Media

African men who have sex with men are ostracised from HIV services

20 July 2009 

Men who have sex with men (MSM) in sub-Saharan Africa are a hidden, stigmatised group which suffers from a high burden of HIV infection without access to appropriate public health provision, say Oxford University researchers in a review paper published in the Lancet.
Although there are many challenges in addressing this problem, the researchers identify a number of steps that African countries and the international community need to take in controlling HIV/AIDS in this marginalised but high-risk group.

Part of the problem is that there is little data on same-sex behaviour and HIV prevalence in sub-Saharan Africa. In reviewing the studies available on a large database of medical literature, the researchers found only 14 of 118 studies assessing HIV risks amongst sub-Saharan African men between 1984 and 2007 had asked men about same-sex behaviour as a potential risk factor.‘There is surprisingly little known about men who have sex with men and their HIV risks in most parts of sub-Saharan Africa,’ says Dr Adrian Smith of the Department for Public Health at the University of Oxford, who led the review. ‘There is a big gap in the available evidence. But what little evidence we do have suggests that MSM are a vulnerable group that exists across sub-Saharan Africa’.However, the situation is improving. In the past six years, studies have begun to look at levels of HIV infection among MSM groups in different African countries.

Dr. Smith says: ‘The research that has been done suggests that these men generally have much higher rates of HIV infection than heterosexual men, but have little or no access to appropriate sexual health care, such as health education, preventive counselling and sexually transmitted disease testing, treatment and care.’Attitudes to homosexuality in Africa compound the problem. MSM face political, religious and social hostility, and homosexuality is illegal in most African countries. Studies carried out across sub-Saharan Africa have reported MSM that have been isolated from their families and been harassed by authorities, including healthcare workers as well as police.‘The stigma keeps men who have sex with men at arms reach from HIV/AIDS prevention and care provision,’ adds Dr Smith.

Dr Smith and colleagues believe that health responses to HIV/AIDS everywhere need to understand more about the different groups they are dealing with. The gap in knowledge about high-risk groups in Africa, including MSM and drug users, needs to be filled. Ways of delivering interventions – condoms, lubricants, health education and counselling, and access to testing and treatment services – to MSM also need to be developed which are appropriate for the local context in each area of sub-Saharan Africa. And finally, the rights of MSM need to be addressed. The more social and legal protection that is given to marginalised groups, the more access to services will improve.

‘Men who have sex with men, as all other Africans, have the right to access and take benefit from HIV prevention, treatment and care. Some African states have started to recognize the issue, and are beginning to tackle the social and legal barriers that have excluded MSM to date. Those that succeed will deliver stronger HIV/AIDS control for MSM and everyone else,’ says Dr Smith.For more information please contact Dr Adrian Smith, Department of Public Health, University of Oxford on +44 (0)1865 289239 or adrian.smith@dphpc.ox.ac.ukOr the Press Office, University of Oxford on +44 (0)1865 280530 or press.office@admin.ox.ac.uk 

Notes to Editors

  • ‘Men who have sex with men and HIV/AIDS in sub-Saharan Africa’ by Adrian D Smith and colleagues from Oxford University, the Population Council in Accra, Ghana, and the Kenya Medical Research Institute in Kilifi is to be published online in The Lancet.
  • A press release from The Lancet, ‘Men who have sex with men in Africa: the forgotten part of the HIV pandemic’, has been sent out by the journal’s press office.
  • Men who have sex with men (MSM) is a term used by medical researchers to describe men who engage in sexual activity with other men, regardless of how they choose to identify themselves sexually and socially. It allows people’s behaviours to be described without considering their social identities, unlike terms such as gay, homosexual, straight or bisexual. 
  • Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe. It represents almost one-third of Oxford University’s income and expenditure, and two-thirds of its external research income. Oxford’s world-renowned global health programme is a leader in the fight against infectious diseases (such as malaria, HIV/AIDS, tuberculosis and avian flu) and other prevalent diseases (such as cancer, stroke, heart disease and diabetes). Key to its success is a long-standing network of dedicated Wellcome Trust-funded research units in Asia (Thailand, Laos and Vietnam) and Kenya, and work at the MRC Unit in The Gambia. Long-term studies of patients around the world are supported by basic science at Oxford and have led to many exciting developments, including potential vaccines for tuberculosis, malaria and HIV, which are in clinical trials.