title: Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland.
abstract: Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using "high," "medium" and "low" levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1-1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1-3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.
authors.affiliation: a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Grover
authors.affiliation: a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Grosso
authors.affiliation: a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Sosthenes
authors.initials: S
authors.lastname: Ketende
authors.affiliation: b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: c Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA.
authors.forename: Virginia
authors.initials: V
authors.lastname: Fonner
authors.affiliation: a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Darrin
authors.initials: D
authors.lastname: Adams
authors.affiliation: d Rock of Hope , Mbabane , Swaziland.
authors.forename: Bhekie
authors.initials: B
authors.lastname: Sithole
authors.affiliation: e Swaziland National AIDS Program , Mbabane , Swaziland.
authors.forename: Zandile
authors.initials: Z
authors.lastname: Mnisi
authors.affiliation: f HealthPlus 4 Men , Mbabane , Swaziland.
authors.forename: Sibusiso Lulu
authors.initials: SL
authors.lastname: Maziya
authors.affiliation: a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D013541:Eswatini / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012747:Sexual Partners; D066270:Social Capital; D058992:Social Participation; D011795:Surveys and Questionnaires
keywords: HIV testing; MSM; Social cohesion; Swaziland; social participation