A new regional study indicates that less than half of men who have sex with men (MSM) across Sub-Saharan Africa report easy access to basic HIV services.
Conducted by the Global Forum on MSM & HIV (MSMGF) in partnership with African Men for Sexual Health and Rights (AMSHeR), the study shows that homophobia, violence, and stigma among healthcare providers are linked with reduced access to HIV services.
“MSM in Sub-Saharan Africa have an aggregate HIV prevalence rate of 17.9%, compared to 5% among the general population,” said MSMGF Executive Director Dr. George Ayala. “Despite the clear need for intervention, the majority of MSM in the region remain unable to access basic resources like condoms and lubricants.”
The results of the study were released today in a new policy brief entitled, “MSM in Sub-Saharan Africa: Health, Access, & HIV,” produced by the MSMGF. The publication examines levels of access to HIV services using data from the most recent Global Men’s Health and Rights (GMHR) survey, which included 692 participants across 35 countries in Sub-Saharan Africa. Survey data is supplemented by findings from 5 focus group discussions conducted in Nigeria, Kenya, and South Africa, as well as interviews with leaders of MSM-focused community-based organizations in 14 cities in the region.
Of all MSM surveyed in Sub-Saharan Africa, less than half reported easy access to each of 5 basic HIV services: condoms (47%), condom-compatible lubricants (19%), HIV testing (48%), HIV treatment (27%), and HIV education materials tailored for MSM (14%). Both survey data and focus group discussions revealed a common set of barriers and facilitators that affect access to HIV services among MSM in the region. The report groups these factors into three categories: relationship with healthcare providers; experiences of homophobia and homophobic violence; and engagement with a local community of MSM.
Compared to MSM who reported the lowest levels of comfort with service providers, those who reported the highest levels of comfort were:
• 3.5 times more likely to report easy access to HIV testing;
• 5.2 times more likely to report easy access to condoms;
• 15.5 times more likely to report easy access to MSM-tailored HIV education materials.
Compared to MSM who reported the highest levels of perceived homophobia, those who reported the lowest levels of perceived homophobia were:
• 12.5 times more likely to report easy access to lubricants;
• 12.5 times more likely to report easy access to HIV testing.
Compared to MSM who reported the lowest levels of connection to a community of MSM, those who reported the highest levels of connection were:
• 6.9 times more likely to report easy access to condoms;
• 8.6 times more likely to report easy access to HIV testing;
• 10.4 times more likely to report easy access to MSM-tailored HIV education materials.
Among GMHR respondents from all regions, MSM in Sub-Saharan Africa reported the highest levels of homophobic violence and the third highest levels of perceived homophobia. Conversely, respondents in Sub-Saharan Africa also reported the highest levels of connection with local MSM communities. Drawing on interviews with community leaders, the brief also profiles a wide range of initiatives that have addressed these challenges and opportunities in local contexts.
“Historically, the communities most affected by HIV have been the first responders,” said Keletso Makofane, MSMGF Senior Research and Programs Associate and lead author of the report. “These community responses have worked to address the social factors that reduce access to services and drive the epidemic. Scaling-up HIV programs among key populations will require robust partnerships with these organizations to be successful.”
The brief concludes with a set of recommendations designed to address the barriers and facilitators revealed by the study: 1) donors must make greater and smarter investments in local community-based organizations; 2) community systems to address HIV among MSM must be integrated with larger health systems; and 3) all stakeholders must work to create an accountable environment conducive to service access for MSM and other key populations.
“Proper community engagement must be central to our response to AIDS among key populations,” said Dr. Ayala. “This is essential, and it can no longer be treated as an afterthought. After 30 years of AIDS, access to basic HIV services remains out of reach for the majority of MSM in Sub-Saharan Africa. Stigma and violence fuel these disparities, and community engagement works to reduce them. Global and local aids responses must design, fund, and evaluate initiatives accordingly. Without attending to the HIV epidemic among MSM and other key populations, we cannot achieve an AIDS-free generation.”
The policy brief “MSM in Sub-Saharan Africa: Health, Access, & HIV” can be found on the MSMGF website Additional publications from the GMHR data set, including peer reviewed journal articles and original MSMGF reports, can be found online.
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