Soweto Clinic Reaches Out To Men Who Have Sex With Men

via Global Forum on MSM and HIV, by Yngve Sjolund

The Health4Men clinic is putting up a determined effort in the fight against high HIV and STI infection rates amongst men-who-have-sex-with-men (MSM) in and around Soweto.

Thanks to support from PEPFAR and USAID, the Simon Nkoli Centre for Men’s Health can offer free and confidential clinic services, which include men's health care check-ups, STI and HIV screening and medical treatment and prevention care. Innovative outreach projects, counselling for individuals and same-sex couples, a range of support groups - including groups for men living with HIV - as well as regular seminars and talks addressing topical issues related to men’s sexual and psychosocial health are also available for MSM.

MSM living in the township are aware that various studies have documented the very high HIV prevalence amongst MSM Sowetans in the past two years.

David Motswagae an outreach worker at the clinic, confirms: “Yes, they know – and it was great to see that most of them knew about the findings of the study, even if they found out from gay media on the web. Participants raised the issue during discussion groups, and most of them said: ‘why are you saying one in three of us are HIV positive? Why is it that other people are still in the closet – and we don’t know their status?”

Same-sex relationships remain difficult terrain for media and health communication in South Africa, and a lack of coverage of MSM issues in the media fuels the marginalization of MSM and their HIV prevention needs. At most, the media tends to reinforce stereotypes that all MSM are gay – or that they have the same HIV prevention needs as gay men. Typecasting all MSM – who do not usually self-identify as being gay - may also alienate this vulnerable group, and deter them from accessing targeted HIV services for fear of being labelled “gay”.

Infection rates have risen steadily in recent years among MSM, despite a decrease in the 1990’s – and according to the CDC (Centers for Disease Control and Prevention), MSM account for 71% of all HIV infections in the U.S.A., where statistics also showed a 30 percent rise in syphilis outbreaks in 2009.
But the numbers for MSM in the USA are not much different from those in South Africa, and the results of three studies conducted in Johannesburg and Durban found that HIV prevalence rates among MSM were as high as about 38 percent - or double that found among South Africa’s general population.

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

SOUTH AFRICA: "Lower Risk of HIV Infection Among Circumcised MSM: Results from the Soweto Men's Study"

IAS Conf on HIV Path, Treatment & Prevention 2009 (07.20.09):: T. Lane; H.F. Raymond; S. Dladla; J. Rasenthe; H. Struthers; W. McFarland; J. McIntyre

Male circumcision has been found to reduce female-to-male HIV transmission through vaginal sex in randomized controlled trials. However, one recent meta-analysis of observational data found insufficient evidence of a protective effect with men who have sex with men (MSM), while noting the lack of data from high-prevalence settings. In the Soweto Men's Study, researchers examined the association between insertive anal intercourse and HIV infection among MSM in a peri-urban South African community.

Researchers enrolled 378 MSM through respondent-driven sampling and surveyed the men about their sexual behavior with their last five partners. Participants were asked whether their sexual role with male partners was insertive, receptive or both. Circumcision status was self-reported, and HIV status was determined by rapid antibody testing. Results were adjusted for network size and recruitment patterns and reported with 95 percent confidence intervals (CI).

Overall, 36.4 percent of MSM were circumcised; HIV prevalence was 13.2 percent (12.4-13.9 percent); and 76.4 percent reported exclusive insertive anal intercourse (75.4-77.3 percent). Among those exclusively insertive, 88.1 percent (87.1-89.1 percent) also reported having female partners. In multivariable analysis, the odds of infection among uncircumcised MSM reporting exclusive insertive anal intercourse with male partners were significantly higher than among insertive circumcised MSM (adjusted odds ratio 4.5; 95 percent CI 3.1-6.7).

"Circumcision may be effective at reducing HIV transmission between men in high-prevalence settings such as Soweto where MSM practice a high degree of sexual role segregation," the researchers concluded. "It may be feasible to conduct a randomized controlled trial of circumcision among MSM in such communities. The acceptability and ethical implications of male circumcision in MSM populations must be assessed prior to initiating clinical trials."

HIV rates in Soweto Township gays

via Scientistlive

New research from UCSF examining HIV among men who have sex with men (MSM) in the township of Soweto in South Africa has found that a third of gay-identified men are infected with HIV.

The study's authors were the first to examine HIV and the community of men who have sex with men in the Soweto Township, an area on the periphery of Johannesburg reserved for black South Africans during apartheid.

The researchers found that Soweto MSM identified themselves as straight, bisexual or gay, with the highest HIV rate among gay identified men, at 33.9 percent. The researchers estimated the rate of HIV infection for bisexual MSM in Soweto to be 6.4 percent and 10 percent for straight identified MSM.

"Our findings clearly indicate that targeted prevention and treatment for men who have sex with men in townships are urgently needed. We also found that, despite South Africa's legal advances in gay rights, stigma and de facto segregation are reflected in the disproportionate rates of HIV infection," said the study's principal investigator, Tim Lane, PhD, MPH, assistant professor at the UCSF Center for AIDS Prevention Studies

The findings are now available in the online edition of the journal AIDS and Behavior and are scheduled for publication in an upcoming print issue.

Of the study's 378 participants, 34.1 percent identified as gay, 30.4 percent as bisexual and 31.7 percent as straight. All but one of the participants were black South Africans and all of South Africa's black African ethnic groups were represented in the sample.

The study showed that MSM's sexual identities predicted their sexual behaviour with other men.

Gay identity was highly correlated with the exclusive practise of receptive anal intercourse and straight and bisexual self-identification was highly correlated with the exclusive practise of insertive anal intercourse with male partners.

"With the correlation of sexual identity and sexual practise, control of condom use in same-sex partnerships tends to be in the hands of bisexual and straight MSM. This finding demonstrates the pressing need to promote condom use among bisexual and straight-MSM for same-sex as well as heterosexual relationships," said Lane.

The authors also looked at other risk factors and found that HIV infection was also associated with being older than 25, lower incomes, purchasing alcohol or drugs for a male partner in exchange for sex, having receptive anal intercourse and having any unprotected anal intercourse with a man.

HIV infection was significantly less likely among men who have sex with men who were circumcised, smoked marijuana, had a regular female partner or reported unprotected vaginal intercourse with women.

"The circumcision findings clearly suggest that for this population of MSM, circumcision could be protective and that MSM should not be excluded from circumcision programs," said Lane.

Study: Circumcision Protects Insertive MSM Partners

via AIDSmeds.com, by Tim Horn

Circumcision may protect men who have sex with men (MSM) against HIV transmission via insertive anal intercourse, according to a cohort study conducted in Soweto, South Africa, and reported Monday, July 20, at the Fifth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town.

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