Turning surveillance into support for men who have sex with men in Africa

Published: July 2, 2013

We need to stop simply doing research into the health and behaviours of gay men and other men who have sex with men (MSM) in resource-poorer countries, and start using research programmes as springboards for programmes of education and support for them. This was the broad consensus from an audience discussion after a session on MSM at the first day of the 7th International AIDS Society conference (IAS 2013) in Kuala Lumpur, Malaysia.
 
The discussion was sparked by a presentation from Stefan Baral of Johns Hopkins University on a pioneering project for MSM in Blantyre, Malawi, that did just that.

Dr Baral at first outlined the challenges facing MSM globally and for those who research their needs. HIV prevalence in MSM worldwide is at least as high as it is in heterosexual people in sub-Saharan Africa: regionally, it ranges from 3% in the Middle East to 25% in the Caribbean. In Africa, sporadic studies have found prevalence ranging from 9% in Sudan to no less than 40% in Malawi itself.
 
HIV incidence studies have only been done rarely in Africa, but found 5% incidence a year in Cape Town, and the extremely high figure of 10% in Nairobi. As for major studies of HIV prevention interventions, not one has been done in the whole of Africa, apart from a single site of the iPrEx pre-exposure prophylaxis study, in Cape Town.
 
The problem in even finding out data on MSM in Africa, let alone providing effective prevention support, is the extremely hostile climate MSM have to live under in most of the continent. Even in South Africa, community opinion remains homophobic, despite a liberal legal climate.

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