Dr. Mmatsie Manentsa believes men who sex with other men (MSM) have been marginalised and excluded from the main message of HIV prevention. That is what drew her to MSM health issues. She has worked hard to educate her colleagues about MSM and to make Zuzimpilo a MSM-friendly clinic.
‘There are a whole lot of issues surrounding being MSM. They go through a lot of discrimination and stigma and have a lot of psychological problems because of that. There are high rates of drug addiction, high rates of anxiety and depression in MSM groups, and added to this, when an MSM is HIV-positive, they have to deal with the added stigma of HIV’, says Dr. Manentsa.
She says there are many misconceptions surrounding men who have sex with men.
‘I think many of us have misconceptions, MSM are not the biggest carriers of HIV. It is just that anal sex holds the biggest risk of infection, whether it is a man and another man engaging in anal sex or a man and a woman engaging in anal sex. Those are some of the misconceptions that are out there, even amongst professionals. It’s not true that MSM are the biggest carriers of HIV’, says Dr. Manentsa.
She explained the risk of anal sex.
‘There are a lot of things that make anal sex risky. First of all, the rectum or the anus does not have much lubrication, so, anal sex leads to a lot of tears which can lead to easier transmission of HIV. Secondly, anal sex leads to higher risk of certain STIs – things like HPV infection which causes anal warts, herpes infection, which will lead to an increased risk for HIV’, says Dr. Manentsa.
She warned that Medical Male Circumcision (MMC) may not curb the risk of HIV in MSM. She says circumcision has no impact on the risk of receptive anal sex. The intervention has been shown to lower a man’s risk of contracting HIV through heterosexual sex.
‘The studies on medical male circumcision were done basically looking at transmission from female to male. So, when we talk about a 60% reduction, we are talking about a man getting HIV from a woman. If you look at the risks of anal sex’¦ they are very high and male circumcision does not seem protect against that’, says Dr. Manentsa.
Dr Manentsa believes men who have sex with men deserve targeted special clinical care.
‘They have risks that are different from your heterosexual patients. As a health professional, you need to be aware of their risk factors and be able to engage them in a language that does not alienate them. Otherwise, that patient might not come back to seek help because they have been treated in a way that does not respect them and their way of life’, says Dr. Manentsa.
She says men who have sex with other men, like every other population group, need to practise safe sex.
‘It is possible to have safe anal sex. It’s just that people need to be taught. The first step would be to use a condom, use lubrication – and the correct type of lubrication because there are differences – and, basically, changing the behaviour of multiple sex partners’, concludes Dr. Manentsa.