(PS6-A15) Effects of Masculinity Norms and Alcohol Use on Hiv-positive Men’s Adoption of COVID-19 Risk Reduction Behaviors in Cape Town, South Africa

Introduction: Throughout the COVID-19 pandemic, adoption of behavioral measures to reduce viral transmission has been essential. For people living with HIV, vulnerability to severe COVID-19 disease may be higher due to poorer immune system functioning, making protective measures (e.g., mask wearing, reducing contact with others) particularly important. For men living with HIV, greater identification with certain masculine norms may inhibit the uptake of protective behaviors. Similarly, alcohol use problems may also be a barrier to uptake of health behaviors that protect people from infection. The aim of the current study was to examine whether identification with masculine norms and greater alcohol use were barriers to adopting COVID-19 risk reduction strategies.

Methods: Data were taken from the baseline assessment of an ongoing cohort study examining HIV-positive men’s engagement in HIV care. Men (N=24) were provided with 11 possible COVID-19 risk reduction behaviors, such as wearing a mask in public, staying away from public places, avoiding large groups, and not attending funerals. The outcome variable was the total number of risk reduction behaviors endorsed. Predictors were (1) self-reliance and risk-taking subscales of the Conformity to Masculine Norms Inventory, given their theoretical relevance to the outcome; and (2) the alcohol subscale of the Alcohol, Smoking, and Substance Involvement Screening Test. Higher scores indicated greater conformity to masculine norms and more alcohol use. Data were analyzed using a linear regression model.

Results: Men endorsed on average four COVID-19 protective measures (range 1- 6), with wearing masks in public places and staying indoors as the most common. Regression analysis results indicated that the overall model predicting number of COVID-19 risk reduction behaviors was significant (p=.01); predictors accounted for 30.1% of the variability in the outcome. Higher alcohol intake was significantly associated with adopting fewer COVID-19 protective behaviors (β = -.11, p=.006). Similarly, greater conformity to the risk-taking masculinity norm subscale was marginally associated with adopting fewer protective measures (β = -.31, p=.06).

Discussion: Greater alcohol use and identification with risk-taking norms were associated with adopting fewer COVID-19 risk reduction strategies in this sample of HIV-positive men. If findings continue to replicate in a larger sample, strategies that address alcohol use and risk-taking norms may be needed to help this group of men adequately protect themselves from COVID-19.