oa SAHARA : Journal of Social Aspects of HIV / AIDS Research Alliance - New HIV prevention technologies and their relevance to MARPS in African epidemics
Men who have sex with men (MSM) in Africa constitute a diverse group of men with different sexual identities and behaviours, many of which do not conform to a 'Westernised' gay identity (Lane, Mogale, Struthers, McIntyre & Kegeles 2008; Lane, Raymond, Dladla, Rasethe, Struthers & McFarland 2009). Many MSM identify as heterosexual and do not disclose their same sex behaviours. They remain hidden and are extremely hard to identify for research purposes or clinical interventions. The sexual health of MSM, specifically sexually transmitted infections (STIs) including HIV has been ignored in the developing world with only fractions of governmental spending allocated to this group who are at especially high risk of HIV transmission and acquisition (Rispel & Metcalf 2009). With some exception, the lives of MSM communities in Africa are characterised by prejudice, stigma, criminalisation and often violence, all of which contravene the principals of human rights. Governments and non-governmental organisations are reluctant to provide programming or interventions for MSM communities and often sanction and promote prejudice. A current example of this is the Homosexuality Bill currently being considered in Uganda that would prescribe the death penalty for practising homosexuals (Thomas 2011). Evidence based HIV prevention and treatment programmes for MSM have mostly not been implemented by African governments, and MSM specific HIV information and education programmes are non existent. Condoms remain poorly available and poorly promoted for MSM and condom compatible lubricants are often entirely unobtainable. HIV and STIs screening programmes follow a heteronormative pattern and are not tailored to MSM sexual health care needs (De Swardt & Rebe 2010). Since older effective prevention and treatment technologies have not been up scaled for African MSM, questions arise regarding the applicability and feasibility of newer prevention technologies such as pre exposure prophylaxis (PrEP) and microbicides. The implementation of these newer technologies may be difficult and they would need to fit into a menu of combination prevention choices that are specifically relevant to African MSM (Cohen, Meussig, Smith, Powers & Kashuba 2012; Shelton 2011).
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