Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland

ABSTRACT

Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using “high,” “medium” and “low” levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1–1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1–3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.

KEYWORDS:

• Social cohesion
• social participation
• MSM
• HIV testing
• Swaziland

Acknowledgements

We thank first and foremost all the study participants for their time and contributions. We thank the study team members including Babazile Dlamini, Edward Okoth and Jessica Greene from PSI Swaziland; study staff and interviewers; and community liaisons including Sibusiso Maziya and the Rock of Hope organization. From USAID, Jennifer Albertini, Natalie Kruse-Levy, Alison Cheng, Sarah Sandison, Clancy Broxton and Ugo Amanyeiwe provided important technical input and support for this study. We also thank the Research to Prevention (R2P) team at Johns Hopkins who helped with this study, including Deanna Kerrigan, Rebecca Fielding-Miller, Emily Hurley, Andrea Vazzano and Brandon Howard. We also thank the members of the Swaziland Most-at-Risk Populations (MARPS) technical working group, the Swaziland Ministry of Health and other Swazi government agencies that provided valuable guidance and helped ensure the success of this study. We appreciate the support and contributions from all the many individuals who contributed in a wide variety of ways to this study. Finally, Xolile Mabuza provided leadership for the implementation of this study in his position as the founding executive director of the Rock of Hope. Tragically, the world lost Xolile in 2015. Xolile's power, energy and drive are greatly missed and we honor his legacy with our work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by the USAID Project SEARCH, Task Order No. 2, and funded by the US Agency for International Development under Contract No. GHH-I-00–07–00032–00, beginning 30 September 2008, and supported by the President's Emergency Plan for AIDS Relief.