Population Briefs

Identifying the HIV Risk and Sexual Health Needs of Men Who Have Sex with Men in Africa

The Landscape

In developed countries, it has long been recognized that men who have sex with men (MSM) are at high risk for HIV and other sexually transmitted infections (STIs). However, in Africa, the stigma associated with homosexual behavior—and the fact that it is illegal in some countries—have kept the health needs of MSM largely hidden. As a result, health systems have lacked vital information for creating effective programs and policies that meet the health needs of this at-risk population.

The Paradigm Shift

The Population Council designed, conducted, and published the first large-scale descriptive study of African MSM, with the goal of generating research to influence policy and program change.

To reach this hidden population, the Council used a recruitment strategy called snowball sampling, in which participants randomly recruit peers from their personal networks. With this strategy, the Council documented sizable populations of MSM in Dakar, Senegal, and Nairobi, Kenya, and gave voice to their health and HIV prevention needs. Researchers also conducted in-depth interviews with service providers and with people such as masseurs, hairdressers, bartenders, and taxi drivers whose jobs put them in routine contact with MSM.

Among MSM in Kenya, Population Council research documented high levels of sex with multiple partners: 79 percent of respondents reported having two or more partners within the past year. While 75 percent reported using a condom at last anal sex with a male partner, 84 percent reported the use of oil-based lubricants, which can cause condom breakage. In Dakar, only 14 percent of MSM reported condom use at last receptive sex.

Study participants were frequent victims of stigma, discrimination, and verbal, physical, and sexual violence. In Dakar, 43 percent of respondents reported being raped at least once, and 13 percent reported being raped by a police officer. Sex workers in Kenya were significantly more likely than other MSM to report an incident of discrimination (59 percent vs. 29 percent) and violence (39 percent vs. 19 percent). Victims of violence were also significantly less likely than other MSM to have used a condom the last time they had receptive anal sex.

Research in both Kenya and Senegal also revealed that many MSM avoid seeking health care—even when experiencing symptoms—for fear of exposing their sexual behaviors. And while many health care providers interviewed were aware that MSM seek treatment at their facilities, they preferred not to discuss treatment and counseling issues with such men.

The Lasting Impact

Before the Council’s research, MSM populations were unrecognized by government agencies in Kenya and Senegal.

These studies provided valuable data on the existence, sexual behavior, and health-seeking practices of MSM and demonstrated that research on MSM can be conducted despite such obstacles as widespread stigmatization and illegality of MSM behavior.

Findings from Kenya helped prompt the National AIDS Control Council to include MSM in national HIV policy, and informed the development and implementation of HIV programs for MSM in Kenya and elsewhere in sub-Saharan Africa. In its book, Off the Map: How HIV/AIDS Programming Is Failing Same-Sex Practicing People in Africa, the International Gay and Lesbian Human Rights Commission called the Council “the first international NGO to recognize that the HIV-related vulnerabilities of men who have sex with men in Africa deserved serious attention.”

More than a decade has passed since the Senegal study; and research, policies, and services addressing the HIV-related needs of MSM are on the rise in sub-Saharan Africa. The Council’s recent contributions have included support for national HIV assessments of MSM in Nigeria and Zambia, and the implementation of the Men’s Health Network, Nigeria, the first national, comprehensive HIV/STI prevention initiative involving MSM and other high-risk men.


Sources

Niang, Cheikh Ibrahima, Moustapha Diagne, Youssoupha Niang, Amadou Mody Moreau, Dominique Gomis, Mayé Diouf, Karim Seck, Abdoulaye Sidibé Wade, Placide Tapsoba, and Chris Castle. 2002. Meeting the Sexual Health Needs of Men Who Have Sex With Men in Senegal, Horizons Final Report. Washington, D.C.: Population Council.

Onyango-Ouma, W., Harriet Birungi, and Scott Geibel. 2005. Understanding the HIV/STI Risks and Prevention Needs of Men Who Have Sex with Men in Nairobi, Kenya, Horizons Final Report. Washington, D.C.: Population Council.

Geibel, Scott, Elisabeth M. van der Elst, Nzioki King’ola, Stanley Luchters, Alun Davies, Esther M. Getambu, Norbert Peshu, Susan M. Graham, R.Scott McClelland, and Eduard J. Sanders. 2007. “‘Are you on the market?’: A capturerecapture enumeration of men who sell sex to men in and around Mombasa, Kenya,” AIDS 21(10): 1349–1354.

Funding

President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development