Putting MSM on the radar
Called Top to Bottom, the timing of the conference couldn’t be more appropriate. It’s just three weeks away from the 30th anniversary of the first-ever diagnosis of AIDS. In 1982, GRID or Gay Related Immune Deficiency was the first name proposed to describe what is known as AIDS today, as the condition was first seen among gay men in America. But soon after, the face of the epidemic changed from that of a gay man. It began to manifest in large numbers in general populations, with women becoming increasingly at risk. The condition was then renamed AIDS, Acquired Immune Deficiency Syndrome. The re-definition inadvertently led to the shift of focus away from gay men’¦ but with drastic consequences.
‘There has been no government-focused MSM prevention campaign. You don’t see bill-boards that talk about this. You don’t see programmes that talk about this. It is very much a neglected population. I think that some of it is understandable. I think that we moved so rapidly into a generalised epidemic where women were particularly at risk that that’s been the major focus. But I think MSM as a group have been neglected and have been left at very high risk and I think it’s time to stop that’ says Dr James McIntyr, Chief Executive Officer of Anova Health Institute, organizers of the conference.
But McIntyre believes that the government’s attitude on men who have sex with men or the MSM community will soon change. He draws the inspiration from the fact that Health Minister, Dr Aaron Motsoaledi, has agreed to give the keynote address at the conference.
‘That’s indicative of the Department of Health and the Minister’s personal response to MSM and recognising the need for programming. That’s very, very positive’, he says.
The winds of change are blowing. Perhaps even more encouraging is the response by the head of the South African National AIDS Council, Dr Nono Simelela, in a recent interview when asked what key issues the next National Strategic Plan on HIV and AIDS, which is currently being formulated, should address.
‘Men who have sex with men, women who are in relationships with other women but also have sex with men’ Simelela says.
‘Those groups exist. Let’s not pretend that those practices are not there. Let’s talk about them. We’ve got a liberal Constitution. The Constitution says people are free to express. And if those groups need care and support, let’s provide it. Let’s get our health providers trained on dealing with those things and provide care in a rights-based manner: respect the dignity of people, respect the rights of people and provide them with care in the best possible way’, she continues.
Anova’s Dr James McIntyre says HIV infection levels among men who have sex with men are growing. A few studies suggest that more than 30% of men who have sex with men in some of the country’s metropolitan areas are HIV-infected.
‘Rates are a little higher than we see in heterosexual men. There have been rates of 33%, 40% in one study. In the Soweto men study in young gay men under the age of 25, the rates were very high. We were approaching 40%. They looked almost like the rate that you see in young women, whereas, in general, young men in South Africa have a much lower rate of HIV’.
Some of the factors that drive the infection levels are peculiar to this community of men, and others are similar as in heterosexual relationships.
‘What drives infection, very often, is unprotected anal intercourse and that in turn relates often to either the lack of condoms, not having lubrication, which is an important issue for men. The government does provide condoms, but doesn’t provide lube. So, often people may use condoms but they will use it with oil-based lubricants where the condom may then develop holes and not work. There are issues around transactional sex as there are in the heterosexual community as well that is very often a survival tactic that we think drives it’, McIntyre says.
But more research needs to be done to determine the risk factors.
‘We are starting to investigate some research around violence within relationships and co-erced sex that we don’t know much about in this community at all. Men who have sex with men very often also have concurrent female partners. In one of the studies in Soweto of men who identified as having had sex with a man within the past year, 25% of them also had female partners. And so, we are not sure in this country of how much cross-over there is. Are these distinct epidemics or are these, in fact, epidemics that are fuelling each other? Understanding that and tailoring messages that those men can relate to, that protect them in whatever their sexual choices becomes important’, he adds.
The conference is the first gathering of its kind to discuss sexual health issues affecting gay men or men who have sex with other men on the African continent.
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