High levels of HIV, low levels of treatment in gay men and trans woman in Johannesburg

15 July 2020

Around 40% of transgender women and gay men tested HIV positive in Johannesburg – but only a third are on treatment.

A study involving 300 transgender women and men who have sex with men, which was carried out in Johannesburg in 2017, found 37% were living with HIV but only around a third of those living with HIV were on treatment.

Most of those taking part in the study, recently published in PLOS One, were Black Africans born in Johannesburg. Most participants were cisgender men, although a substantial minority were trans women.

Study participants underwent HIV testing, plus viral load testing if HIV positive, and answered questions on socio-demographics, HIV testing history, and engagement in care.

Just over half (56%) of those who tested HIV positive said they were already aware of their status. Just under a third (30%) reported being on antiretroviral treatment (ART).

Just under half of those with HIV (47%) had suppressed viral loads, which is similar to the national average among men.

Of the 39 participants who reported being on ART, 10 were virally unsuppressed. Interestingly, 29 HIV-positive participants who said they had not been diagnosed before the study or did not report being on ART, were virally suppressed. This suggests some participants were reluctant to disclose their HIV-positive status to the research team.

Younger participants were less likely to be virally suppressed than older participants, emphasising the need for more youth-friendly testing and care.

Paying for sex using money, gifts or favours was strongly associated with being virally suppressed.

Just under two-thirds of HIV-negative participants (61%) said they had tested for HIV in the previous six months and around three-quarters (73%) reported testing in the last year. Around 5% of HIV-negative participants said they had never tested for HIV before.

HIV-negative participants were more likely to identify as bisexual or heterosexual than HIV-positive participants (40% vs. 12%).

Transgender women were less likely than cisgender men to have tested for HIV. Testing was associated with some awareness of increased HIV risk, including selling sex to men. But despite the fact that having a sexually transmitted infection (STI) increases the chances of getting HIV, having STI symptoms was not associated with HIV testing.

Public clinics or hospitals were the most commonplace for HIV-testing (favoured by 47% of those who had tested), followed by community HIV testing centres for the general public (favoured by 25%). Around 13% of those who had tested for HIV used a service specifically for men who have sex with men (MSM-specific).

Participants reported high levels of satisfaction with the privacy and respect they were shown across all HIV testing locations. Only 6% reported a future preference for HIV self-testing.

Public clinics were the most common place to receive HIV treatment and care (favoured by 76% of those on ART), followed by MSM-specific clinics (favoured by 18%), with a small proportion attending private clinics.

Around 90% of those on ART said they were satisfied with the privacy and respect they were shown while receiving HIV care, a level that rose to 100% among those visiting MSM-specific clinics.

Photo credit:
iStock/streetmuse. Photos are used for illustrative purposes only. They do not imply health status or behaviour of any individuals depicted.

Written by Hester Phillips