Background: Qualitative research has suggested that men''s lifetime experience of violence leads to HIV risk behaviors, but little quantitative evidence has demonstrated the same. We sought to test how experiencing or witnessing of violence in childhood and adulthood can influence HIV risk behaviors among men.
Methods: We conducted cross sectional surveys with 1,091 men ages 20-34 at informant-identified hot spot venues across 19 districts in Eswatini (covering all four regions of the country). Gender attitudes were assessed by the GEM Scale, and hazardous drinking by the AUDIT-C.
Results: Men were 26 years old on average, and 15% were married/cohabiting. Half (51%) were employed, and 62% had completed secondary school. Before the age of 18, 75% had been beaten at home (e.g., with a stick/whip) and 40% had been beaten often or very often; 22% had seen their mother being beaten by her partner. In adulthood, one-third (34%) had ever witnessed an armed attack, one quarter (25%) had ever been/felt close to death, and 18% had been robbed at gunpoint or knifepoint. These events were no more common in urban versus rural areas. Current hazardous drinking was 41%, and 36% of all respondents had multiple sexual partners in the last year. In multivariable analyses controlling for demographic characteristics, experiencing/witnessing violence as a child, or as an adult, were associated with increased odds of current hazardous drinking (respectively: aOR=1.4 (95%CI: 1.0, 1.9), p< 0.05; aOR=2.3 (95%CI: 1.8, 3.1), p< 0.001). Experiencing/witnessing violence as an adult was also associated with having a higher number of sexual partners in the last year (p< 0.01) and with endorsing more inequitable gender norms (p< 0.001).
Conclusions: The majority of men in this study across Eswatini experienced or witnessed violence as children and as adults. These experiences were significantly associated with increased HIV risk behaviors and endorsement of inequitable gender norms. To reduce HIV risk for both men and their partners, it is imperative to prevent these traumas from occurring and increase opportunities for men and boys to cope with past traumas.