Factors influencing the adoption of HIV prevention measures in low socio-economic communities of inner-city Durban, South Africa

Abstract

South Africa is the epicentre of the HIV pandemic. Although there have been health promotion education campaigns to reduce HIV  incidence, these have not achieved the desired outcomes. When exploring the effectiveness of these campaigns, it is useful not only to  examine HIV knowledge, but also to explore the relationship between that knowledge and health-related behaviour. This study aimed to  determine the (1) level of knowledge of HIV prevention, (2) relationship between the level of knowledge and the adoption of these  behaviours and (3) barriers to sexual behaviour change of vulnerable women in Durban’s city centre, KwaZuluNatal, South Africa. A  mixed methods approach was used to collect information from a marginalised population of women (n = 109) attending a non- governmental organisation, which provides for the needs of people from low socio-economic strata. Data were collected during  September 2018 at a wellness day programme at the centre. A total of 109 women, over the age of 18 years answered the questionnaire.  Knowledge of HIV transmission was high, with majority of participants correctly identifying modes of transmission. Almost all the  participants (91.2%) had been tested for HIV, with 68.8% tested a minimum of three times. Despite this, sexual risk behaviour was high.  Despite the high level of knowledge of HIV transmission, there was no relationship between HIV knowledge and adoption of behaviours  for the prevention of HIV transmission (p = .457). However, bivariate analysis showed an association between transactional sex and living  in informal housing (OR = 31.94, 95% CI: 5.65–180.63, p < .001). Living in informal housing was also associated with having multiple  current sexual partners (OR = 6.30, 95% CI: 1.39–28.42, p = .02). Multivariate analysis, after adjusting for all other factors, indicated that  the odds of having transactional sex was increased by 23 times in those who did not have formal housing (OR = 23.306, 95% CI: 3.97– 144.59, p = .001). Qualitative responses showed that women perceived poverty as the overarching factor determining the lifestyle choices  which impacted their health. They indicated a need for employment opportunities and provision of housing to alleviate both poverty as  well as transactional sex. Although, participants from this study understood the benefits of the protective behaviours to prevent HIV  transmission, economic and social factors do not afford this vulnerable group the opportunity nor the motivation to adopt such  behaviours. In the current climate of increasing unemployment and escalating GBV, urgent interventions are needed in terms of  employment opportunities and empowerment drives to prevent an increase in HIV transmission.