Research

HIV transmission is dependent on the route of acquisition, the infecting viral load and the presence of inflammation and activated immune system cells below mucosal surfaces.8 Addressing these factors lowers HIV transmissibility. Unprotected, especially receptive, anal sex remains a high-risk behaviour for HIV transmission with a transmission risk about 18 times higher than for penile-vaginal sex, and is a major driver of high HIV rates among MSM.9 IDUs who inject themselves with HIV-contaminated needles provide a direct access point for HIV, and established infection can therefore occur with relatively lower viral loads. CSWs are likely to transmit HIV if they become infected themselves because of the greater number of sex partners that they encounter. All these population groups benefit from targeted HIV programmes.

While research now highlights that men who have sex with men (MSM) in places such as South Africa are at particular risk of HIV infection, left relatively unexplored are potential relationships between one of the most pressing social issues affecting peri-urban MSM – namely homophobic stigma – and sexual risk-taking behaviour. Drawing on research from the Ukwazana baseline study of 316 township MSM in Cape Town we examine how homophobic stigma relates to psychosocial factors such as depression and self-efficacy and the risk activity of unprotected anal intercourse (UAI). By deploying cross-sectional association models, we examine a series of relationships between these variables and offer evidence to suggest that HIV prevention programmes aimed at sexual minority groups should be mindful of potentially complex relationships between social stigmas such as homophobia and sexual risk-taking behaviour.

Men who have sex with men (MSM) are at high risk for HIV acquisition and transmission owing to the high risks associated with unprotected anal sex and barriers to accessing appropriate health services.

Various studies have proven the value of early initiation of antiretroviral treatment (ART) for both prevention and treatment.

This article illustrates the need for the immediate implementation of early ART among high risk populations such as men who have sex with men (MSM) where current safe sex interventions have proved limited or at worst ineffective.

The World Health Organisation has recently released a report on basic health care for MSM and transgender people entitled “Prevention and Treatment of HIV and Other Sexually Transmitted Infections among Men Who Have Sex with Men and Transgender People: Recommendations for a Public Health Approach.

Until recently, African MSM have been under-researched and under-resourced, and this has contributed to their stigmatisation.

Fortunately this deficiency has been recognised locally and a number of innovative programmes have been developed to address this.

The Top2btm symposium on prevention, treatment and care of MSM sought to bring together these programmes to share experiences.

The HIV prevalence rate among men-who-have-sex-with-men (MSM) in South Africa has been found to be consistently higher than the general population in a number of research studies. The reasons for this increased vulnerability to HIV infection have not been widely researched. This exploratory research offers a broad overview of the various elements that affect HIV risk among MSM in Cape Town, South Africa and offers recommendations for HIV prevention efforts and further research.