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HIV transmission is dependent on the route of acquisition, the infecting viral load and the presence of inflammation and activated immune system cells below mucosal surfaces.8 Addressing these factors lowers HIV transmissibility. Unprotected, especially receptive, anal sex remains a high-risk behaviour for HIV transmission with a transmission risk about 18 times higher than for penile-vaginal sex, and is a major driver of high HIV rates among MSM.9 IDUs who inject themselves with HIV-contaminated needles provide a direct access point for HIV, and established infection can therefore occur with relatively lower viral loads. CSWs are likely to transmit HIV if they become infected themselves because of the greater number of sex partners that they encounter. All these population groups benefit from targeted HIV programmes.

While research now highlights that men who have sex with men (MSM) in places such as South Africa are at particular risk of HIV infection, left relatively unexplored are potential relationships between one of the most pressing social issues affecting peri-urban MSM – namely homophobic stigma – and sexual risk-taking behaviour. Drawing on research from the Ukwazana baseline study of 316 township MSM in Cape Town we examine how homophobic stigma relates to psychosocial factors such as depression and self-efficacy and the risk activity of unprotected anal intercourse (UAI). By deploying cross-sectional association models, we examine a series of relationships between these variables and offer evidence to suggest that HIV prevention programmes aimed at sexual minority groups should be mindful of potentially complex relationships between social stigmas such as homophobia and sexual risk-taking behaviour.