Sexual Health of Gay and Bisexual men in Sub-Sahara Africa

Gay and bisexual men may be the most vulnerable population for HIV in Sub-Sahara Africa, writes Shazma Gaffoor.

Gay and bisexual men may be the most vulnerable population for HIV in Sub-Sahara Africa, writes Shazma Gaffoor.

HIV is one of the world’s most serious public health challenges without an effective cure. There are currently 38 million people living with HIV worldwide, of which over 19 million live in sub-Saharan Africa, the current day epicentre of the epidemic.

“HIV has been prevalent in many of the sub-Saharan countries for the past 20 years. While we’ve known for a long time that rates are high across the board, we’ve realised in the last few years how they seem considerably higher still among  gay and bisexual men,” says Dr Adam Bourne, Deputy Director at the Australian Research Centre in Sex, Health and Society at La Trobe University. “For a long time we have studied the factors shaping vulnerability to HIV in other populations, but much less work has occurred among gay and bisexual men in this context.”

Dr Bourne is part of a project called TRANSFORM (Targeted Research Advancing the Sexual Heath for Men who have Sex with Men), a bio-behavioural study of HIV and mental health among gay men in Kenya and South Africa. The study is conducted in collaboration with Wits Reproductive Health Institute in South Africa, the University of Nairobi in Kenya, as well as colleagues from the University of Oxford and the London School of Hygiene & Tropical Medicine in the UK.

The project aims to identify the prevalence of HIV and other sexual infections among gay and bisexual men in Kenya and South Africa and to understand some of the individual and social level factors that shape their vulnerability to HIV. That includes issues such as their mental health as well the stigma and discrimination they may experience within their communities. The four-year study is nearing completion and is beginning to release findings.

“We’ve asked questions about how they interact with other gay and bisexual men and how they try to keep themselves safe in what can be a rather hostile environment,” says Dr Bourne. “Sex between men is illegal in countries like Kenya. There is a lot of harassment directed towards gay and bisexual men from the police and from the wider society. It can be an unsafe space to be gay.”

Living in a hostile environment, questions arose about how gay and bisexual men source information on HIV and sexual health, or how they obtain lubricants or similar products due to their strict surroundings.

“If we know more about how people engage with one another, then we are better placed to work with them,” says Dr Bourne. “If we know that gay men are using a particular app or social media platform, then we know those are the places we need to go to, to help educate them about HIV by directing them to access condoms or lubricants safely or where to go and get a HIV test.”

Dr Bourne and his team have met with the local ministries of health and are also liaising with the local community organisations which help support gay and bisexual men. Due to the local governments’ attitude towards the LGBTQI community in general, the team often finds it challenging to draw attention to the issues relating to the gay communities.

“If you’re trying to secure the resource to deliver HIV prevention and care programs for gay and bisexual men,  this is the kind of data that would tell a funder where there’s a problem, how big it is, and what can be done to help address it,” says Dr Bourne. “These data help people understand what they can do in order to make a difference.”