About 50% of men who have sex with other men in Soweto are HIV positive, writes Yngve Sjolund.
About 50% of black gay men or men who have sex with men (MSM) in Soweto are living with HIV. Research statistics from the Global Forum on MSM and HIV estimates that HIV prevalence among the black gay male community of the township is four times higher than the general population.
Dr Michael Laurino from the Health4Men Clinic at Baragwanath Hospital in Soweto says research in South Africa shows that African men having sex with men are a particularly vulnerable group, specifically those living in peri-urban informal settlements.
The forum is the only global HIV and Aids advocacy network specifically devoted to the needs of men who have sex with men. Various studies indicate the prevalence of HIV among gay men in South Africa is between 10,4% and 33,9%. As a result, men who have sex with men have been identified by the government and major donors for targeted health interventions intended to decrease the impact of the virus on this group.
Nthato Ramushu, a nurse at the Health4Men Clinic, says it is fighting against high rates of HIV and sexually transmitted infections among these men in Soweto and other areas around the country. “The term MSM is quite new for many people and because same-sex sexuality is easily misunderstood, this group is often neglected in HIV prevention and treatment campaigns. Almost half of the men living in Soweto who are gay or are MSM won’t say they are gay or identify themselves to anyone as gay,” he says.
According to Ramushu, men who have sex with men in all communities have specific needs in terms of healthcare and access to health services. He says they are also known to be at a higher risk of HIV infection and transmission. “There is approximately 5% of men in South Africa having sex with other men and HIV prevalence among these men in townships like Soweto is estimated to be between 30% and 50%,” says Ramushu.
David Motsagea, an outreach coordinator for the Health4Men Clinic, says informal talks in the community revealed that alcohol and multiple concurrent partners are major influences on the high level of HIV in Soweto. “Feedback from the community showed most gay people and men who have sex with men are desperate and find themselves in a community of Africans where they are not accepted. Most people’s understanding of men who have sex with men in the township is that it means a man is gay. Education has been needed to show people that other groups fall under the category of MSM,” he says.
According to Motsagea, a man who is still in the “closet” is at greater risk of being exposed to HIV because he can have only secret relationships, during the night. “This man, referred to as an ‘after-nine’, will engage in ‘quickies’, which means he may not have a condom with him and there is a greater chance he and his partner are exposed to the HI virus.”
Motsagea says men who are attracted to men sometimes marry women because they want to conform to society’s expectations and have a wife and children. “It happens often in the community where the clinic lies, because males have to do what their parents tell them to do and live according to societal expectations. So it is very difficult for young people who get pressured to get married and have a family but are attracted to men,” he says.
Big issues among black people about being gay are stigma and acceptance. “For African men to come out and say ‘I am gay or MSM’ or ‘I prefer to have sex with men’ can lead to their parents disowning them since it is considered not acceptable. Other issues of independence, manhood and power struggles continue to be predominant problems.”
Motsegea says that for previous generations it was difficult to discuss sexuality, but today parents have information from print media and television that allows them to be open. “Only now do men have the platform to talk. Before, if someone was MSM or thought they were gay, they would have to conform to their parents’ expectations. A difference can be seen now where people are starting to accept those who are MSM because of access to information.”
Laurino says the MSM population at the clinic is aware of HIV and using condoms and that sexually transmitted infections such as gonorrhoea relate to sexual activity without using a condom. “HIV is a generalised condition and sometimes people don’t see the link that HIV is a sexually transmitted disease. Everyone talks about HIV but don’t seem to make the psychological link that it is sexually transmitted because it is a condition that affects the whole body, not just the genital area. Genital conditions are more obvious and visible as a sexually transmitted disease.”
The message to use condoms is out there but people do not always want to use them because of a lack of knowledge.” Many HIV-infected couples feel they can continue not using condoms because they are HIV positive anyway. What they don’t realise is that they are reinfecting each other with the disease over and over and should always wear condoms,” says Ramushu.
Because men who have sex with men were identified as a target group needing health intervention to reduce HIV rates, the Health4Men project was launched in Cape Town in 2009. It was the first of its kind to provide an easy location for men to take steps against sexually transmitted and HIV infections and offer men’s wellness services in the Western Cape, Gauteng and North West.
Approximately 3 200 patients have been helped through its outreach work and through attendance at the Soweto clinic. The actual number of people managed with antiretrovirals on a regular basis is about 2 500.
“Men who are considering having sex with other men—or are occasionally having sex with men—can go to the clinic to discuss concerns and anxieties and can get help managing their health in terms of their HIV status and screening for sexually transmitted infections. It is a safe space that is confidential and easily accessible,” says Laurino.
Yngve Sjolund is a consultant for various HIV/Aids NGOs, writing and editing research material about HIV, sexual and reproductive rights, gender-based violence and sexual minorities. This article was made possible through funding from the Open Society Foundation of South Africa’s media fellowship programme