Research Article

Trust as a Risk Factor: A Systematic Review of Unprotected Sex and HIV Transmission Among Men Who Have Sex with Men (MSM) in Sub-Saharan Africa

Ikekhwa Albert Ikhile 1 * , Azwihangwisi Helen Mavhandu-Mudzusi 2
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1 Department of Gender and Sexuality Studies, University of South Africa, Pretoria 0001, South Africa2 College of Human Sciences, University of South Africa, Pretoria 0001, South Africa* Corresponding Author
International Journal of Social Sciences and Artistic Innovations, 5(4), December 2025, 25-36, https://doi.org/10.35745/ijssai2025v05.04.0019
Submitted: 05 June 2025, Published: 30 December 2025
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ABSTRACT

Men who have sex with men (MSM) in sub-Saharan Africa continue to bear a disproportionate burden of HIV, a reality shaped not only by biological and structural determinants but also by intricate interpersonal dynamics. Among these, trust within intimate relationships has emerged as a critical yet understudied factor influencing sexual risk-taking. This systematic review explores the role of trust as a potential risk factor for unprotected sex and HIV transmission among MSM in sub-Saharan Africa. A comprehensive literature search was conducted across six databases: PubMed, Scopus, Web of Science, Embase, PsycINFO, and African Index Medicus, using a combination of keywords related to MSM, trust, unprotected sex, and HIV. Studies published between 2000 and 2024 were screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. From an initial pool of 640 records, 64 full-text articles were assessed for eligibility, and 12 studies met the inclusion criteria for final synthesis. The findings indicate that trust often motivates the decision to engage in condomless sex, particularly in perceived monogamous or emotionally intimate relationships. However, this trust is frequently misplaced, leading to increased vulnerability to HIV, especially in contexts marked by stigma, criminalisation, and limited access to affirming healthcare services. The review underscores the need for HIV prevention strategies that consider the emotional and relational dimensions of sexual behaviour among MSM. Integrating couple-centred interventions and culturally sensitive messaging around trust and sexual health may enhance risk reduction efforts and improve health outcomes in this marginalised population.
Keywords: HIV, MSM, Trust, Condomless sex, Sub-Saharan Africa, Prevention

CITATION (APA)

Ikhile, I. A., & Mavhandu-Mudzusi, A. H. (2025). Trust as a Risk Factor: A Systematic Review of Unprotected Sex and HIV Transmission Among Men Who Have Sex with Men (MSM) in Sub-Saharan Africa. International Journal of Social Sciences and Artistic Innovations, 5(4), 25-36. https://doi.org/10.35745/ijssai2025v05.04.0019

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