title: Characterizing the Individual, Social, and Structural Determinants of Condom Use Among Men Who Have Sex with Men in Swaziland.
abstract: Within the broadly generalized HIV epidemic in Swaziland, men who have sex with men (MSM) have specific HIV acquisition and transmission risks. In the current era of expanding antiretroviral therapy-based prevention and treatment approaches, condom use remains a core component of mitigating these risks. A cross-sectional study characterizing the vulnerabilities for HIV among MSM in Swaziland was analyzed to describe factors associated with condom use at last sex with a male partner. Bivariate and multivariate logistic regression analyses were conducted to assess correlates of condom use at last sex with both casual and regular male partners. Disclosure of sexual practices to a healthcare provider and being able to count on other MSM to support condom use were significantly associated with condom use at last sex with a causal and a regular partner, respectively. Reporting difficulty insisting on condom use was inversely associated with condom use at last sex with both regular and casual partners. In addition, having faced legal discrimination was similarly inversely associated with condom use at last sex with a regular partner. Condom use among MSM in Swaziland may increase with improved partner communication, provider sensitization to encourage sexual disclosure, and the promotion of safer sex norms within MSM communities. These approaches, in combination with existing and emerging evidence of informed and human rights affirming prevention and HIV treatment approaches may reduce the incidence of HIV among MSM in Swaziland and all those in their sexual networks.
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Carolyn Adele
authors.initials: CA
authors.lastname: Brown
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Ashley Lynn
authors.initials: AL
authors.lastname: Grosso
authors.affiliation: 2 Futures Group , Washington, District of Columbia.
authors.forename: Darrin
authors.initials: D
authors.lastname: Adams
authors.affiliation: 3 Rock of Hope , Mbabane, Swaziland .
authors.forename: Bhekie
authors.initials: B
authors.lastname: Sithole
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Sosthenes
authors.initials: S
authors.lastname: Ketende
authors.affiliation: 4 Population Services International , Mbabane, Swaziland .
authors.forename: Jessica
authors.initials: J
authors.lastname: Greene
authors.affiliation: 3 Rock of Hope , Mbabane, Swaziland .
authors.forename: Sibusiso
authors.initials: S
authors.lastname: Maziya
authors.affiliation: 5 Swaziland National AIDS Program , Mbabane, Swaziland .
authors.forename: Zandile
authors.initials: Z
authors.lastname: Mnisi
authors.affiliation: 3 Rock of Hope , Mbabane, Swaziland .
authors.forename: Xolile
authors.initials: X
authors.lastname: Mabuza
authors.affiliation: 1 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D013541:Eswatini; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D055815:Young Adult