1. Sexual Orientation, Violence and AIDS in Africa
Chukwuemeka Anyamele, (Research Triangle Institute) Ronald Lwabaayi, (Livelihood Development International) Tuu-Van Nguyen, (University of Sussex)
Hans Binswanger (World Bank)

2. The hidden epidemics Of AIDS fueled by sex between men
Of violence against MSM from lower classes who cannot or do not want to hide
In Africa it has not been politically correct to talk about or study sexual minorities
Official HIV/AIDS and crime statistics reflect neither of these epidemics
All evidence comes from small case studies, surveys, and the experience of MSM who are starting to speak out

3. 2002 WHO World Report on Violence and Health
Sexual violence against men takes place in homes, schools, on the street, in the military, during wars, in prison, and at police posts
3.6 percent of men report such violence in Namibia, 20 percent in Peru
Forced sexual initiation during adolescence common for both men and women, but more for women
Ranges from 6. 4 % of men in South African study to 30 percent in Cameroon study

4. The Study of 250 MSM in Dakar
Lives characterized by rejection and violence
Half verbally abused by family members
A fourth forced to move in the last 12 months
37 percent forced to have sex in last 12 months
13 percent have been raped by a policeman

5. Discrimination and Violence in Southern and Eastern Africa

6. Other Social Risks

7. Sexual Behavior in Senegal Study
Mean age of sample: 25 years
Mean age at first sexual contact: 15 years
One third of sample:
First male sexual encounter with family member
Vast majority have had sex with women
of these 88 % had vaginal sex, 25 % anal sex
13 % are married, 25 % have children
Good condom knowledge, low use, even in anal sex
Most reporting having had STI
But scared of seeking medical care

8. The HIV/AIDS Bridges Between MSM/WSW and the General Population
LGBTI
Special
Groups
Risk of being subject to violence
due to sexual orientation
MSM: Men who have Sex with Men
Non-existent
LGBTI: Lesbian, Gay, Bisexual, Transgender and Intersex people
Medium
Special Groups: e.g. Inmates of correctional institutions
High
Spillover of HIV/AIDS
Very High

9. HIV/AIDS in Sexual Minorities In Eastern and Southern Africa

10. HIV/AIDS
Given their high risk, the prevalence of HIV/AIDS is significantly worse among MSM
In Senegal it is 21 percent among MSM, while less than 2 percent in the general population
There is a significant spillover of the HIV epidemic to their women and their children
HIV-positive MSMs face a double stigma
They will be even more isolated than AIDS victims in general, and may face terminal illness and death alone

11. In spite of these facts, in most African countries there are only tiny prevention, care or treatment programs that reach sexual minorities
This is unacceptable for them as well as the population at large

12. The agreed elements of a strategy
Developed over many years by different actors
Agreed at International AIDS Conference in Bangkok, five or six years ago
Based on Human Rights and Empowerment
Going well beyond HIV and AIDS
With specific components focused on prevention, treatment, care and support

13. Three prevention models need to be applied together
The epidemiological-behavioral model centered on perceptions and behaviors, seeks to alter such behaviors through interventions addressing information, risk perception, perception of control over one's behavior, self-confidence, and the attitudes of different population groups to the HIV disease
The anthropological-cultural model focuses on meanings of behavior, change codes and values that enhance risks and impede preventive behaviors. It calls for the design of interventions to the various identity sub-groups based on a thorough understanding of these meanings
The political-economic or empowerment model seeks to reduce social, rather than individual, vulnerability. It sees the roots of the epidemic in structural (i.e., class, gender, and lifestyle) inequality. It calls for LGBTI groups to organize, press for their rights and organize their own fight against violence and AIDS.

14. Why are LGBTI Organizations Needed
To spread information, reduce stigma, provide a social safety net, and fight against violence from the population and the police
Given stigma, secrecy, service delivery from public sector or NGOS cannot reach MSMs and WSWs
A global review showed that only where LGBTIs are organized is there any HIV/AIDS prevention and care program among MSMs and WSWs

15. Three Key Actors The State NGOs LGBTI Associations
To focus HIV/AIDS prevention messages on sex: vaginal, anal, oral
To improve the climate and legislation in support of human rights and prevention of violence
To spread the messages
To advocate for human rights
To provide health and other services to special populations
NGOs
At the core of targeted prevention efforts, care, treatment and livelihood development,
Advocacy for and defense of their own human rights
Put pressure on states and civil society
LGBTI Associations