Questions have been asked about a major new study on HIV prevalence among men who have sex with men (MSM), including gay and bisexual men, in three South African cities.
The findings of the Human Sciences Research Council study, called the Marang Men’s Project, was released on Tuesday, based on research conducted from 2012 to 2013 among 925 MSM. The results were widely reported in the mainstream press.
The study found that relative to national estimates, HIV prevalence is very high among MSM in South Africa’s three largest cities. In Cape Town, the overall prevalence of HIV among the MSM recruited into the study was 22.3%, in Johannesburg it was 26.8%. In Durban, the prevalence was unusually high among respondents, namely 48.2%.
Researchers found that HIV prevalence was higher among self-identified gay men, especially in Johannesburg and Cape Town, compared to those who identified as bisexual or straight. For example, in Cape Town self-identified gay MSM were three times more likely to be living with HIV than their bisexual counterparts. “The statistical difference between the two was significant,” said the authors.
The study also found that a large percentage of the men surveyed engaged in either selling or buying sex (transactional sex). Over half of the respondents (52.6%) in Cape Town, 11.4% in Durban and 23.1% in Johannesburg reported that they had “sold sex to men” in the last six months.
A high percentage of the MSM surveyed further reported that they had been previously jailed, with this being highest among respondents in Cape Town (67.8%), followed by Johannesburg (42.6%) and lowest in Durban (8.7%).
Some may question the implications of how the gay, bisexual and MSM community – already targets of discrimination – may be viewed by the broader public on the basis of the study. Are MSM really more likely to be former criminals? Do they really engage in transactional sex more often than other people? These kinds of questions are important because data without context could be misused.
Mambaonline asked Allanise Cloete, the Project Director of the Marang Men’s Project, about the findings. She insisted that she and the study’s authors had gone to great lengths to tell the media that the findings “are not representative of the MSM population, they are representative of a very specific subcategory of MSM.”
She said that, “It is irresponsible for the media to document behaviours without contextualising behaviour,” adding that “we are worried about how the public will respond to this – we must be very cautious.”
Cloete explained that the participants in the study were sourced through peer recruitment, in which they were asked to refer their friends in their social networks to take part. This “unpredictable recruitment” could explain, for example, the high rate of incarceration among many of the men surveyed, especially in Cape Town.
With regard to the higher rate of HIV infection among self-identified gay men, she said that similar findings have been seen in other MSM studies in South Africa and in Africa. Cloete agreed, however, that the raw data does not include social or cultural contexts to help explain this.
For example, the way that MSM self-identify in South Africa is often linked to sexual behaviour, roles and gender expression. In other words, it may be that men who identify as gay are often the receptive partner (bottom) and those who identify as bisexual or straight may often be the insertive partner (top). Being penetrated is considerably more risky when it comes to HIV infection, which could explain why gay-identifying MSM may have a higher rate of infection.
For Cloete, the primary value of the research is for it to be used to lobby for a national MSM prevention programme. “It can become an advocacy tool,” she said.
Cloete also cited the study’s findings of high police discrimination due to sexual orientation. Among respondents in Cape Town, 37.1% reported police discrimination while 26.2% and 20.8% of respondents in Durban and Johannesburg, respectively, reported the same.
The study further confirmed the importance of MSM-affirming health clinics in serving the community, finding that many preferred to be tested at “gay-friendly health centres.” (In Durban, in contrast to the other study cities, almost a quarter of the respondents (23.8%) indicated that their most recent HIV test had been done by a traditional healer.)
Cloete argued that the study confirms that “there is a need for more comprehensive HIV intervention that speaks to the needs of MSM in the country.” She added: “HIV affects the MSM population very deeply and hits this population very hard. We need to look at these micro epidemics – we can’t ignore them.”