Format

Send to

Choose Destination
Health Place. 2018 Mar;50:98-104. doi: 10.1016/j.healthplace.2017.12.009. Epub 2018 Feb 3.

Context matters: Community social cohesion and health behaviors in two South African areas.

Author information

1
University of California San Francisco, Center for AIDS Prevention Studies, Department of Medicine, San Francisco, CA, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: sheri.lippman@ucsf.edu.
2
University of California, Berkeley, Division of Epidemiology, School of Public Health, Berkeley, CA, USA; Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, MA, USA.
3
University of California San Francisco, Center for AIDS Prevention Studies, Department of Medicine, San Francisco, CA, USA.
4
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
5
University of Washington, Department of Global Health, Seattle, WA, USA; International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa.
6
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Health, University of New England, Armidale, NSW, Australia; Wits Reproductive Health and HIV Institute (WRHI), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
7
Sonke Gender Justice, Cape Town, South Africa.
8
International Training and Education Center for Health (I-TECH) South Africa, Pretoria, Republic of South Africa.
9
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
10
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.

Abstract

BACKGROUND:

Understanding how social contexts shape HIV risk will facilitate development of effective prevention responses. Social cohesion, the trust and connectedness experienced in communities, has been associated with improved sexual health and HIV-related outcomes, but little research has been conducted in high prevalence settings.

METHODS:

We conducted population-based surveys with adults 18-49 in high HIV prevalence districts in Mpumalanga (n = 2057) and North West Province (n = 1044), South Africa. Community social cohesion scores were calculated among the 70 clusters. We used multilevel logistic regression stratified by gender to assess individual- and group-level associations between social cohesion and HIV-related behaviors: recent HIV testing, heavy alcohol use, and concurrent sexual partnerships.

RESULTS:

Group-level cohesion was protective in Mpumalanga, where perceived social cohesion was higher. For each unit increase in group cohesion, the odds of heavy drinking among men were reduced by 40% (95%CI 0.25, 0.65); the odds of women reporting concurrent sexual partnerships were reduced by 45% (95%CI 0.19, 1.04; p = 0.06); and the odds of reporting recent HIV testing were 1.6 and 1.9 times higher in men and women, respectively.

CONCLUSIONS:

We identified potential health benefits of cohesion across three HIV-related health behaviors in one region with higher overall evidence of group cohesion. There may be a minimum level of cohesion required to yield positive health effects.

KEYWORDS:

Alcohol; HIV testing; Health behavior; Sexual behavior; Social cohesion; South Africa

PMID:
29414427
PMCID:
PMC5962353
DOI:
10.1016/j.healthplace.2017.12.009
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center