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Abstract

A population-based estimate of the number of MSM sex workers in inner-city Johannesburg, South Africa: Implications for HIV prevention (PDF) 
Poster presentation at 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, 19-22 July
Kellerman,Scott E.; Fipaza,Zukiswa; Bagnol,Brigitte; Scorgie,Fiona; Geibel,Scott
Publication date: 2009


Background
MSM in Africa are disproportionately affected by HIV (22% prevalence among MSM in Dakar, Senegal, 25% in coastal Kenya, 35% in Soweto, Johannesburg), are largely hidden throughout most of the continent, and many demonstrate considerable HIV risk behaviors. While greater attention has been focused on MSM populations in Africa in recent years, subgroups of MSM, such as MSM sex workers, generally are not considered in HIV prevention planning despite documented significantly higher risk behaviors among these men.

Methods
Using capture-recapture (CR) methodology, we obtained a population-based enumeration of MSM sex workers (i.e., any man who accepts money or goods in exchange for sex with another man) in inner-city Johannesburg (Hillbrow, Berea, Yeoville, Braamfontein) from April to May 2009. With a 30-member team of enumerators familiar with these neighborhoods, we mapped areas where MSM sex workers congregate (bars, cruising spots, parks, and two brothels). For the CR, the team approached individuals in these areas, determined whether they were MSM sex workers, and offered a distinctive "tag" (i.e., key chain) to those who assented, on two separate nights one week apart.

Results
We counted 424 (95% CI: 377-471) MSM sex workers, 163 the first week, 141 the second week, with 88 recaptures. Most MSM sex workers were found in 28 bars, night clubs, and taverns, or around 20 cruising spots in area streets and parks. Anecdotally, enumerators reported MSM sex worker clients are non-gay-identified men who want "no-strings-attached anonymous sexual encounters."

Conclusions
We identified a surprisingly large population-based estimate of MSM sex workers working in inner-city Johannesburg. While we were not able to obtain behavioral information from these men, previous research suggests that HIV prevention behaviors are largely absent. This project documents the existence of an important HIV risk group in South Africa that is not currently targeted by existing HIV prevention programs.