HIV Knowledge and Associated Factors among Internet-Using Men Who Have Sex with Men (MSM) in South Africa and the United States

This research compares factors associated with low HIV/AIDS knowledge among internet-using men who have sex with men (MSM) in South Africa and the United States (US). [Footnotes are removed throughout by the editor.]

The method, used in both countries in 2010, is described as: "1,154 MSM in the US and 439 MSM in South Africa, were recruited through banner advertisements on Facebook.com targeted to men who stated they were interested in men on their Facebook profiles....Facebook users who clicked on the banner ads were taken to an internet-based survey. To be eligible to begin the survey men had to report male-to-male sex in the past year.

The survey collected information on participant demographics (age, race, education, and employment), sexual orientation, the number of friends, colleagues, or acquaintances they felt identified as gay or bisexual, HIV testing behavior, knowledge of HIV transmission, condom and water-based lubrication use, and questions on gay identity. HIV knowledge was quantified using the brief HIV knowledge scale (HIV-KQ-18), an internally consistent and stable HIV knowledge scale shown to be appropriate for low-literacy populations. Questions in the HIV-KQ-18 focus on basic HIV transmission and prevention and are summed to form an index of overall HIV knowledge (0-18) with non-responses and 'don't know' coded as incorrect.

Statistical analyses were conducted....Separate multivariable logistic regression models were built, one for the US and one for South Africa, using the dichotomous 'low knowledge' variable as our outcome."

Results showed both groups of respondents to be primarily of white race, homosexual sexual orientation, and having had sex with only men. "Median knowledge scores were 16/18 correct for both cohorts, with 13.4% (59) and 17.1% (197) respondents in South Africa and the United States correctly responding to all 18 knowledge questions, respectively."

The following factors were associated with low knowledge:

• Men with less than 12 years of education
• Men never HIV tested.
• Unemployed South African MSM
• South African MSM not using condom-compatible lubrication
• Small South African personal networks - "For each ten point increase in the number of gay or bisexual friends known, the odds of scoring low on HIV knowledge decreased 11% (p = .024)."
• Decreasing pride and acceptance of homosexuality among US MSM
• Youth and age in the US - "Compared to US MSM age 25-29, those age 18-24 and 50+ were 2.3 (p = .002) and 3.2 (p<.001) times as likely to score in the lowest quintile on knowledge scores, respectively."
• Race as a construct - "Compared to white non-Hispanics, Hispanics were 1.9 times as likely to score low on HIV knowledge (p = .018)."

The study concludes that those developing programmes for MSM in South Africa might consider focusing educational services towards MSM who have lower education levels, less integration into gay or bisexual communities, no HIV testing history, limited use of condom-compatible lube, and who are unemployed. In the United States, Hispanic MSM, those who have low pride and acceptance of homosexuality, those who have not tested for HIV, those with less than a high school education, and those aged 18-24 or over 50 may be at risk for gaps in HIV knowledge.