A survey on the sex habits of gay men in Cape Town exposes weaknesses in the government’s Aids education campaign
Wilhelm Disbergen
A study of the sexual behaviour and risk taking among gay men in Cape Town the first of its kind to be conducted in South Africa has uncovered some shocking results. Despite the incidence of Aids in South Africa, many men are still having unprotected, anonymous sex.
The Triangle Project, a gay and lesbian outreach organisation funded by the Elton John Aids Foundation, asked men at gay venues across Cape Town to complete a questionnaire on their sexual activities. The venues included bars, clubs, steambaths and gay cruising areas in the city and on the Cape Flats.
The aim of the survey was to establish the sexual habits and risk taking among homosexual men an area that has until now been completely neglected in South African HIV epidemiology.
Although the study does not confirm a sero-prevalence of HIV among the respondents, it helps establish an understanding of the sexual risks gay men take.
Cape Town is widely known as the “gay capital” of South Africa. Knowing exactly which places to target in combating the spread of HIV among homosexual men is essential to the Triangle Project, which has limited resources.
The survey was “scene” based and this reflected strongly in the demographics of the respondents, with more than 75% between the ages of 20 and 39. With difficulties in accessing informal networks of township-based gay men, the respondents were predominantly white (62% were white, 25% coloured, 3% Indian and only 9% black).
Of the respondents questioned, 47% indicated that they were currently in a relationship. But 60% of these men had sex with people other than their partners in the past year.
More than half of the men said they had between two and 10 sexual partners in the past 12 months, with 12,7% reporting having had between 20 and 90 sexual partners in the past year.
Only 13% of the men said they paid for sex in the past year and 17% said they have received money for sex in the same period. When asked whether they had sex with a woman in the past year, 15% of respondents said they had. They were not asked whether this had been safe or unsafe sex.
The men were asked whether they had been tested for HIV and what their HIV status was. The response was that 82% believed they are HIV-negative while 7,7% stated that they believed they were positive. Of the 71% of men who reported having had anal sex in the last year, 25% said they did not use condoms. Two-thirds of the men who did not use condoms said the man they had sex with might have been HIV-positive.
The men were then given a list of 16 environments where they could have had sex recently. Their homes featured quite prominently, with a response from 91%, 43% had sex at a steambath, 39% at the beach, 31% in a bar, 25% in a dark room at a club and 15% in public parks.
A link was found between public and high-risk sexual behaviour. Men who frequented steambaths and dark rooms were 66% more likely to have had unprotected sex in the past year than those who had sex at home.
Men under the age of 30 were less likely to have had an HIV test than their seniors. A quarter of the men who had between 11 and 20 sexual partners in the past year tested HIV-positive.
The survey showed that the majority of the respondents were consistently protecting themselves, although condom failure (splitting, tearing or slipping off) was reported by 23% at least once in the past year. Most of the men who had HIV tests went after they experienced condom failure.
The survey asked the men about their drug use, because it affects their high-risk behaviour. Ecstasy, poppers and dagga featured prominently, with recreational drug use most prevalent among the 20 to 29 age group as well as among HIV-positive men. There was a clear correlation between drug use and a higher number of sexual partners. The respondents who used recreational drugs reported condom failure and were three times more likely to have had unprotected sex.
The greater exposure to HIV-infection among young men aged 20 to 29 years was also illustrated in the high number who replied in the affirmative to the question: “I find it hard to say ‘No’ to sex that I don’t want.”
The survey has concluded that national, provincial and local health funds should be made available to support work being done to prevent the further spread of HIV among gay men.
According to Nigel Crawhall, member on the board of the Triangle Project, the Department of Health insists that the best statistical method of collating information about HIV prevalence in South Africa remains antenatal sero-prevalence. This is because pregnant women are sexually active, constitute an easily identifiable, accessible and stable population, and are more likely than other groups to be representative of the general population.
Because gay men do not attend antenatal clinics, the Department of Health is demonstrating a lack of commitment to inclusion and diversity that could amount to homophobia, Crawhall said.
Annie Leatt, director of the Triangle Project, says the health department is ignoring the prevalence of HIV among gay men and men who have sex with men.
She believes HIV prevention should done be in a realistic and non-judgemental way. Asking men to abstain is unrealistic. Safe sex should be eroticised in an effort to make it appealing. Providing condoms and lubicrants in public places does not encourage people to have sex, but provides realistic measures against HIV transmission.
Leatt says safer-sex messages need to be explicit and open with a message that is sex-positive: having sex is not the problem having unsafe sex is.
She said the finding that 12% of gay men had between 20 and 90 sexual partners last year is not unusual heterosexuals “get up to the same thing”.
The finding that condom failure was rife probably indicated that these men used government-issue condoms which were all one size, Leatt said. This ignores the fact that penis size varies significantly. Incorrect lubrication could be another reason, as younger gay men were often inexperienced in using lubricants.
Leatt complained that the government did not do enough to address the problems of young, gay men. They are not well-informed and lack both skills and information for HIV prevention.
Triangle will be doing its regular “condom bash” on May 5, targeting townships on the Cape Flats and distributing an estimated 15?000 condoms.