New study reveals exceptionally high HIV prevalence among men who have sex with men in Mpumalanga, indicating an urgent need to improve services.
According to the Mpumalanga Men’s Study, gay, bisexual and other men who have sex with men (MSM) in Mpumalanga are among the hardest hit by the HIV epidemic. HIV prevalence may be up to 30% among this high-risk group with large numbers of new infections occurring in the last 12 months.
The study, conducted by the University of California, San Francisco (UCSF) and the Anova Health Institute, recruited 605 MSM from the Gert Sibande and Ehlanzeni district municipalities to take a behavioural survey and receive counseling and testing for HIV.
The researchers found that 30% of the participants in Gert Sibande and 16% in Ehlanzeni were HIV positive. New HIV infections were also on the rise. In Gert Sibande, 22% of participants who reported testing HIV-negative in the last year tested HIV-positive in the study; in Ehlanzeni the figure was 17%.
The study further showed that men did not test regularly. Although nearly two-thirds had taken an HIV test in their lives, only 1 in 5 reported doing so regularly, every six months. Of those men who had never tested prior to enrolling in the study, 20% were determined to be HIV-positive by rapid test.
“These findings demonstrate that MSM in Mpumalanga are not utilising available HIV services in proportion to their need,” said Dr. Tim Lane of UCSF, the Study’s Principal Investigator.
The stigma MSM face in the public health care sector may be partially at fault. “Almost everyone knows where to find a nearby clinic that offers testing and treatment. But choosing a clinic where you will not experience stigma for being a gay or bisexual man is a more difficult task. Many just avoid testing for as long as they can,” Lane explains.
The researchers believe that traditional HIV messaging should be tailored to better suit the lifestyles of MSM.
“The data show that the traditional prevention messages of consistent condom use and reducing partner numbers may not resonate with the reality of many MSM’s relationships,” said Lane.
“MSM may be telling counselors and researchers what they think we want to hear. When this happens, they don’t receive appropriate counseling on reducing their risk, or on talking to regular and non-regular partners about HIV.”
Whilst most MSM reported consistent condom use, even among those who used protection and limited their partners (one male partner in the last six months), HIV prevalence was high at 21% in Gert Sibande and 27% in Ehlanzeni.
“MSM may require more nuanced prevention messages,” he said. “We should emphasize knowing your status, testing as a couple, protecting your partner or partners if you are positive, and considering all prevention options if you are negative.”
Making health services more MSM-appropriate
The Anova Health Institute’s Health4Men project, which provides health services specifically tailored towards MSM, welcomed the release of the findings. “Health4Men has recently partnered with the Mpumalanga Department of Health to address MSM sexual health in that province,” said Anova’s Glenn de Swardt.
“The partnership will see the establishment of MSM-focused sites in Ermelo and Nelspruit, from where we will train and mentor health workers in the public sector to provide MSM-competent health services throughout the province.”
“We are also initiating a dynamic prevention campaign targeting MSM which will include a significant element of community engagement.” De Swardt added that Health4Men will also be focusing on rural MSM populations in Limpopo and North West provinces within months.
About the study
Mpumalanga Men’s Study participants were between 18 and 41 years of age. Around 75% had finished matric. Fewer than half were employed in the prior six months. More than three quarters identified themselves as gay or bisexual and reported having a regular male partner. Roughly one-third reported having a regular female partner.
All study participants had the opportunity to receive same-day HIV test results. Each was given a prevention pack that included condoms, water-based lubricant, and MSM-specific prevention information provided by Health4Men. HIV-positive MSM were referred to care at local clinics where clinical staff had received sensitivity training from Health4Men.
For interviews or further information
Tim Lane, University of California, San Francisco, Center for AIDS Prevention Studies, San Francisco, CA, USA, +1-415-867-2324, firstname.lastname@example.org
Helen Struthers, Anova Health Institute, Johannesburg, South Africa, +27-83-308-6662, email@example.com