (ages 18-35 years) men are inadequately engaged in HIV prevention and treatment globally, including in South Africa, increasing the likelihood of them having sexually transmissible HIV (i.e. living with HIV but with high viral loads). We sought to understand how men’s experiences of poverty and violence, impacted on transmissible HIV, directly or indirectly via mental health and substance misuse.

Setting

Rural communities in northern KwaZulu-Natal, South Africa.

Methods

Cross-sectional population-based random selection (September 2018-June 2019), assessing transmissible HIV (living with HIV and viral load ≥400 copies/mL) via dried blood spots, and socio-demographic 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 life chances.

Results

2,086 young (ages 18-36 years) men and 8.6%(n=178) men had transmissible HIV. In SEM no direct pathways between food insecurity, or violence experience, and transmissible HIV. Poor mental health and alcohol use mediated the relationship between violence experience and food insecurity and transmissible HIV. Life chances also mediated the food insecurity to transmissible HIV pathway.

Conclusions

There was a high level of transmissible HIV in a representative sample of young men. The analysis highlights the need to address both the proximate ‘drivers’ poor mental health and substance misuse, as well as the social contexts shaping these among young men, namely poverty and violence experience. Building holistic interventions that adequately engage these multiple challenges is critical for improving HIV among young men.
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