Black South African men who have sex with men (MSM) face a set of adverse circumstances, including economic hardship and stigmatization, that combine to put them at an elevated risk for hazardous substance use and HIV infection. This creates a context where substance use is normative and high-risk sexual behavior is often engaged in covertly and under the influence of intoxicating substances. The overarching objective of this dissertation was to explore determinants of hazardous drinking and HIV risk behavior among black South African MSM with a particular focus on the role of social networks. In order to achieve this, I used data drawn from the study, “HIV and Sexual Risk in African MSM in South African Townships” (R01-MH083557; PI: Sandfort, PhD). First, I conducted a systematic literature review to identify studies that used social network analysis to evaluate alcohol use among adults in order to answer the question: how have social network characteristics been shown to influence adults’ drinking behaviors, both in terms of characteristics of their network structures and characteristics of their network ties? Results of the review demonstrated that characteristics of one’s peers as well as social network structure influenced egos’ alcohol consumption in a variety of ways and across settings. Second, I described drug and alcohol use among black South African MSM and identified determinants of hazardous drinking, a highly prevalent form of alcohol use identified in the sample. The results showed that hazardous drinking was highly prevalent and multiple indicators of social vulnerability were identified as independent determinants of hazardous drinking. Third, I assessed the relationship between substance use and sexual risk behavior and explored the moderating effects of psychosocial factors. The results showed that there was not a main effect between substance use and sexual risk behavior; however, among men with high intentions to engage in safer sex, substance use was associated with increased risky sexual behavior. Overall, this dissertation increased our understanding of social networks, substance use and HIV risk behavior among black South African MSM. Our results suggest the importance of using pre-existing social networks to deliver potential interventions. The results also suggest that the most vulnerable members of this community are at increased risk of hazardous drinking. Lastly, efforts to reduce HIV risk behavior should focus on both increasing safer sex intentions and negating the impact of substance use on sexual risk behavior. Taken together, these studies provide insight for developing potential interventions, including intervention that use social network data to facilitate behavioral change, as well as undertaking further research among a critical population.

This dissertation examines how Black and Latino men who have sex with men (MSM) are making sense of the contemporary HIV/AIDS epidemic and their relation to it. Black and Latino MSM in the United States are disproportionately impacted by HIV. Interdisciplinary scholarship on the matter has conceptualized risk as an intrinsic facet of HIV. However, this research has paid little attention to the process by which Black and Latino MSM form their HIV risk perceptions. In this dissertation, I advance the “risk ecology framework” as a novel socioecological approach for understanding risk perception. This framework conceives of HIV risk perception as emerging from individuals’ relationship to HIV as shaped by the intersecting influences of the broader social environment. I base my analysis on 40 in-depth semi-structured interviews with HIV-negative Black and Latino MSM in New York City, as well as a year of participant-observation with a health advocacy group that serves this community. I find respondents form their risk perceptions by reflecting on HIV vis-à-vis their respective and distinctive social locations. The intersections of race, class, and sexuality come to be associated with HIV risk across the ecological levels of an individual’s lived experience, revealing a risk ecology, or a set of interrelated potential threats posed by HIV. I find this risk ecology to be reflected in Black and Latino MSM’s framing of HIV as a risk to their bodily health and social wellbeing, on the one hand. Or, its framing as personally irrelevant, on the other. Relationships and interactions with family, friends, and romantic/sexual partners inform what Black and Latino MSM understand HIV to potentially threaten. Respondents and the people in their lives draw upon culturally-available discourses, rhetoric, and beliefs concerning HIV that reflect how the institutionalization of racial, social, and sexual inequalities structure risk perception. With respect to health-relevant behaviors, I demonstrate how the analysis of risk perception formation clarifies the ways in which Black and Latino MSM make use of preventative tools and construct meanings about sex. I conclude with a discussion of the broader implications of the risk ecology framework for future health policy and further sociological research. By interrogating what it means to be at-risk, this dissertation lends crucial insight into the persistence of the HIV epidemic at a time when the means to end it are available, and also enriches sociological understandings of risk both within and beyond the public health domain.

By gathering information from a volunteer sample of men who sleep with men (MSM) in the Johannesburg inner city, the study aimed to discover those decisions and behaviour that influence their health decision-making and health-seeking behaviour, particularly as far as HIV and their sexual health was concerned. Eleven in-depth interviews were conducted by three interviewers using a semistructured interview guide which asked questions on demographics, health-seeking behaviour, sexual orientations and behaviour, knowledge of HIV/AIDS and community support. During analysis, collected data was classified into the themes of access to health care, personal and general MSM HIV risk perceptions, sexual behaviour, alcohol and unprotected sex, prostitution, religion and stigma, violence and discrimination. This study was the first qualitative study researching MSM in the Johannesburg inner city and provides useful baseline information for further qualitative MSM studies in the geographical area and for the development of MSM aligned interventions. / Sociology / M.A. Sociology

ENGLISH ABSTRACT: This research study examines the beliefs related to HIV/AIDS risks and the perceived effectiveness of preventative measures among men who have sex with men (MSM) in the Philippines. Using a questionnaire developed using the Health Belief Model (HBM), this study endeavors to understand beliefs and thus improve counseling guidelines for MSM who continue to engage in risky sexual behaviors following VCT and a negative HIV test. The impact of HIV/AIDS on the Philippines is beginning to increase, affecting men and their partners. The rapid growth of HIV/AIDS among Filipino MSM indicates that more attention must be paid to the barriers and benefits of condom use within this high-risk population. A background of the presence and prevalence of HIV/AIDS is presented. This study aims to answer the question of why MSM choose to have unprotected sex despite the risk of HIV/AIDS. Multiple barriers to condom use are identified, including the availability of condoms, partner resistance, and reduced pleasure. The impacts of culture and society, the media, role models, social networking, drug use, and riskseeking behavior on safer sex are assessed. Currently, supplying condoms and providing voluntary testing and counseling is the primary mode of preventing the spread of HIV/AIDS, but this study sheds light on the critical issues of condom availability, perceived benefits and barriers to condom use, and the disconnect between belief and behavior regarding HIV/AIDS and unprotected sex among MSM in the Philippines. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie is ‗n ondersoek na die gelowe (beliefs) teenoor MIV/Vigs van mans wat seks het met mans. Die studie poog verder om ondersoek in te stel na moontlike voorkomende maatreëls wat ingestel kan word om die pandemie te bekamp. Vir die doel van hierdie studie is ‗n vraelys ontwikkel , deur gebruik te maak van die Health Belief Model, met die doel om ‗n beter begrip te kry van die redes vir risikogedrag onder mans wat seks het met mans in die Fillipyne. Die voorkoms van MIV/Vigs by mans wat seks het met mans is steeds aan die toeneem in die Fillipyne en dringende maatreëls is nodig om die groei van die pandemie te beperk. Die studie gee ‗n agtergrond tot MIV/Vigs in die Fillipyne. Die ondersoek gaan dan voort om te probeer bepaal waarom risikogroepe steeds voortgaan om aan onbeskermende seksuele aktiwiteite deel te neem. Resultate van die studie toon aan dat daar verskeie faktore is wat die gebruik van kondome ontmoedig in die risikogroep wat in hierdie studie aangespreek word. Kondome is nie altyd beskikbaar nie; seksuele vennote wil nie kondome gebruik nie en die vermindering in seksuele plesier word as redes aangevoer. Hierdie studie maak ‗n betekenisvolle bydrae tot die kennisbasis van die gelowe en houdings van mans wat seks het met mans ( en dan MIV-positief raak) en sal na alle waarskynlikheid betekenisvol bydra tot die meer suksesvolle bestuur van hierdie risikogroep in die Fillipyne.

By gathering information from a volunteer sample of men who sleep with men (MSM) in the Johannesburg inner city, the study aimed to discover those decisions and behaviour that influence their health decision-making and health-seeking behaviour, particularly as far as HIV and their sexual health was concerned. Eleven in-depth interviews were conducted by three interviewers using a semistructured interview guide which asked questions on demographics, health-seeking behaviour, sexual orientations and behaviour, knowledge of HIV/AIDS and community support. During analysis, collected data was classified into the themes of access to health care, personal and general MSM HIV risk perceptions, sexual behaviour, alcohol and unprotected sex, prostitution, religion and stigma, violence and discrimination. This study was the first qualitative study researching MSM in the Johannesburg inner city and provides useful baseline information for further qualitative MSM studies in the geographical area and for the development of MSM aligned interventions. / Sociology / M.A. Sociology

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Since the beginning of the HIV epidemic in the early 1980s, men who have sex with men (MSM) have been disproportionately affected by the virus. Sex between men is the main route of transmission of HIV in some parts of the world. In some other places it is a secondary route of transmission. Worldwide, MSM are classified as most-at-risk populations because of their higher risk of HIV transmission. Although sex between men occurs in most societies, its existence, importance in HIV prevention are frequently denied. Often, these men are neglected in HIV prevention interventions. Sexual acts between men have often been condemned and sometimes criminalized. In some countries, penalties for those accused of sexual acts between men are among the severest available. Elsewhere, even where same-sex behaviour is not illegal, there is frequently unofficial persecution by the authorities or discrimination against or stigmatisation of those men known or thought to be having sexual relations with other men. For these reasons, in many parts of the world, sex between men is hidden or secretive. This makes an assessment of its extent, and of the various types of sexual acts that occur, even more difficult. As a result of being neglected, there has been generally lack of research and services directed towards MSM. In sub-Saharan Africa, for instance, it was only over 10 years ago, in 2001, when the first behavioural survey among MSM was conducted. However, few countries have conducted such studies and MSM’s specific health needs, especially for HIV prevention, are still not being met. In most countries, like Swaziland, the HIV prevalence is still generalized. Although Swaziland bears the burden the highest HIV prevalence in the world at 26% for the age group 15-49 (UNAIDS, 2010), interventions to MSM and other most-at-risk populations are limited. The study’s main aim was to identify the prevention needs of MSM in Swaziland. A total of 50 MSM were interviewed in order to find information. In addition, five key informants who were managers of HIV prevention programmes were also interviewed. It was established that there is a gap between the MSM’s needs and the interventions currently available. There were factors that put MSM at risk for HIV infection that were identified by the study. It was established that some of the HIV prevention did not meet the specific needs and expectations of MSM. Knowledge on some HIV risk behaviours and some prevention strategies targeting MSM was limited. / AFRIKAANSE OPSOMMING: Sedert die begin van die MIV-epidemie in die vroeë 1980's, het die mans wat seks het met mans (MSM) is buite verhouding beïnvloed deur die virus. Seks tussen mans is die belangrikste roete van die oordrag van MIV in sommige dele van die wêreld. In sommige ander plekke is dit is 'n sekondêre roete van oordrag. Wêreldwyd, MSM word geklassifiseer as die meeste-at-Risk bevolking as gevolg van hul hoër risiko van MIV-oordrag. Alhoewel seks tussen mans in die meeste samelewings voorkom, word dikwels sy bestaan, belang in MIV-voorkoming geweier. Dikwels word hierdie manne verwaarloos in MIV-voorkoming intervensies. Seksuele dade tussen mans dikwels veroordeel en soms gekriminaliseer. In sommige lande, strawwe vir diegene wat beskuldig word van seksuele dade tussen mans is onder die ergste beskikbaar. Elders, selfs waar van dieselfde geslag gedrag nie onwettig is nie, is daar dikwels nie-amptelike vervolging deur die owerhede of diskriminasie of stigmatisering van daardie manne wat bekend is of gedink word om seksuele verhoudings met ander mans. Vir hierdie redes, seks tussen mans, in baie dele van die wêreld is verborge of geheimsinnig. Dit maak 'n assessering van die omvang, en van die verskillende tipes van seksuele dade wat plaasvind, nog moeiliker. As 'n gevolg van verwaarloos, is daar gewoonlik gebrek aan navorsing en dienste gerig op MSM. In sub-Sahara Afrika, byvoorbeeld, dit was net meer as 10 jaar gelede, in 2001, toe die eerste gedrags-opname onder MSM is uitgevoer. Egter, het 'n paar lande uitgevoer sodanige studies en MSM se spesifieke gesondheid behoeftes, veral vir MIV-voorkoming, is nog steeds nie bereik word nie. In die meeste lande, soos Swaziland, die voorkoms van MIV is nog steeds algemene. Hoewel Swaziland dra die las om die hoogste voorkoms van MIV in die wêreld op 26% vir die ouderdomsgroep 15-49 (UNAIDS, 2010), intervensies MSM en ander die meeste-op-risiko bevolkings is beperk. Die studie se hoofdoel was om die voorkoming van MSM te identifiseer in Swaziland. 'N totaal van 50 MSM is ondervra ten einde inligting te vind. Daarbenewens is ook vyf sleutel informante wat bestuurders van die voorkoming van MIV-programme ondervra. Daar is vasgestel dat daar is 'n gaping tussen die MSM se behoeftes en die intervensies wat tans beskikbaar is. Daar is faktore wat sit MSM 'n risiko vir MIV-infeksie wat deur die studie geïdentifiseer is. Daar is vasgestel dat sommige van die MIV-voorkoming het nie voldoen aan die spesifieke behoeftes en verwagtinge van MSM. Kennis op 'n aantal MIV-risiko gedrag en 'n paar voorkoming strategieë fokus MSM is beperk.

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: The objective of this study was to measure the level of HIV and Aids knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape. The study served to recommend guidelines for effective and enhanced targeted intervention response for MSM student community. A total of 36 MSM students aged between 19 and 36 (of which most were South African, black and Xhosa speaking) were recruited to take part in the study. Selection was done via snowball sampling. Respondents completed questionnaires upon consenting to participate in the study. The study found moderately high levels of basic HIV knowledge among the sampled MSM population. There were, however, lower levels of knowledge reported regarding the associated risk and effective prevention strategies of anal sex when compared to similar information about vaginal sex and oral sex. Findings also show that participants had very positive attitudes towards HIV testing, condom use and a non-discriminating environment. Respondents lacked confidence in both management and student leadership with regards to their responsibility in mitigating homophobia/discrimination against MSM student population. Furthermore, a high number of respondents reported having sex with men and women as well as multiple sexual partnerships. Self-reported alcohol and drug use were found to be very low, with the majority of participants indicating non-use. Participants stated little challenges accessing health care services. However, respondents felt MSM specific information about health care related rights and needs were lacking. Recommendations from this study include current HIV and Aids policy reform, mainstreaming MSM-friendly health care services, introducing combination HIV prevention programmes such as Mpowerment and addressing the human rights needs of MSM. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die vlakke van MIV en Vigs kennis, houdings en veilige seksuele praktyke onder manlike studente wat seks het met mans (MSM) by 'n hoër onderwys instansie in die Wes-Kaap te meet. Die studie het gepoog om riglyne daar te stel vir die bewerkstelling van effektiewe en verbeterde geteikende intervensies vir die MSM studente gemeenskap. Daar was 36 MSM studente tussen die ouderdomme van 19 en 36 (meestal Suid-Afrikaans, swart en Xhosa-sprekend) gewerf vir die studie. Seleksie is gedoen deur middel van die sneeubal steekproef-metode. Deelnemers het 'n vraelys voltooi nadat hulle ingewillig het om deel te neem aan die studie. Deelnemers het matig tot hoë vlakke van basiese MIV en Vigs kennis getoon. Daar was egter laer vlakke van kennis oor gepaardgaande risiko’s en effektiewe voorkoming strategieë ten opsigte van anale seks in vergelyking met dieselfde informasie oor vaginale en orale seks. Die studie het verder bevind dat deelnemers baie positiewe houdings gehad het teenoor MIV-toetsing, die gebruik van kondome en 'n nie-diskriminerende omgewing. Verder het hulle min vertroue getoon in beide die bestuur en studente leierskap se vermoë om sake wat verband hou met homofobie en/of diskriminasie teen die MSM studente bevolking, effektief te hanteer. Daar is gevind dat baie respondente seks het met mans en vroue en ook verskeie seksuele maats het. Self-gerapporteerde alkohol- en dwelmgebruik was relatief laag onder respondente met die meerderheid wat aangedui het hulle glad nie alkohol of dwelms gebruik nie. Deelnemers het ook rapporteer dat gesondheidsdienste vir hulle maklik toeganklik is. Respondente het ook gevoel dat MSM spesifieke informasie oor gesondheidsverwante regte en behoeftes tans ontbreek. Aanbevelings wat voortspruit uit hierdie studie sluit in die hersien van die huidige MIV en Vigs beleid, die skepping van MSM-vriendelike dienste, die implementering van MIV-voorkomingsprogramme soos Mpowerment en die bevordering van menseregte wat verband hou met MSM.

Indiana University-Purdue University Indianapolis (IUPUI) / Sexual encounters among gay men produce distinct meanings when methamphetamine is involved. Few studies have inquired about the meanings gay men ascribe to their meth and sex encounters. We have yet to ask, what meanings do these experiences hold and how are they constructed? Using qualitative data gathered from one-on-one semi-structured interviews with eleven men, at least 18 years of age and who report using meth during sex with another man in the past 90 days, this study explored the meanings constructed from the participants’ meth-sex experiences. The analysis revealed several important themes helping to explain why these men use meth and have sex with other men including belonging; being in, searching for and falling out of love; having sex for 12 hours; dealing with HIV; and, confronting addiction. The findings impart a meaningful role for belonging, love, sex and disease as socially constructed through the intersection of the body, mind, social interaction and the environment in which lived experiences unfold. Previous research supports several of these themes while at least one theme, i.e. love, extends our understanding of meth and sex among gay men. I assert belonging binds the themes together. The desire to belong came across more powerful and determining in its meaningfulness than the risks associated with sexual encounters where meth is present.

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