South African women with AIDS conspiracy beliefs half as likely to use condoms

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In Cape Town, African women who think that AIDS is man-made are half as likely as other African women to have used a condom during their most recent sexual encounter, researchers report in the journal AIDS and Behavior. In addition, African men who believe that HIV is harmless while antiretroviral drugs are harmful are half as likely to use condoms as other men.

There are important differences in the findings for men and women, which suggests that gender is crucial to understanding AIDS conspiracy and denialism in South Africa.

A previous ethnographic study has also found that the attribution of blame for HIV and AIDS expressed the different concerns of men and women. Women’s accounts centred on the domestic context, whereas men - who had had greater exposure to international economic and political forces beyond their control - tended to blame more distant agents such as scientists, governments, soldiers and Americans.

Glossary

odds ratio

Comparing one group with another, expresses differences in the odds of something happening. An odds ratio above 1 means something is more likely to happen in the group of interest; an odds ratio below 1 means it is less likely to happen. Similar to ‘relative risk’. 

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

representative sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

depression

A mental health problem causing long-lasting low mood that interferes with everyday life.

For the current study, Eduard Grebe and Nicoli Nattrass analysed responses to the 2009 Cape Area Panel Study, a cross-sectional survey of young adults aged 19 to 29 in metropolitan Cape Town. They believe their sample is broadly representative of urban Africans and coloureds of the age group in this area.

A total of 2901 individuals took part, 45% of whom were described as African, 49% as coloured and 5% as white.

Respondents were asked if they agreed or disagreed with three statements associated with AIDS conspiracy beliefs - that AIDS was invented to kill black people, that AIDS was created by scientists in America and that AIDS was deliberately created by humans. Individuals who agreed with more than one statement were considered to have AIDS conspiracy beliefs.

Whereas only 2.6% of non-Africans held conspiracy beliefs, one in five (19.7%) of young adult Africans did so.

The rest of the results we report only concern the 735 African women and 578 African men in the sample. Moreover, they are statistically significant results from multivariate analysis, which is adjusted for confounding factors.

Among African women, holding conspiracy beliefs was associated with lower levels of education and lower household income, but there was no clear association with employment or age. Members of religious organisations were half as likely to have conspiracy beliefs as other women.

However, women who had scored highly for psychological distress (frequent experience of nervousness, hopelessness, worthlessness, depression etc) were twice as likely to hold conspiracy beliefs as other women (odds ratio 2.52, 95% confidence interval 1.33 to 4.76).

There were very strong correlations between beliefs in witchcraft, beliefs in the importance of initiation rituals for men and AIDS conspiracy beliefs.

Women who had never heard of the Treatment Action Campaign (a group which has campaigned vigorously against conspiracy theories) were three times as likely as others to hold conspiracy beliefs. On the other hand, women who often got news from TV, radio or newspapers were actually more likely to hold conspiracy beliefs than others.

Whereas the researchers identified a number of factors that are associated with women holding conspiracy beliefs, the picture is less clear-cut for African men. For the majority of the factors previously cited, there were no statistically significant associations between the factors and having conspiracy beliefs.

However the association with psychological distress was equally important (odds ratio 3.01, 95% confidence interval 1.41 - 6.41).

And whereas women who got news from the TV, radio or newspapers tended to hold conspiracy beliefs, men using the media are less likely to hold these beliefs.

AIDS beliefs and condom use

Respondents were asked whether a condom had been used during their last sexual encounter. In terms of conspiracy beliefs, the picture is once again different for African women and men.

Women holding conspiracy beliefs were half as likely as other women to have used a condom (odds ratio 0.55, 95% confidence interval 0.32 to 0.94).

For African men, the results were not statistically significant (odds ratio 0.84, 95% confidence interval 0.47 to 1.51).

Beliefs about AIDS denialism were also assessed during the survey. Respondents who believed both that HIV is harmless and that antiretroviral drugs do more harm than good were classed as having AIDS denialist beliefs, and this was the case for 18.4% of African respondents.

Whereas there were no associations between AIDS denialism and condom use for women, men with denialist beliefs were half as likely to have used a condom the last time they had sex (odds ratio 0.45, 95% confidence interval 0.26 to 0.77).

This study builds on previous South African research which demonstrated that AIDS conspiracy beliefs were associated with lower rates of HIV testing. The current authors note that “political divisions over AIDS continue to matter via their negative impact on safe sex”.

References

Grebe E & Nattrass N AIDS Conspiracy Beliefs and Unsafe Sex in Cape Town. AIDS & Behavior, online ahead of print 2011. DOI 10.1007/s10461-011-9958-2. Click here for the free abstract.