Efficacy of Tailored Clinic Trainings to Improve Knowledge of Men Who Have Sex with Men Health Needs and Reduce Homoprejudicial Attitudes in South Africa.

PURPOSE: An urgent need exists for training on men who have sex with men (MSM) health needs at public health clinics across Africa. There is also a need to consider the impact of specific training for clinicians and clinic support staff, both of whom come into contact with MSM. Consideration must also be given to the relationship between two key outcomes of such training: increased knowledge regarding MSM and their health and reductions in homoprejudicial attitudes. METHODS: This article explores the impact of training for clinicians and clinic support staff in the Western Cape, South Africa (n = 196), where some training modules were undertaken by both groups and some modules only by clinicians. Participants were evaluated at baseline and post-training on MSM knowledge and homoprejudicial attitudes. RESULTS: After training, both clinicians and clinic support staff showed an increase in knowledge and a reduction in homoprejudicial attitude scores, with similar proportional improvements for both groups. Additional trainings for clinicians also resulted in significant improvements in their knowledge. However, reductions in homoprejudicial attitudes were related to the type of knowledge obtained. A threshold effect in post-training knowledge scores of 9 or greater on sensitivity material significantly increased the likelihood of a reduction in homoprejudicial attitudes. CONCLUSION: These findings show that training for both types of clinic workers is important and effective, but facilitators should be mindful of complex relationships between knowledge and homoprejudicial attitudes.

Homophobic stigma, depression, self-efficacy and unprotected anal intercourse for peri-urban township men who have sex with men in Cape Town, South Africa: a cross-sectional association model.

While research now highlights that men who have sex with men (MSM) in places such as South Africa are at particular risk of HIV infection, left relatively unexplored are potential relationships between one of the most pressing social issues affecting peri-urban MSM - namely homophobic stigma - and sexual risk-taking behaviour. Drawing on research from the Ukwazana baseline study of 316 township MSM in Cape Town we examine how homophobic stigma relates to psychosocial factors such as depression and self-efficacy and the risk activity of unprotected anal intercourse (UAI). By deploying cross-sectional association models, we examine a series of relationships between these variables and offer evidence to suggest that HIV prevention programmes aimed at sexual minority groups should be mindful of potentially complex relationships between social stigmas such as homophobia and sexual risk-taking behaviour.

An exploration into the role of depression and self-efficacy on township men who have sex with men's ability to engage in safer sexual practices.

Men who have sex with men (MSM) in South Africa remain at particular risk of HIV infection. The Ukwazana baseline survey is the first to explore this risk in relation to psychological factors associated with unprotected anal intercourse (UAI). A cohort of 316 MSM from township peri-urban Cape Town took part in the survey. The survey found that 55.2% had engaged in UAI over the preceding 6 months. Depression was significantly associated with UAI. Respondents with self-efficacy scores less than two standard deviations above the mean were also more likely to have engaged in UAI. A Sobel test for mediation highlighted that the depression-UAI association was partially mediated by self-efficacy, indicating that most of the effect of depression on UAI was not covarying with self-efficacy. This study, therefore, highlights that both depression and self-efficacy should be considered factors to be addressed in HIV-prevention programmes aimed at peri-urban MSM.