According to researchers these findings highlight the need for HIV prevention messages regarding men who have sex with men in South Africa to be mainstreamed with prevention messages for the general population. It also means that sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence.
The researchers, led by Rachel Jewkes from the South African Medical Research Council, reached these conclusions by conducting a survey involving 1 700 adult men from randomly selected households in the Eastern Cape and KwaZulu-Natal. The survey used technology that created a completely private and anonymous environment and included questions about the respondents’ lifetime history of same-sex experiences.
The authors found that 92 (5.4 percent of participants) reported consensual sexual activity (such as anal or oral sex or masturbation) with another man at some time during their life; 9.6 percent (162 men) reported that they had been forced to have sex with another man and three percent reported that they had perpetrated sexual violence against another man.
Furthermore, most of the men who reported consensual sex with men also stated that they had a current female partner. Men who reported consensual oral or anal sex with a man were also more likely to be HIV positive than men without such a history.
“Our estimates of any consensual sexual activity between men, including consensual oral or anal sex, are consistent with reports from other developing countries although we were unable to locate comparable population-based data from Africa,” the authors say.
“Male–female concurrency was common among [men who have sex with men] in these data, suggesting that prevention messaging about the risks associated with male to male sex needs to be mainstreamed into HIV prevention messaging for the general population in a way that does not invite homophobic stigmatisation.
“Also required are further efforts to promote access to post-rape services for male survivors of sexual violence,” the authors report.
In an accompanying comment, Jerome Singh from the University of Kwazulu-Natal, says who was not involved in the study: “[This] paper highlights several important findings, including that HIV prevalence amongst South African [men who have sex with men] also has public health implications for South African women, given high levels of bisexuality and sexual concurrency amongst South African [men who have sex with men].
“Assuming these findings are generalisable to the rest of sub-Saharan Africa, addressing the health needs of African [men who have sex with men] will require policymakers to meaningfully address significant socio-cultural and legal barriers that hinder access by [men who have sex with men] to HIV-related health services,” Singh adds.