Understanding HIV risks among men who have sex with men in Africa
van Griensven, F.; Sanders, E.J.
Sexually Transmitted Diseases 35(4): 355-356
2008
ISSN/ISBN: 0148-5717 PMID: 18362856 DOI: 10.1097/olq.0b013e31816bf64cDocument Number: 199907
In this issue of the Journal, Sharma et al.(1) reported the results of focus group discussions regarding HIV risks in relation to emerging group identities, sexual risk taking, and health care usage among 30 men who have sex with men (MSM) from Nairobi, Kenya. This study shows us a rare glimpse into the private lives of Kenyan MSM and the myriad of legal, social, and economic problems confronting MSM in Kenya and likely in many other African countries. These problems include stigma and discrimination, fear of humiliation when accessing health care, concerns about involuntary disclosure of sexual behavior, power differentials between partners in negotiating condom use, fundamental misconceptions about HIV risk, self-medication for sexually transmitted diseases, and low uptake of HIV testing. Because discrimination of MSM is strong in Kenya, the men who came forward to participate in these focus groups are likely a selected population and the problems they discussed may be worse for those outside the focus groups. Obviously, these types of problems are not unique to MSM in Kenya or Africa, but in the African context of strong societal disapproval and risk for legal and other repercussions in case of disclosure they are much more difficult to address. Indeed, in a study among 224 MSM in Kampala, Uganda HIV/ AIDS was given a low priority compared with other concerns and was ranked well behind discrimination and lack of acceptance in society.(2) Findings from the Kenyan and the Uganda studies(1,2) show the urgent need for HIV preventive interventions in African MSM.