Background: There is often limited focus on the vulnerabilities men face in their lives - either as key public health issues or as they link to HIV transmission. We examined such vulnerabilities and their association with HIV risk behaviors among men in Durban, South Africa.
Methods: We surveyed 962 men ages 20-40 recruited at community ''hot spot'' venues (n=649) and at HIV service sites (n=313) in two informal settlements in Durban, from May-September 2017. Adult experiences of violence and of deprivation, and childhood experiences of abuse and of parental absence, were each measured with sets of 2-4 items. Alcohol abuse was measured by the AUDIT-C; depression by the PHQ4 scale (alpha=0.81).
Results: Respondents'' average age was 28; 15% were married/cohabiting. On average respondents had 3.7 sexual partners in the last year, and 14% used condoms consistently with their last three non-marital partners. About 40% had ever witnessed an armed attack, been robbed at knifepoint/gunpoint, and had felt close to death. Before age 18, 77% had been beaten physically at home (14% ''very often''), 21% had seen/heard their mother being beaten by her husband/boyfriend, 42% were not raised by at least one biological parent, and 37% had lost a parent. Half (52%) abuse alcohol, and 30% were moderately or severely depressed. In multivariate analyses, adult experiences of violence (p=0.001) and of deprivation (p=0.001), and childhood experiences of abuse (p< 0.05), were each associated with having multiple sexual partners in the last year. Childhood experiences of abuse and of parental absence were associated with less consistent condom use (p< 0.05 and p< 0.01, respectively). Parental absence was also associated with having more age-disparate partners (p< 0.05). Men who abused alcohol had more partners in the last year (p< 0.001) and more highly age-disparate partners (p< 0.01). Depression was also associated with having more partners (p< 0.05).
Conclusions: Men in Durban are experiencing serious vulnerabilities including depression, alcohol abuse, and childhood and adult experiences of deprivation and violence. Each of these factors had direct effects on key HIV risk behaviors. Interventions should focus on reducing such vulnerabilities, to promote wellbeing and to curtail the HIV epidemic.