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Around the world, men who have sex with men (MSM) are 28 times more likely to acquire HIV than other people.  There’re a few reasons why this is:  One of them is the fact that anal sex is more conducive to HIV transmission than vaginal sex, because the lining of the anus is more fragile than that of the vagina, but there are a number of psychosocial factors that also contribute towards why so many of us in the MSM community are more prone to acquiring HIV.

For many of us, there is a lot of trauma involved in “coming out” about our sexual orientation.  This means that many of us are not open about our sexual lifestyles and this can also result in many men not seeking the mental health support/ sexual health resources/ information/ condoms and water-based lube that they need to prevent HIV transmission.  Many men who are HIV-positive do not know that they are HIV-positive, and their fear of being shamed or being subjected to stigma and even violence can prevent them from seeking the healthcare they need to ensure they stay healthy.

People living with HIV are known to be healthy and live long satisfying lives if they receive the treatment and healthcare support that they need, but many MSM are still not getting this because of their fear of discrimination and trauma associated with prejudice and homophobia.  Not having access to primary healthcare resources and information also results in a community that will be more prone to sexually transmitted infections and having a sexually transmitted infection makes a person more susceptible to HIV transmission.

The MSM community is more susceptible to having multiple sexual partners, struggling with depression and anxiety and can often be found to turn to drugs and alcohol to self-medicate, which in turn, further facilitates the transmission of HIV due to the risky sexual behaviour associated with substance abuse.

The relationship between the MSM community and HIV transmission is a complex one.  Stigma, fear, depression, trauma, substance abuse and a culture of multiple sexual partners all contribute to a high probability of not only acquiring HIV, but also not seeking out the treatment required to prevent HIV-related illness.

As a community, we can do a lot to minimise these challenges.  We can promote a culture that doesn’t rely so heavily on alcohol and drug use as a means to socialise and interact.   We can normalise and encourage the use of HIV-prevention drugs like PrEP for HIV-negative men, and not shame men who choose to use them.  We can uplift and support those of us who are living with HIV and help them to access the care and medication that they need to keep the virus undetectable. An undetectable viral load has been proven to prevent the transmission of HIV, even during condomless sex.

We need to educate ourselves and one another holistically too.  It’s not enough to know about our sexual health, take PrEP or ARVs and make sure we always have condoms and water-based lube on us at all times.  We also need to take care of ourselves and one another emotionally and psychologically. Increasing incidents of chemsex barebacking has been linked to feelings of isolation and loneliness.  Depression and anxiety have been identified as being motivating factors for men to have condomless sex with multiple partners under the influence of drugs as a means of escapism and in an attempt to connect with others.

Stigma and cultural or religious opposition to same-sex relations are to blame for a rise in the epidemic and the resulting pain, isolation and death of many MSM.  The most powerful form of activism that we can employ as a community is to encourage more intimacy, acceptance, transparency and encouragement to access care for one another.

If you’d like more information about gaining access to care call, text or send a ‘please-call-me’ to Call4Care weekdays 9 AM to 4 PM on 071 683 3226

PrEP, free HIV testing and ARVs are available from:

Ivan Toms Men’s Health Clinic, 1 Portswood Rd, Greenpoint Cape Town.


The Health4Men Services Clinic in Yeoville, corner of Kenmere Rd and Hopkins, Yeoville, Johannesburg.

Bruce J. Little is the Content Creator for Anova Health Institute.


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