The Health4Men clinic is putting up a determined effort in the fight against high HIV and STI infection rates amongst men-who-have-sex-with-men (MSM) in and around Soweto.
Thanks to support from PEPFAR and USAID, the Simon Nkoli Centre for Men’s Health can offer free and confidential clinic services, which include men’s health care check-ups, STI and HIV screening and medical treatment and prevention care. Innovative outreach projects, counselling for individuals and same-sex couples, a range of support groups – including groups for men living with HIV – as well as regular seminars and talks addressing topical issues related to men’s sexual and psychosocial health are also available for MSM.
MSM living in the township are aware that various studies have documented the very high HIV prevalence amongst MSM Sowetans in the past two years.
David Motswagae an outreach worker at the clinic, confirms: “Yes, they know – and it was great to see that most of them knew about the findings of the study, even if they found out from gay media on the web. Participants raised the issue during discussion groups, and most of them said: ‘why are you saying one in three of us are HIV positive? Why is it that other people are still in the closet – and we don’t know their status?”
Same-sex relationships remain difficult terrain for media and health communication in South Africa, and a lack of coverage of MSM issues in the media fuels the marginalization of MSM and their HIV prevention needs. At most, the media tends to reinforce stereotypes that all MSM are gay – or that they have the same HIV prevention needs as gay men. Typecasting all MSM – who do not usually self-identify as being gay – may also alienate this vulnerable group, and deter them from accessing targeted HIV services for fear of being labelled “gay”.
Infection rates have risen steadily in recent years among MSM, despite a decrease in the 1990’s – and according to the CDC (Centers for Disease Control and Prevention), MSM account for 71% of all HIV infections in the U.S.A., where statistics also showed a 30 percent rise in syphilis outbreaks in 2009.
But the numbers for MSM in the USA are not much different from those in South Africa, and the results of three studies conducted in Johannesburg and Durban found that HIV prevalence rates among MSM were as high as about 38 percent – or double that found among South Africa’s general population.
While conducting informal talks and supports groups in Soweto, community participants cited alcohol and multiple concurrent partners (MCP) as the most important drivers of the high HIV statistics.
“The feedback we got from the community is that most gay people and MSM are somewhat desperate. You find yourself in a community of Africans, whereby you are not accepted. Now you find, here is a guy who is still in the closet – we call them ‘after nine’s’. So this person is in the ‘closet’ and that means the only relationship that you can have with this man is during the night, in secret. So this man will be engaging in ‘quickies’ – and that means that there are chances that he may not have a condom or lube with him. So the chances are very high that he and you are getting exposed to HIV and other STIs”.
Government reports also estimate that about 6 percent of lesbian, bisexual, transgender or intersex (LGBTI) and MSM surveyed have reported being turned away from government clinics, while the national strategic plan (NSP) specifies that at least 70 percent of MSM should have been reached with a comprehensive, customized HIV prevention package by 2011. Meeting this target is unlikely: a recent government review of NSP progress indicates that nobody is collecting data on HIV prevention among MSM and that there are no national initiatives aimed at preventing HIV transmission in MSM.
It is also natural that, when dealing with potentially embarrassing medical issues, most MSM would rather receive care in an environment where people understand them.
‘Before we came up with the concept Health4Men, we did informal group discussions, which are where most of the information around this problem was identified, and why Health4Men was started. Clients would come to us in confidence and tell us that ‘you know what, when we go to public clinics, it seems that we are misunderstood. These people don’t understand us. When I go there, and say I have got an STI, this nurse will look at my penis and you will find that the STI is in the anus …’ At the end of the day the nurse will ask ‘why now is the STI in the anus, why not on the penis – what are you doing?’ You know they will come up with very insulting words that makes the client feel embarrassed and bad about themselves.’ When gay men or MSM go to clinics, the nurses laugh at them because they cannot grasp the concept of same-sex sexuality and that some people are different sexually – they just don’t understand the lifestyle that gay or homosexual preferences are different. Nurses are even too scared to talk about sex.”
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