Poor mental health caused by stress can lead men who have sex with men (MSM) to engage in higher HIV-risk behaviour, including having unprotected sex, multiple sexual partners and substance abuse.

A new study, designed to reduce the risk of contracting HIV among MSM in South Africa and Namibia, highlighted the stress MSM experience through stigma and social isolation. 

It found that counteracting these stressors by building healthy coping mechanisms could reduce HIV transmission, counteracting behaviours placing MSM into a high-HIV-risk category.

The research was conducted by the Human Sciences Research Council (HSRC) in partnership with the Gay and Lesbian Network in KZN and Positive Vibes in Namibia.

Minority stress is chronic stress experienced by a stigmatised minority group, such as MSM exposed to homophobic social environments. The MSM who participated in both countries, reported similar stressors despite legal protections for MSM in South Africa not existing in Namibia. Minority stress in MSM was examined during in-depth interviews to learn more about their coping mechanisms.

Defence mechanisms included denial, concealing sexual orientation and pretending to be straight, to reduce pressure felt to conform. Substances were often used to lessen inhibitions when exploring sexuality and reduce pain during intercourse.

Interviewers of 27 MSM couples (16 in Namibia and 11 in South Africa) identified key HIV-risks, relationship challenges and defence and coping mechanisms. MSM couples experience similar challenges to opposite-sex couples including communication difficulties, infidelity, and abuse. However, the different context increases MSM’s susceptibility to anxiety and fear of discrimination. Consequently, MSM may rely heavily on their partner’s emotional support. Regular challenges are exaggerated by the hostile environment in which MSM must live and love.

Good mental health is critical to healthy coping mechanisms and the research established four strategies that could help MSM deal with minority stress.

These are, developing open communication to foster commitment and relationship planning. Secondly, clearly defined sexual agreements could reduce risks associated with infidelity.

Thirdly, building resilience against stigma and discrimination through the support of a partner may lessen anxiety and isolation. Finally, finding safe spaces to express their love freely can support mental health and reduce HIV risk-taking behaviour.