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Understanding risk from the frontlines of a hidden epidemic: Sexuality, masculinities and social pressures among men who have sex with in South Africa.

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Presentation on theme: "Understanding risk from the frontlines of a hidden epidemic: Sexuality, masculinities and social pressures among men who have sex with in South Africa."— Presentation transcript:

1 Understanding risk from the frontlines of a hidden epidemic: Sexuality, masculinities and social pressures among men who have sex with in South Africa Jeremiah Chikovore Human Sciences Research Council, Durban, South Africa AIDS2014, Melbourne, Australia, 20-25 th June 2014 Image: WHO

2 The HIV epidemic in MSM Globally, MSM are 13 x more likely to acquire HIV infection than the general population. Prevalence rates for MSM in South Africa are 10-43% Compared with the adult rate of 17.9% in 2012 A contextualized perspective to YMSM risk is essential McIntyre, et al. 2013; Shisana, et al. 2014; UNAIDS, 2013; DTHF, 2011

3 Risk determinants for MSM [1] Individual risk factors for MSM Unprotected receptive anal intercourse High frequency of male partners High number of lifetime partners Injecting drug use Non use of protection with regular partners In US and UK: higher prevalence rates in Black MSM due to Poor linkage to care with low rates of successful treatment High STI prevalence which facilitates HIV transmission In YMSM: sex mixing, early debut and history of child abuse * Structural factors and health care delivery important, not necessarily sexual and drug use risk behaviors UNAIDS, 2013; DTHF, 2011; Beyrer, et al. 2012, McIntyre, et al. 2013

4 Structural factors in MSM risk Stigma & discriminat ion Criminali- sation Poverty and inequality Violence and racism Gender norms Insensiti- ve health systems UNAIDS, 2013; Mills, Beyrer et al. 2012; McIntyre et al. 2013; DTHF; MSMGF 2012 Risk determinants for MSM [2]

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6 Controversy around and diversity in MSM Subordination & marginalization as aspects of postcolonial and hetero-patriarchal dynamics (Epprecht 2013; Obbo 1995) Reddy (1998): notion of gay masculinity presents a false impression of inclusiveness and solidarity; gay relations are defined by racism, sexism and classism Swarr (2004): most white men who identify as gay are masculine, and white same-sex gay masculinity has been drawn and positioned differently from Colored and Black same sex masculinity.

7 Masculinity and violence against MSM Masculinities are multiple, competitive, hierarchical, and strive to exclude femininity Framework helps explain the violence within and against MSM Penetration is symbolic of masculinity. Preferred likely by older and bisexual men Gay/female identifying MSM significantly and associated with experiencing coerced sex MSM who experience partner violence may not perceive it as such owing to machismo Suggs 2001, Connell 1995; Reddy & Louw 2002; Betron & Gonzalez-Figueroa 2009

8 … and silence and risk behaviour Bisexual men conceal sexuality to fit ‘normal’ profile (Reddy and Louw 2002) Zulu men become masculine through marrying and setting up a homestead (Hunter 2005) Disclosure triggers derision and mocking (Jobson 2010). Resulting silence causes failure MSM to engage with their health. IPV victims are driven into sexual risk behavior unprotected sex more sex linked to alcohol and other substance use (Dunkle, et al. 2013). ‘Counteractive buffering’: (Vincke & Bolton, 1995)

9 Young and MSM [1] Knox et al. (2011) Young MSM less likely to be tested; Black MSM less likely than White MSM; students less likely than the employed. Those attracted to both men and women were less likely to be tested Black men likely to be younger and student Those HIV positive likely to be Black and self-employed Younger men - receptive and feminine - relied on older men to initiate safety measures (Henriksson & Månsson, 1995) Practical problems using condoms e.g. due to erectile dysfunction, lead ol der MSM to demand non-use of condoms (McIntyre, Jobson et al, 2013) Reddy & Louw 2002: Notion of “promotion”

10 Young and MSM [2] Unemployment Dependence on family for survival and abode Family may be unsupportive Mental tensions Resort to sex work and drugs For survival and coping with sex work Hazards of sex work and drug use motivate more intensive drug use to cope. ‘… he’s the one always getting involved, he gets piss drunk, and then he gets f*d (my edit) all over the show but… (no sir, it’s not me, it’s the wine)’ from (Jobson 2010: p39)

11 Risk for Young MSM Blackfeminine HIV infected studentpovertyreceptive Drugs/sex work Lack of knowledge Self- employed homeless Mental health vulnerable

12 Way forward There is impetus regarding work on MSM in the country There is need to systematically determine the risk profile for YMSM groups in their diversity Effort must be made to track the epidemic and its determinants in YMSM There is need continue efforts to reach young people in and out of school with information about sexual diversity. It is necessary to consider different to reach YMSM and MSM generally, and give them a sense of community There is need to ensure support and care are provided effectively in a non-stigma laden setting at points where MSM first call for help

13 Image: http://www.health-e.org.za/ Thank you!


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