HIV risk among male security guards in the Kampala Metropolitan Area: Theory, perception, and associated factors

Abstract

Introduction: Despite being characterised among priority populations at high HIV risk in Uganda, male security guards' HIV risk and associated factors are not documented. Objective: To develop a grounded theory of HIV risk and reduction and determine the perception, prevalence and associated factors of HIV risk among male security guards in the Kampala metropolitan area. Methods: An exploratory sequential mixed methods approach employing grounded theory qualitative and cross-sectional quantitative designs. Male security guards ≥18 years old, employed in private security firms >6 months, in the Kampala metropolitan area, were enrolled. The grounded theory study entailed 56 interviews, nine focus group discussions and memoing techniques and employed manual inductive content and constant comparative analysis. For the quantitative study involving 594 men, the dependent variable was high HIV risk. Data were analyzed using survey and multi-level mixed effects Poisson regression analysis. Results: Four core domains emerged for the risk of HIV including (i) sociosexual practices (ii) risky behavior, (iii) workplace environment (iv) and misinformation. Several risk reduction strategies have been identified. Individual strategies for HIV prevention include staying faithful to a partner, regular testing, reducing alcohol consumption, using condoms, and adopting behavioral changes. Interpersonally, open communication, workplace testing, and mandatory testing are crucial. Organizationally, programs, community testing, mass sensitization, and community activities are recommended. Policy-level focus is on improving access to biomedical HIV prevention methods and enhancing services. The prevalence of actual and perceived high HIV risk was 92.3% [95%CI 89.8-94.3] and 63.3% [95%CI 59.8-66.8] respectively. The Spearman’s rho correlation coefficient was 0.005 with a p-value 0.9043 for the H0 that the actual and perceived HIV risk are independent. HIV testing [aPR= 0.97, 95%CI 0.95- 0.99, p= 0.027], knowledge of partner’s HIV status [aPR= 1.05, 95%CI 1.01- 1.09, p= 0.015], alternative HIV prevention methods [aPR= 0.97, 95%CI 0.97- 0.97, p= <0.001], circumcision [aPR= 1.05, 95%CI 1.02- 1.09, p= 0.004] and living in shared housing [aPR= 1.04, 95%CI 1.02- 1.06, p= 0.001] were independent factors significantly associated with high HIV risk. Conclusions: There was a high actual risk of HIV among male security guards; there was no agreement between actual and perceived HIV risk. HIV risk was associated with HIV testing, knowledge of a partner's HIV status, circumcision, living in shared housing, and alternative HIV prevention methods. From the new grounded theory, male security officers are at a higher risk of contracting HIV due to sociosexual practices, risky sexual behaviors, workplace context, and misinformation about HIV testing and prevention. Prospective follow-up studies should be conducted to determine whether the HIV risk changes over time and which factors are associated with these changes.