An online survey conducted by the OUT Lesbian, Gay, Bisexual, Transgender and Inter-sex network in 2007 shows that 15 ‘€“ 20% of men in South Africa, which translates to about 1.8 million men, have sex with other men. Non-governmental organizations and activists have cautioned that this is a high-risk group and its continued marginalization in national AIDS programmes poses a threat to making real progress in addressing AIDS. So far, programmes in South Africa, largely driven by the National Strategic Plan for HIV and AIDS, have been designed to respond to what has been described as a ‘€œgeneral heterosexual epidemic’€. This is of concern to Dr Oscar Radebe, a medical officer with Health for Men, an NGO that offers health services to men.      

‘€œWhat we know is the National Strategic Plan, which is expiring next year, has projections around what our targets are in terms of prevention. But, unfortunately, we haven’€™t reached any targets in terms of MSM. We’€™ll never get to bringing down the prevalence of HIV if we don’€™t target a group that is most vulnerable, who cannot access any kind of service. We’€™ve come a long way with the struggle. I think this is another struggle that we have to look at in a different manner’€, Radebe says.

Chairperson of the Treatment Action Campaign, Nonkosi Khumalo said the struggle for inclusion of men who have sex with men in government AIDS programmes will be taken up. She describes their exclusion as ‘€œa violation of human rights’€.

‘€œWe can’€™t live in a space where we ideally think these groups do not exist ‘€“ there are no men that are having sex with men. Activists will continue to push for the recognition of these rights because HIV is not HIV on its own. HIV thrives because there is a high rate of violation of human rights in the African region’€, says Khumalo.

Director of the support team of the Joint United Nations Programme on HIV/AIDS in eastern and southern Africa, Professor Sheila Tlou, reiterated Khumalo’€™s argument on human rights.

‘€œThose are still neglected in a lot of the countries, mainly because in those countries we still have very punitive laws that criminalize such behaviours. The problem becomes that such groups then go under-ground and they have the right to access HIV prevention, treatment, care and support services just like the other members of society. It’€™s really a question of human rights’€.

Gay people and men who have sex with men in Africa have been under threat. For instance, on the one hand Uganda has policies that are discriminatory on lesbians and gays, while Malawi has prosecution laws. On the other, South Africa has a Constitution that protects the right to sexual orientation, yet is lacking in implementing the right. This is evident in the prejudicial nature of our public health service in providing care to men who sex with men.

‘€œWe’€™ve identified a group that is at risk. But, now, what do we have for them? How do they access any kind of preventative methods? Do they actually have any preventative methods because, remember, the closest thing that they could get is to the clinic, where there are so many barriers?’€ , says Dr Radebe of Health for men.

Radebe says government health services have failed to acknowledge and to understand men who have sex with men.    

‘€œIt could be a straight or married man who will sleep with another man. If they test positive it’€™s difficult for them to actually access services. They get judged a lot. They get stigmatised’€, he says.

He adds that health care workers need to be sensitized around dealing with this community of men.

‘€œIt’€™s a different approach and it’€™s not throwing this to the health care workers to say, ‘€˜you are forced to actually do this’€™; it’€™s part of what we are trained to do. Already you are in the setting where you’€™re providing services. But you’€™ve got to realize that you’€™ve got to learn more about your client in a different perspective because you’€™ve got a new epidemic that is coming in, a new obstacle that doesn’€™t want to bring down HIV prevalence. We need to try and talk about HIV in that context with health care workers and the Department of Health and integrate MSM programmes and training’€.

Deputy Health Minister, Dr Gwen Ramokgopa, pointed out that the Bill of Rights in the Constitution guarantees rights to all regardless of sexual orientation. She also acknowledged that the country needs to go a long way to ensure that health services implement this right.      

‘€œWe still need to ensure that the stigma that is there in society is also dealt with so that it shouldn’€™t be that you’€™re respected and/or you have access to services based on one sexual orientation or the other. And, indeed in the case of HIV and AIDS, men having sex with other men are identified as one of the high risk groups, so we need to extend services there. Many men who have sex with men are family members. They are even married to women. They have children and all that. It’€™s important that we look at high risk situations and we become as scientific as possible and as humane as possible in terms of tackling the epidemic’€, Ramokgopa said.