Both research and press coverage of HIV/AIDS in sub-Saharan Africa have overwhelmingly focused on heterosexual transmissions. In effect, this focus replicates the prejudice that keeps gay men out of sight in African life in general. This month, the respected British medical journal The Lancet takes on this gap in public and scientific awareness with a report on gay men and HIV/AIDS in sub-Saharan Africa. Their review of the current state of affairs makes for grim reading.
As the study, authored by Dr. Adrian Smith et al. of Oxford University, succinctly points out, "Globally, men who have sex with men (MSM) continue to bear a high burden of HIV infection. In sub-Saharan Africa, same-sex behaviors have been largely neglected by HIV research up to now." There is, however, some recent research on gay men in sub-Saharan Africa, and the Lancet study is a comprehensive review of the results of that research, seeking to reach some basic conclusions. Here's what they found.
Overall, HIV rates among MSM in sub-Saharan Africa are 10 times higher than within the male population in general. In surveying the reasons for this wide gap, the researchers cited the various repercussions from a single, basic cause: homophobia. As Dr. Smith writes, the HIV rates in African gay men are "driven by cultural, religious and political unwillingness to accept [gay men] as equal members of society." This unwillingness is part of what Smith calls a "profound stigma and social hostility at every level of society concerning either same-sex behaviors amongst men, or homosexuality." As his study points out, "The HIV/AIDS community now has considerable challenges in clarifying and addressing the needs of MSM in sub-Saharan Africa; homosexuality is illegal in most countries, and political and social hostility are endemic."
Because of the intense homophobia in sub-Saharan Africa, gay men are driven underground, and engage in high risk practices (intravenous drug use, multiple partners, prostitution) that increase the rate of infection. "Unprotected anal sex is commonplace," the study says, "knowledge and access to inappropriate risk prevention measure are inadequate and... in some contexts, many MSM engage in transactional sex." Gay men stand at the meeting point between social prejudice and poor public resources, as Smith et al. point out: "High rates of HIV infection, HIV risk behavior, and evidence of behavioral links between MSM and heterosexual networks have been reported. Yet most African MSM have no safe access to relevant HIV/AIDS information and services, and many African states have not begun to recognise or address the needs of these men in the context of national HIV/AIDS prevention and control programs." As Smith told the BBC in an interview, "This has the consequence that this group becomes extremely hard to reach."
Clearly, a substantial cause of the ten-fold higher infection rate among gay men is governmental refusal to admit they even exist, and to educate them about their special risks and options. Smith also spoke to the BBC about "a desperate need for delivering a basic package of prevention for HIV", including ensuring supplies of condoms. "There is also a need to sensitize, educate and train those involved in HIV, the interface with men who have sex with men, to educate those involved in care and prevention activities," he said. "The belated response to MSM with HIV infection needs rapid and sustained national and international commitment to the development of appropriate interventions and action to reduce structural and social barriers to make these accessible."
The situation for gay men in sub-Saharan Africa is, in short, very grim. As the Lancet study says, "In the early 1980s, silence equals death became a rallying cry" for the gay community. "Nearly three decades later in sub-Saharan African the silence remains, driven by cultural, religious, and political unwillingness to accept MSM as equal members of society." At least now there is the beginning of research aimed at unveiling this long-shrouded crisis.