HIV This Week

Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe H. Lancet. 2009;374: 416-422.

Globally, men who have sex with men continue to bear a high burden of HIV infection. In sub-Saharan Africa, same-sex behaviours have been largely neglected by HIV research up to now. The results from recent studies, however, indicate the widespread existence of groups of men who have sex with men across Africa, and high rates of HIV infection, HIV risk behaviour, and evidence of behavioural links between men who have sex with men and heterosexual networks have been reported. Yet most African men who have sex with men have no safe access to relevant HIV information and services, and many African states have not begun to recognise or address the needs of these men in the context of national HIV prevention and control programmes. The HIV community now has considerable challenges in clarifying and addressing the needs of men who have sex with men in sub-Saharan Africa; homosexuality is illegal in most countries, and political and social hostility are endemic. An effective response to HIV requires improved strategic information about all risk groups, including men who have sex with men. The belated response to men who have sex with men with HIV infection needs rapid and sustained national and international commitment to the development of appropriate interventions and action to reduce structural and social barriers to make these accessible.

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 Editors’ note: Major barriers exist in access to effective HIV prevention, treatment, and care and support for men who have sex with men in sub-Saharan Africa. Not the least of these is the need for African political commitment to legal reforms and social protection for sexual minorities and those who work with them. It is not surprising that HIV subtypes in African men who have sex with men are similar to those occurring in the general population given that a high proportion of them report recent female sexual partners and many are married. What is surprising is how little is known about them. Only 17 of 52 African countries reported any information about risk knowledge and behaviour, HIV prevalence, and access to care among men who have sex with men in their 2008 reports of progress on the 2001 Declaration of Commitment. The silence must be broken to start to reverse the inaction that is so harmful to men who have sex with men, and to everyone else in Africa.