Vasu Reddy

Men who have sex with men: stigma and discrimination

Faculty of Humanities and Social Sciences, School of Social Sciences, La Trobe University, Melbourne (Bundoora), VIC, Australia (D Altman MA); National Centre in HIV Social Research, University of New South Wales, Sydney, NSW, Australia (P Aggleton PhD); Michael Kirby Centre for Public Health and Human Rights, Monash University, Melbourne, VIC, Australia (M Williams LLB); University of Hong Kong, Pokfulam, Hong Kong (T Kong PhD); Human Sciences Research Council, Pretoria, South Africa (V Reddy PhD); Grupo Dignidade, Curitiba, Brazil (D Harrad MA); Associacao Brasileira de Lesbicas, Gays, Bissexuais, Travestis e Transexuais, Curitiba, Brazil (T Reis PhD); and Mailman School of Public Health, Columbia University, New York, NY, USA (R Parker PhD)

You become afraid to tell them that you are gay: health service utilization by men who have sex with men in South African cities.

We describe the utilization of health services by men who have sex with men (MSM) in South African cities, their perceptions of available health services, and their service preferences. We triangulated data from 32 key informant interviews (KIIs), 18 focus group discussions (FGDs) with MSM in four cities, and a survey of 285 MSM in two cities, recruited through respondent-driven sampling in 2008. FGDs and KIIs revealed that targeted public health sector programs for MSM were limited, and that MSM experienced stigma, discrimination, and negative health worker attitudes. Fifty-seven per cent of the survey participants had used public health services in the previous 12 months, and 69 per cent had no private health insurance, with no difference by HIV status. Despite these findings, South Africa is well placed to take the lead in sub-Saharan Africa in providing responsive and appropriate HIV services for MSM.

Social vulnerability and HIV testing among South African men who have sex with men

This study examined whether social vulnerability is associated with HIV testing among South African men who have sex with men (MSM). A community-based survey was conducted with 300 MSM in Pretoria in 2008. The sample was stratified by age, race and residential status. Social vulnerability was assessed using measures of demographic characteristics, psychosocial determinants and indicators of sexual minority stress. Being black, living in a township and lacking HIV knowledge reduced MSMs likelihood of ever having tested for HIV. Among those who had tested, lower income and not self-identifying as gay reduced mens likelihood of having tested more than once. Lower income and internalized homophobia reduced mens likelihood of having tested recently. Overall, MSM in socially vulnerable positions were less likely to get tested for HIV. Efforts to mitigate the effects of social vulnerability on HIV testing practices are needed in order to encourage regular HIV testing among South African MSM.

HIV testing and self-reported HIV status in South African men who have sex with men: results from a community-based survey

Objective: To investigate the characteristics of South African men who have sex with men (MSM) who (1) have been tested for HIV and (2) are HIV positive. Methods: Data were collected from 1045 MSM in community surveys using questionnaires that were administered either face-to-face, by mail or on the internet. The mean age of the men was 29.9 years. The race distribution was 35.3% black, 17.0% coloured, 5.3% Indian and 41.1% white. Results: The proportion of MSM tested for HIV was 69.7%; having been tested was independently associated with being older, being more open about one’s homosexuality and being homosexually instead of bisexually attracted; black MSM, students and MSM living in KwaZulu-Natal were less likely to have been tested. Of the 728 MSM who had been tested, 14.1% (n = 103) reported to be HIV positive (9.9% of the total sample). Being HIV positive is independently associated with two factors: men who were positive were more likely to have a lower level of education and to know other people who had HIV/AIDS; race was not independently associated with HIV status among those who had been tested. Conclusions: The likelihood of having been tested for HIV seems to decrease with increasing social vulnerability. Racially, the distribution of HIV among MSM seems to differ from that of the general South African population, suggesting that while intertwined with the heterosexual epidemic there is also an epidemic among South African MSM with specific dynamics. These findings suggest that in-depth research is urgently needed to address the lack of understanding of HIV testing practices and HIV prevalence in South African MSM.

Forced sexual experiences as risk factor for self-reported HIV infection among southern African lesbian and bisexual women.

Even though women who have sex with women are usually understood to be at no or very low risk for HIV infection, we explored whether lesbian and bisexual women in a geographical area with high HIV prevalence (Southern Africa) get tested for HIV and whether, among those women who get tested, there are women who live with HIV/AIDS. The study was conducted in collaboration with community-based organizations in Botswana, Namibia, South Africa and Zimbabwe. Data were collected via written surveys of women who in the preceding year had had sex with a woman (18 years and older; N = 591). Most participating women identified as lesbian and black. Almost half of the women (47.2%) reported ever having had consensual heterosexual sex. Engagement in transactional sex (lifetime) was reported by 18.6% of all women. Forced sex by men or women was reported by 31.1% of all women. A large proportion of the women reported to ever have been tested for HIV (78.3%); number of lifetime female and male partners was independently associated with having been tested; women who had engaged in transactional sex with women only or with women and men were less likely to have been tested. Self-reported HIV prevalence among tested women who knew their serostatus was 9.6%. Besides age, the sole independent predictor of a positive serostatus was having experienced forced sex by men, by women, or by both men and women. Study findings indicate that despite the image of invulnerability, HIV/AIDS is a reality for lesbian and bisexual women in Southern Africa. Surprisingly, it is not sex with men per se, but rather forced sex that is the important risk factor for self-reported HIV infection among the participating women. HIV/AIDS policy should also address the needs of lesbian, bisexual and other women who have sex with women.

The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa.

The objective of this study is to assess (1) whether beliefs about trust and condom use affect sexual risk behaviour, and (2) if beliefs about trust and condom use impact sexual risk behaviour directly or if this relationship is mediated by other determinants. The Information-Motivation-Behavioural Skills model was used as a framework for the mediation analysis. A diverse cohort of three hundred 18–40 year old men who have sex with men (MSM) residing in Pretoria, South Africa, were recruited and surveyed for this project. Findings indicate that men who report a high frequency of past unprotected anal intercourse are more likely to believe that it is not necessary to use condoms with a trusted or steady partner regardless of their current partnership status. This fallacy of intimacy appears to affect sexual risk behaviour through intentions and attitudes regarding safer sex practices. Based on these findings, we recommend that more attention be given in gaining a better understanding of how beliefs about trust and condom use are formed and how they can be changed among MSM in South Africa.

Decriminalisation of homosexuality in post-apartheid South Africa: A brief legal case history review from sodomy to marriage

abstract As a form of social control, the law may proscribe and facilitate homosexuality in respect of identity formation. This focus provides a brief legal case history review to demonstrate that legal victories facilitate identity politics for homosexuals. It is argued that not only the question of ‘freedom’, but also the development and refinement of citizenship claims become paramount for the queer subject in the post-apartheid project.

‘They think that gays have money’: gender identity and transactional sex among Black men who have sex with men in four South African townships

Transactional sex has not been studied much among men who have sex with men in Africa. Consequently, little is understood about attitudes towards the practice, the circumstances that give rise to it or how transactional sex relationships are managed. We conducted in-depth interviews with 81 Black men aged 20–44 from four low-resourced townships in Tshwane, South Africa. We found that transactional sex was a widely used strategy for initiating and sustaining relationships with regular and casual partners, and was motivated by both the need for subsistence and for consumption. Alcohol-based exchanges in particular provided men in the townships with a covert and safe platform to communicate erotic, sexual and romantic attraction to other men, and bars and other drinking places were a popular venue for meeting potential sexual partners. The majority of ‘feminine-identifying’ men had engaged in transactional sex as the providers of money and material goods compared to men who identified as either ‘masculine’ or as ‘both masculine and feminine’. Surprisingly, however, this did not necessarily give them greater control in these relationships. Our study provides an initial foray into a complex sociosexual phenomenon and suggests that gender identity is an important construct for understanding transactional sex relationships among men in Africa.

HIV Testing Practices of South African Township MSM in the Era of Expanded Access to ART

AbstractWhile men who have sex with men (MSM) in Africa are at high risk for HIV infection, few of those already infected know their status. Effectively promoting frequent HIV testing—of increasing importance with the expanding accessibility of antiretroviral treatment—requires an understanding of the testing practices in this population. To understand men’s HIV testing practices, including their behavior, experiences, and perceptions, we conducted in-depth interviews with 81 black South African MSM (ages 20–39), purposively recruited from four townships. Many men in the sample had tested for HIV. While ever having tested seemed to facilitate repeat testing, men still expressed a high level of discomfort with testing. It was common to test after having engaged in risky behavior, thus increasing anxiety about testing that was already present. Fear that they might test HIV positive caused some men to avoid testing until they were clearly sick, and others to avoid testing completely. HIV testing may increase in this population if it becomes a routine practice, instead of being driven by anxiety-inducing incidents. Mobilization through social support might facilitate frequent testing while education about current treatment options is needed. ResumenAunque la población de hombres que tienen sexo con hombres (HSH) en África corre un alto riesgo de infección del VIH, pocos de ellos que ya están infectados con el virus conocen su diagnóstico. Promover exitosamente el uso de la prueba del VIH frecuente y regularmente—una práctica de creciente importancia con la mayor disponibilidad de los tratamientos antiretrovirales—requiere un entendimiento de las prácticas de esta población en relación a la prueba. Para entender las prácticas de la prueba del VIH en hombres, incluyendo sus comportamientos, experiencias y percepciones, llevamos a cabo entrevistas en profundidad con 81 HSH negros sudafricanos de 20 a 39 años de edad, intencionalmente reclutados de cuatro localidades (townships). Al parecer, muchos de los hombres se habían hecho la prueba. Aunque el hecho de haberse hecho la prueba parece facilitar la repetición de esta, los hombres expresaron altos niveles de incomodidad. Fue común hacerse la prueba después de haber tenido conductas de riesgo, así aumentando la ansiedad sobre la prueba ya existente. El temor de tener un resultado de VIH-positivo causó que algunos hombres postergaran la prueba hasta que estuvieran claramente enfermos y a otros que evitaran someterse a ella por completo. Convertir a la prueba de VIH en una práctica rutinaria, en vez de un acto estimulado por incidentes coyunturales y altamente preocupantes, probablemente incrementará el uso de la prueba entre esta población. Una movilización a través del apoyo social podría facilitar el uso frecuente de la prueba.

African same-sex sexualities and gender-diversity: an introduction

Good quality social science and humanities research about same-sex sexuality in Africa is rare. This does not imply that same-sex sexuality is not practised in Africa. The alarming news reports that appear with increasing regularity about extreme expressions of homophobia in some African countries (in recent times most notably Nigeria and Uganda) indicate that same-sex sexual relations are, indeed, part of the African sexual landscape. Discussions about same-sex sexuality being ‘un-African’ would be moot, if African people did not engage in it. In contrast, there are also supportive news reports, such as the recent traditional African gay wedding in the town of KwaDukuza (the birthplace of Nobel Laureate, Albert Luthuli), South Africa where Tshepo Modisane and Thoba Sithole married each other in a public ceremony to confirm as Modisane says their public expression as ‘a sign that black gay men can commit and build a family through a happy and loving marriage’ (http://www.mambaonline.com/article.asp? artid1⁄48020). However, our understanding of same-sex sexuality in Africa has increased to a dramatic extent in response to the HIV epidemic, recognising that in the recent past we did not know much about the relationship between same-sex sexuality and HIV outside of the richer countries of the West (Johnson 2007; Reddy, Sandfort, and Rispel 2009). Although this epidemic, especially in sub-Saharan Africa, was long believed to be exclusively characterised by heterosexual transmission, research in the recent past strongly indicates that in these countries, the odds of being infected with HIV is higher among men who have sex with men than among men in general (Beyrer et al. 2010; Lane et al. 2011; Rispel et al. 2011; Sanders et al. 2013). Attention to the same-sex transmission of HIV has also contributed to the proliferation of community-based organisations with a focus on same-sex sexuality. A consequence of this growth is an increasing societal visibility of same-sex sexuality, which likely also contributed to the mobilisation of counter forces in religion, politics, culture, tradition and, indeed, the law. The HIV-related literature on same-sex sexuality, however, has its limitations. This literature is primarily of an epidemiological nature, focusing on HIV prevalence (see, however, Lorway 2006) and on men (see, however, Sandfort et al. 2013). Overall, it provides us with another lens, albeit an incomplete one, with which to understand the story of same-sex sexuality. To begin to address this problem, we organised a conference entitled ‘African Samesex Sexualities and Gender Diversity’, which was held between 13–16 February, 2011,