BBC: Anti-Gay Attitudes to Blame for High African HIV Rate

The BBC is reporting on the findings of a Lancet Medical Journal report regarding high HIV rates among gay men in some African countries. The conclusions? Blame anti-gay attitudes.

HIV rates among gay men in some African countries are 10 times higher than among the general male population, says research in medical journal the Lancet.

The report said prejudice towards gay people was leading to isolation and harassment, which in turn led to risky sexual practices among gay communities

I would never discount the fact that the stigma of being a gay male in sub-Saharan Africa would lead such men to be less willing to seek treatment. But that determination can hardly be the primary reason behind such high numbers in light of other contributing factors. Yet the BBC report leads with this conclusion despite other findings that would likely be the focus of such a report in a world where cause and effect didn't take a back seat to hope and change.

For instance, lead researcher Adrian Smith reported some of the other obvious findings but relegated them to a mere side note in an effort to promote the anti-gay cause and effect angle.

The Oxford University researchers found that the prevalence of HIV/Aids among gay men in sub-Saharan African has been "driven by cultural, religious and political unwillingness to accept [gay men] as equal members of society".

Lead researcher Adrian Smith told the BBC there was "profound stigma and social hostility at every level of society concerning either same-sex behaviours amongst men, or homosexuality".

"This has the consequence that this group becomes extremely hard to reach," he said.

Mr Smith said that gay male sex had always been acknowledged as being particularly dangerous in terms of contracting HIV/Aids.

But gay men were also more likely to be involved in other high-risk behaviours, including sex work, having multiple partners and being in contact with intravenous drug use, he said

Keep in mind the tie in with gay male sex as a high risk behavior as you read the following statement by a gay rights activist that was promoted in the BBC article:

George Kanuma, a gay rights activist in Burundi, told the BBC many men "hide their sexual orientation" to get married and have children, but continue to have sex with men.

"Most of them know that you can contract HIV/Aids or any infection when you are making sex with women, but not when you are having sex with another man," he said. 

This statement and subsequent report by the BBC is the real tragedy of the Aids epidemic.

If by chance it is true that a majority of gay men in Africa are unaware of the dangers of gay sex I believe that they were let down by the very people that should have been telling them so for the last 20 plus years. I however remain skeptical that these men can come to conclude that unprotected sex with women is risky yet they can't come to the same conclusions about gay male sex. If the practice has such an overwhelming negative stigma attached to it one can hardly conclude that it would be viewed as the healthy alternative to having sex with a woman.

I understand that some local customs, societal barriers and logistical complexities make awareness efforts difficult but it seems incomprehensible that anti-gay attitudes are so much of a contributing factor that other more plausible and alarming causes for the high prevalence of Aids are hardly mentioned in the BBC report. 

Even so, if I was to give the gay activist George Kanuma the benefit of the doubt I would propose that it is the reluctance of many to place gay male sex in a higher risk category that has helped perpetuate the problem and in fact make it worse. Unfortunately that particular attitude was not the subject of the Lancet report.

Update: When looking at these studies it is important to understand why certain statistics stick out like a sore thumb. I was unable to get the actual text of the Lancet but managed to get more information that was originally available in the BBC article. The first thing that struck me is that we need some clear definitions.

For instance, the study found that the rate of infection among gay men in sub-Saharan Africa was ten times that of the general male population yet we have not been provided actual numbers. The numbers will help us make important cross references to other high risk groups.

We also have to look at other contrinbuting factors. For instance, heterosexual transmission is the most prevalent mode of transmission on the continent according to the New York Times. It is not clear to me whether or not prevention efforts were focused in a mannner to address the most urgent needs, i.e. women and children.

Another statistic to consider, what are the chances that a man having unprotected gay male sex  will contract HIV? More importantly, what is that number with respect to unprotected heterosexual sex? 

For sure, religious beliefs, societal pressures and various laws have provided a barrier to gay males that practice male sex (MSM). Yet it is also clear that it was not thought until recently to be as important as it is now believed to be.

Several recent studies suggest that unprotected anal sex between men is probably a more important factor in the epidemics in sub-Saharan Africa than is commonly thought. In Zambia, one in three (33%) surveyed men who have sex with men tested HIV-positive. In the Kenyan port city of Mombasa, 43% of men who said they had sex only with other men were found to be living with HIV. HIV prevalence of 22% was found among the 463 men who have sex with men who participated in a study in Dakar, Senegal.  - UNAIDS.org

This is a very important point. Not only are there barriers to treating and educating gay men in the area but they may have also been victims of demographics. It is quite possible that the prevention and treatment efforts were directed to those areas perceived as most important.

It is also important to note that while blogs such as The Huffington Post immediatly scream homophobia the numbers suggest that the rate among gay men in Africa is potentially in line with other high-risk groups.(We need to see actual numbers to draw a concrete conclusion)

Sex work

Sex work is an important factor in many of West Africa’s HIV epidemics. More than one third (35%) of female sex workers surveyed in 2006 in Mali were living with HIV, and infection levels exceeding 20% have been documented among sex workers in Senegal and Burkina Faso. Sex work plays an important, but less central, role in HIV transmission in southern Africa, where exceptionally high background prevalence results in substantial HIV transmission during sexual intercourse unrelated to sex work.

Injecting drug use

Injecting drug use is a factor to some extent in several of the HIV epidemics in East and southern Africa, including Mauritius, where the use of contaminated injecting equipment is the main cause of HIV infection. In various studies, about half of the injecting drug users tested in the Kenyan cities of Mombassa (50%) and Nairobi (53%) were HIV positive.

We can't blame homophobia for the high sex rate among drug users and the sex industry although there is certain to be a segment of the population that fall into multiple demographic groups. It would be interesting to see how these rates line up with the actual numbers from the Lancet and other studies before jumping to the extreme conclusions.

Terry Trippany is The Watcher at Watcher of Weasels.