Men who have sex with men: Missing link in HIV and AIDS fight Malawi

It is Saturday afternoon; James (not his real name) from Chitawira Township in the commercial city of Malawi, Blantyre has more questions than answers after coming from a nearby clinic where he was diagnosed with HIV.

James, a gay is in dilemma on how he got the virus despite being sleeping with his fellow men in the past two years.

“l have been thinking that you contract HIV  only if you sleep with the opposite sex,” he says, before asking for a glass of water to quench his thirst.

He says MSMs are often exposed to stigma, discrimination, interpersonal violence and poor access to quality health care and support services.

“This even puts us in greater danger of contracting HIV. Unfortunately, due to the fact that MSMs are still not considered to be a high HIV infection risk group by many HIV/AIDS organizations, very little has been done to address the epidemic amongst us,” James says.

He says even though MSM are generally not considered to be a high HIV infection risk group, sex among them  is very risky because they mostly have unprotected sex.

“Many have the mindset that anal sex is safer,” James reveals.

A third born in a family of five children, James notes that the fight against HIV and AIDS is far from over until MSMs are involved.

“MSMs have not been embraced across the continent, but a matter of fact is that the practice still continues, “he says.

A training manual by Panos, titled Mediating HIV & AIDS in Southern Africa, Malawi tops the chats with high prevalence of the pandemic among MSM with the prevalence at 21.4 percent, followed by Botswana with 19.4 and Namibia has 12.11 percent.

The reports show that MSM risk of contracting HIV and AIDS is 19.3 percent greater than men having sex with women.

James also stressed that another dangerous thing is that there are also multiple partners in MSM.

For instance, he says many MSMs engage in multiple concurrent sexual relationships and transactional sex with an aim to conceal their true sexual orientation.

“We are supposed to be involved in the fight of HIV/AIDS because some of us also engage in sexual activities with women and many are married to or are in a long-term relationship with a woman,” he says.

Recent research has revealed alarmingly high HIV prevalence rates amongst MSM in Malawi.

For instance, Centre for the Development of People (CEDEP) report of 2008 says prevalence rate among Men who have sex with Men (MSM) is at 21 per cent.

The research further states that men like James are 45 times greater at risk of contracting the virus than sex between men and women.

These findings bring into question the decisions made by many HIV & AIDS organizations and the authorities   to focus primarily on heterosexual individuals in their HIV & AIDS campaigns, often completely excluding MSM from these initiatives.

James says there is need to involve minority groups such same sex partners if the country is to win the fight against the HIV and AIDS pandemic.

He says it is very important to involve minority groups because statistics have shown that HIV prevalence rate is very high in minority groups and stressing that if they are not involved, then the country cannot halt HIV transmission.

“It seems the investments are not yielding optimal results since the other section of high risk group is left out,” he notes.

James says early research on the primary modes of HIV transmission in Malawi suggested that men and women were equally vulnerable to HIV infection, and that the virus was mainly transmitted through heterosexual intercourse.

He says as a result, heterosexual couples, sero-discordant couples, people in multiple concurrent sexual partnerships and female commercial sex workers were the only groups considered most at risk for contracting HIV.

He observes that these groups subsequently received more attention from HIV & AIDS research and intervention campaigns.

“I feel this could be due to the fact that homosexuality is largely condemned by most Malawian cultures and religious groups, and even punishable by law,” James says.

He also notes that since homosexuality is regarded as a taboo subject amongst many Malawians, it makes very difficult to make contact with MSM, elicit public debate about the issue and conduct thorough research on MSM in the country.

James Says these attitudes towards homosexuality have caused many MSM to become victims of stigmatization and discrimination and that Fear of possible victimization has also led to many MSM concealing their sexual orientation.

He also emphasized that due to such factors, they have been unable to access quality health care services such as voluntary HIV counseling and testing (VCT).

“HIV testing rate amongst us is very low, resulting in many HIV positive MSM not knowing their status,” he says.

A Study which was conducted by an International Aids Society and was presented at the XVII International AIDS Conference in 2008  found that the number of HIV positive MSM who  knew their HIV status was only 4.7% in Malawi, 17.4% in Botswana and 59.2% in Namibia.

James says this has not only made MSM more vulnerable to HIV infection but also made it more difficult for researchers to gain access to them and investigate the HIV risk behavior and prevalence rates.

“Consequently, due to lack of data, we are not considered to be a priority target group by many HIV & AIDS programme planners and health care officials,” he says.

In a white shirt and black tie, James says discrimination due to the country’s unacceptability of the existence of the groups is also a major setback in their involvement in the fight against HIV and AIDS.

James further says cultural values should align themselves with the changing world and embrace ideologies propagating
homosexuality.

“We are in a global world where human rights are held in high esteem. What I mean is that time has come for us to accept that MSM are within our society. So, when we talk about fighting HIV and Aids leaving us out, we will not win this battle.

“The criminalization of homosexual practices in many African countries should be addressed, as it plays a critical role in the widespread stigmatization and discrimination that we suffer. This could be done by putting more pressure on these Governments to decriminalize homosexual practices,” he says.

Furthermore, he emphasized that health services specifically focused on the special needs of MSM should be made more widely available, and that MSM should be made more aware of these services.

He mentioned things that includes, increasing the availability of VCT, antiretroviral (ARV) treatment, STI treatment and condoms to MSM,” he says.

The Malawi HIV and AIDS national policy: A call for renewed action for October 2003 says people who engage in same sex relationships are socially and culturally vulnerable to prevailing attitudes.

“If they aren’t accorded access to HIV/AIDS prevention, education, treatment, care and support they may endanger others as a result of their ignorance,” says the policy.

The policy also recognizes the practice of transitional sex including sex workers saying government through National AIDS Commission will ensure that these people and their clients are aware of the pandemic and take responsibility for protecting themselves and their sexual partners.

James, wraps up the interview stressing that the fight against HIV and AIDS will be far from over as long as Men having sex with other men are not catered for in prevention.

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