Background: Adolescent girls and young women (AGYW, ages 15-24) are at high risk of HIV in South Africa. Context-specific data on characteristics, HIV risk and health-seeking behaviors of male partners of AGYW are sorely needed to develop more effective HIV programs.
Methods: We surveyed 962 men ages 20-40 recruited at community ''hot spot'' venues (n=649) and HIV service sites (n=313) in two informal settlements in Durban, from May-September 2017. We present descriptive and regression analyses of men''s characteristics and their partnership and service-use experiences.
Results: Men''s average age was 28, 15% were married/cohabiting, and 61% were employed. Over two-thirds (71%) reported two or more sexual partners in the last year; 24% had five or more. Overall, 75% had AGYW partner(s); 54% had both AGYW partners and partners age 25+. Men''s last three partners were 3.4 years younger on average; 8% had partners 10+ years younger. Thirty-two percent reported consistent condom use with their last partner; 14% with each of their last three non-marital partners. Sixty-four percent reported HIV testing in the last year. Among HIV-positive men (n=84), 87% were on treatment, and 24% knew that they were virally suppressed. In multivariate analyses controlling for demographic characteristics, men with more sexual partners in the last year were more likely to have a technical college/university education (p< 0.05), be employed (p=0.01), and be small business owners/entrepreneurs (p< 0.01). Taxi drivers had more age disparate partners (p< 0.001) as well as more partners ages 15-19 in the last year (p< 0.05), and were less likely to have tested for HIV (p< 0.05). Formally employed men were about half as likely to be virally suppressed as informally or unemployed men (p< 0.05).
Conclusions: Men in informal settlements in Durban are at very high risk of both acquiring HIV and transmitting to AGYW due to high numbers of partners, overlapping partnerships of AGYW and older women, inconsistent condom use, suboptimal testing, and low viral load suppression. Engaging men in primary HIV prevention and targeted health services is critical, and in Durban, focusing on reaching men at workplaces, technical colleges/universities, taxi ranks and self-owned businesses may yield the greatest results.