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Jeremiah Chikovore Human Sciences Research Council, Durban, South Africa

Image: WHO. Understanding risk from the frontlines of a hidden epidemic: Sexuality , masculinities and social pressures among men who have sex with in South Africa. Jeremiah Chikovore Human Sciences Research Council, Durban, South Africa AIDS2014, Melbourne, Australia, 20-25 th June 2014.

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Jeremiah Chikovore Human Sciences Research Council, Durban, South Africa

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  1. Image: WHO Understanding risk from the frontlines of a hidden epidemic: Sexuality, masculinitiesand social pressures among men who have sex with in South Africa Jeremiah Chikovore Human Sciences Research Council, Durban, South Africa AIDS2014, Melbourne, Australia, 20-25th June 2014

  2. The HIV epidemic in MSM • Globally, MSM are 13 x more likely to acquire HIV infection than the general population. • Prevalence rates for MSM in South Africa are 10-43% Compared with the adult rate of 17.9% in 2012 • A contextualized perspective to YMSM risk is essential McIntyre, et al. 2013; Shisana, et al. 2014; UNAIDS, 2013; DTHF, 2011

  3. Risk determinants for MSM [1] • Individual risk factors for MSM • Unprotected receptive anal intercourse • High frequency of male partners • High number of lifetime partners • Injecting drug use • Non use of protection with regular partners • In US and UK: higher prevalence rates in Black MSM due to • Poor linkage to care with low rates of successful treatment • High STI prevalence which facilitates HIV transmission • In YMSM: sex mixing, early debut and history of child abuse * Structural factors and health care delivery important, not necessarily sexual and drug use risk behaviors UNAIDS, 2013; DTHF, 2011; Beyrer, et al. 2012, McIntyre, et al. 2013

  4. Risk determinants for MSM [2] UNAIDS, 2013; Mills, Beyrer et al. 2012; McIntyre et al. 2013; DTHF; MSMGF 2012

  5. Controversy around and diversity in MSM • Subordination & marginalization as aspects of postcolonial and hetero-patriarchal dynamics (Epprecht 2013; Obbo 1995) • Reddy (1998):notion of gay masculinity presents a false impression of inclusiveness and solidarity; gay relations are defined by racism, sexism and classism • Swarr (2004): most white men who identify as gay are masculine, and white same-sex gay masculinity has been drawn and positioned differently from Colored and Black same sex masculinity.

  6. Masculinity and violence against MSM • Masculinities are multiple, competitive, hierarchical, and strive to exclude femininity • Framework helps explain the violence within and againstMSM • Penetration is symbolic of masculinity. • Preferred likely by older and bisexual men • Gay/female identifying MSM significantly and associated with experiencing coerced sex • MSM who experience partner violence may not perceive it as such owing to machismo Suggs 2001, Connell 1995; Reddy & Louw 2002; Betron & Gonzalez-Figueroa 2009

  7. … and silence and risk behaviour • Bisexual men conceal sexuality to fit ‘normal’ profile (Reddy and Louw 2002) • Zulu men become masculine through marrying and setting up a homestead (Hunter 2005) • Disclosure triggers derision and mocking (Jobson 2010). • Resulting silence causes failure MSM to engage with their health. • IPV victims are driven into sexual risk behavior • unprotected sex • more sex linked to alcohol and other substance use (Dunkle, et al. 2013). • ‘Counteractive buffering’: (Vincke & Bolton, 1995)

  8. Young and MSM [1] • Knox et al. (2011) • Young MSM less likely to be tested; Black MSM less likely than White MSM; students less likely than the employed. • Those attracted to both men and women were less likely to be tested • Black men likely to be younger and student • Those HIV positive likely to be Black and self-employed • Younger men - receptive and feminine - relied on older men to initiate safety measures(Henriksson & Månsson, 1995) • Practical problems using condoms e.g. due to erectile dysfunction, lead older MSM to demand non-use of condoms (McIntyre, Jobson et al, 2013) • Reddy & Louw 2002: Notion of “promotion”

  9. Young and MSM [2] • Unemployment • Dependence on family for survival and abode • Family may be unsupportive • Mental tensions • Resort to sex work and drugs • For survival and coping with sex work • Hazards of sex work and drug use motivate more intensive drug use to cope. ‘… he’s the one always getting involved, he gets piss drunk, and then he gets f*d (my edit) all over the show but… (no sir, it’s not me, it’s the wine)’ from(Jobson 2010: p39)

  10. Way forward • There is impetus regarding work on MSM in the country • There is need to systematically determine the risk profile for YMSM groups in their diversity • Effort must be made to track the epidemic and its determinants in YMSM • There is need continue efforts to reach young people in and out of school with information about sexual diversity. • It is necessary to consider different to reach YMSM and MSM generally, and give them a sense of community • There is need to ensure support and care are provided effectively in a non-stigma laden setting at points where MSM first call for help

  11. Thank you! Image: http://www.health-e.org.za/

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