Providing prisoners, sex workers, adolescents and men who have sex with men with
sexual and reproductive health services has been advocated by the World
Health Organisation and the United Nations and several other international bodies.
Services not always available
result, most national governments have heeded this advice and cater for these
groups, known as key populations.
part of accessing quality and effective sexual and reproductive health services
is to strengthen HIV prevention and to
provide everyone with access to HIV treatment, care and
But, in many
African countries, knowledge to guide HIV programming for men who have sex with
men is only just developing. And when there are guidelines, the services are
not always available.
that many people in these key populations do not get the services they need.
National HIV Prevention Strategy specifically acknowledges that these
populations must be targeted in its HIV programming, but homosexuality is still a crime in the country.
Read: Homosexuality ban threatens HIV
progress in Uganda
though there is a moratorium on criminalising male-male sexual
relationships, men who have sex with men have difficulty getting access to
also criminalises homosexuality. It has nevertheless started to implement
different harm-reduction HIV interventions for key populations, including men who have sex with men.
15% of men who have sex
with men are HIV positive in the country. The figure is double in the country’s
capital Dar es Salaam.
are similar in Malawi, where the crude HIV prevalence is 15.4%. Just over 90%
of the HIV infections were reported as previously undiagnosed.
studies on men who have sex with men have been done in Malawi and Tanzania.
Malawi reflects the negative general public attitudes towards these men. Many
of the studies also show that stigma and discrimination
The research shows that there is still a low uptake
of HIV prevention and health services among these men. They fear seeking health
services and disclosing their sexual orientation because of discrimination.
Another study, which corroborates this, shows that only
9% of men who have sex with men in Malawi disclosed their sexual practices to a
health care provider.
shows that only 18% of the men who have sex with men that were interviewed said
they were exposed to HIV prevention messages that were relevant to them.
Read: Few gay and bisexual teen males go
for HIV tests
men are aware of the HIV risks, they believed that within their wider community
there is a general lack of HIV information for men who have sex with men, low
awareness of the appropriate prevention and low perception of risks related to
health workers said they provided services to everyone without regard of sexual
orientation, the men interviewed in our study said they experienced constrained
access to services.
providers themselves face a number of challenges. One is their concern about
adverse repercussions if they provide services to men in
same sex sexual relationships.
that they lack awareness. We asked health workers how capable they were at
establishing the sexual history of their patients. This would include asking
questions about a person’s sexual orientation and sexual practices so that they
could better understand the individual’s risk and what clinical care was
needed. This was clearly an area of great difficulty.
experience as a medical school testifies that our graduates may not be ready to
take down the sexual history of their patients in a
non-judgmental way. This clearly will have an impact on their ability to provide
sexual reproductive and health services.
Read: 9 myths about HIV
observation is anecdotal and more work is required to quantify the extent to
which this a major limitation in clinical management.
We will be
doing more research into:
- What affects these men from accessing the health system?
- How can the systems and access be improved?
- What interventions exist and how can they be used in the two countries?
- What is the best way to communicate with these men?
similar study in Malawi and Tanzania will allow the researchers to
cross-fertilise their expertise and share the lessons learnt, which would
strengthen the findings.
Adamson S. Muula, Professor of Epidemiology and
Public Health, University of Malawi
was originally published on The Conversation. Read the original article.
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