EPISODE 5 - MSM

Rates of HIV infection are 10 times higher among gay men than the general population.  This is because HIV spreads very easily through anal sex. As Dr Siyabonga Voxeka, a medical practitioner in Lusikisiki explains, anal intercourse carries a high risk of HIV infection because cuts in the anus can easily occur, leading to bleeding which makes it easy for HIV to enter the bloodstream and infect someone.  But this is not the only reason for high rates of HIV amongst gay men.  Experience of discrimination and harassment also plays a part.

Gays and lesbians are protected against discrimination by the South African constitution. But on the ground people like Zamxolo Ntewukeni, a gay man from Cathcart Eastern Cape, still live with continual taunts and harassment because people know he is gay.  Some even claim that he and his gay friends are "demons". Despite all this, Zamxolo is adamant that this is "my life and I'm not going to change for anybody."

In Manenberg, Adiel Peters, a young gay man active in a support group for gay men in the area, explains that there is very little messaging aimed at gay people in the official AIDS information programmes of South Africa.  When they started working with other gay guys in Mannenberg they found no booklets or posters to help spread the message about using condoms and safer sex. The silence about gay men can be very confusing.  In his experience, the media focus on heterosexual couples leaves many gay men thinking that HIV is only vaginally transmitted and leads to them having unprotected anal sex. Some, people say "gay people bring HIV".  This makes gay men not want to go for a test and to close their eyes and minds to HIV. "Gay men" says Adiel "need to know how to use a condom properly and most importantly need to use lube to prevent the condom from breaking."

Gay men don't only have other gay men as partners. There are many married men who have secret affairs with gay men. Ntsikelelo Mbuzwana, a 25 year old from Khayelitsha, Cape Town, explains that many gay men have "after nine" affairs with married men. Such men don't see themselves as gay, but they have sex with gay men. Often these relationships involve unprotected sex. "Discrimination in the community and feelings of inferiority can make gay men reckless and," says Ntsikelelo , "leading them to concentrate more on alcohol and having a good time comes before thinking about condoms". Ntikelelo wishes everyone who is married would also use condoms. "Don't say this is my husband he will never infect me. Many people have been infected within relationships because they trusted each other.  Even if you trust your partner you must go and get tested. It's never too late and it's your right to know your status" he says.

IT'S A FACT

The relative risk of HIV transmission per sex act is twice as high for the receptive partner in anal sex in comparison to heterosexual vaginal sex.

A national study of youth aged 15-24 in South Africa found that of those who were sexually active, 5.5 % of males and 5.3% of females have had anal sex at least once.

New research on MSM in Soweto found that 1 in 3 gay men is HIV positive and that between 6.4 and 10% of bisexuals are also HIV positive. The research concluded that "targeted prevention and treatment for men who have sex with men is urgently needed."

A 2008 study of 92 men who have sex with men living with HIV in Cape Town found that 11 of the men were currently married, and 36 had unprotected vaginal sex more than once in the previous 3 months with their partners who were unaware of their positive status.

These high rates of HIV infection reflect stigma associated with gay identity, the researchers concluded. They recommended that more effort was needed to make it possible for people to disclose their HIV status and to reduce stigma and discrimination.