OUT LGBT Well-being recently hosted a specialist seminar in Johannesburg focused on key gaps in health services for gay, bisexual and other men who have sex with men (MSM).
Held on 22 September in Rosebank, the event, titled “Advancing Men Who Have Sex With Men (MSM) Health Seminar: Beyond the Basics”, brought together around 40 public health professionals and advocates.
OUT Executive Director Dawie Nel said the organisation has provided sexual health services to MSM in Johannesburg since 2019 and hoped to share its expertise and experience with the public health sector following the funding-related closure of MSM-specific clinics.
“We’re trying to move our MSM clients into the public health system, and in that process, we want to equip facilities to see our clients in a competent and sensitised way, with the hope that MSM continue to receive services,” he explained.
The seminar focused on two key areas: sexually transmitted infections (STIs), particularly undiagnosed asymptomatic STIs, and sexualised drug use, known as chemsex, and its associated health risks and demands.
The Hidden Risk of Asymptomatic STIs
Dr Elaine Saayman, who works with Sediba Hope Medical Centre and OUT’s +DR medical practice in Pretoria, offered an in-depth presentation on the importance of screening and testing for asymptomatic STIs.
She highlighted that healthcare providers in South Africa typically do not test patients for STIs unless they have obvious symptoms. Saayman also provided details about the use of Doxy-PEP as a preventive measure for syphilis, chlamydia and gonorrhoea.
Doxy-PEP involves an individual taking a dose of doxycycline (Doxy), a widely used antibiotic, within 72 hours of engaging in unsafe sex to help prevent these STIs from taking hold.
In May, the World Health Organization (WHO) recommended the use of Doxy-PEP for MSM and transgender women who have a high risk or recent history of bacterial STIs, but healthcare providers rarely prescribe it in South Africa.
Saayman further provided information about HPV-related cancer prevention, including HPV vaccines, and the importance of incorporating anal health into routine primary care for MSM — an area that often receives insufficient attention.
Research Shows High STI Rates Among MSM
Dr Etienne Muller, a principal medical scientist at the National Institute for Communicable Diseases (NICD), strengthened Dr Saayman’s call for wider testing for asymptomatic STIs among MSM by presenting results from 2023 research conducted with OUT’s assistance on the prevalence of STIs within this group.
The study found that 15% of MSM who showed no symptoms tested positive for an STI.
Reinforcing these concerns, recent data from the Gauteng Department of Health also showed that the percentage of men with STIs in the province rose from 12% in 2020 to 15% in 2023.
Chemsex and Harm Reduction Spark Debate
Finally, the seminar tackled the often-controversial topic of MSM who engage in chemsex (MSMC).
OUT Social Worker Hulisani Mudzanani presented the organisation’s work among a group of HIV-positive MSMC in Soweto. The programme used a targeted harm reduction approach — focusing on reducing risk rather than abstinence — which resulted in a significant increase in participants remaining on their HIV treatment.
The presentation sparked spirited debate among participants about how the public health sector could implement a harm reduction strategy while substance use remains criminalised and presents a moral quandary for some.
Calls for Broader Sexual Health Services
Jay Matlou, Programme Manager at Access Chapter 2, said the seminar made a valuable contribution towards broadening sexual health services for MSM.
“As a country we’ve done a lot of work, incredible work around, you know, HIV, TB and so forth, but STI information, there’s a bit of relaxation around that, and I think we need to volume that up and integrate STI information into the mainstream,” he said.
Matlou added: “It’s very important to have conversations focusing on MSM health because we’re still in an ongoing struggle around MSM people accessing healthcare, comprehensive healthcare services, due to stigma.”
The seminar highlighted that expanding access to healthcare for MSM requires more than simply moving patients into mainstream services. It also means ensuring those services are equipped to respond to their specific health needs — from asymptomatic STIs and anal health to chemsex and harm reduction — without stigma or judgement.
As specialised MSM services become less available, that challenge is becoming increasingly urgent and the message clearer: Access to healthcare means little if people do not feel understood, respected and safe enough to use it.
