Background: Gender role inequalities and risky sexual behaviour among adult South African men may drive the HIV epidemic. Yet screening tools on how to identify men at greater risk for HIV are limited.
Methods: We assessed whether traditional beliefs on gender roles were associated with high risk sexual behaviour. Cross-sectional data from a parent study (Imbizo) was used. Enrolment for “Imbizo” took place over two years. In year one (1 April - 30 September 2014), we measured characteristics of men presenting for medical male circumcision (MMC). In year two (22 June - 30 November 2015) we implemented an exclusive intervention strategy to increase the number of men (25 to 49 years) presenting for MMC. We analysed behavioural risk data from enrolled men, and controlled for the year of enrolment. Structured questionnaires were administered to men (aged 18 to 49 years) who were eligible for circumcision and able to communicate in one of the study-approved languages. The questionnaire included demographic information, relationship status, sexual partner history, condom use, sexual debut and a scale on gender roles. Men were categorized as having either “traditional (male dominance in relationships)” or “progressive (gender equality)” beliefs on gender roles.
Results: A total of 3,836 men were screened and 2,813 (73.3%) included. Overall median age was 26 years (interquartile range 21-31 years). Reliability of the gender roles scale was 0.6. Men with traditional beliefs on gender roles were more likely to report concurrent multiple partners (Odds Ratio (OR) 1.7 [95% CI 1.2-2.3]; p< 0.01) and were unsure of their last partner''s HIV status (OR 1.4 [95% CI 1.2-1.7]; p< 0.01). Men who enrolled in year 2 (OR 0.8 [95% CI 0.7-0.9) and those ≥ 45 years (OR 0.4 [95% CI 0.2-0.8]; p< 0.01) were less likely to have traditional beliefs on gender roles.
Conclusions: Men with traditional beliefs on gender roles could be good candidates for HIV prevention programmes, as they engage in high risk behaviour. Men (25 - 49 years) with progressive beliefs could be targeted for MMC awareness campaigns. The gender roles scale could be used as a screening tool to identify men at high risk for HIV.