Gay Men in Africa and HIV/AIDS

Throughout most African countries, social and political stigma and discrimination creates an environment that makes it difficult for gay men to recaeive information and education about HIV, to access health services and to live an open life. This environment has also lead to an absence of information about how many gay men are living with HIV and AIDS in Africa.

back to top Gay men or men who have sex with men?

Gay, bisexual, homosexual, transgender, transexual and heterosexual are all terms that men who have sex with men (MSM) may use to describe their sexual identity. This page covers issues affecting all men who have sex with men in Africa. However, as the term 'gay' is more widely used throughout Africa, this term is generally used throughout the page to refer to all of the identities outlined above.

back to top What is the legal situation regarding gay men in Africa?

Anti-gay laws often contradict the constitution of African countries and their commitment to human rights.^{1 2} Nevertheless, across the African continent a total of 36 countries out of 53 have laws, as shown below, which make homosexuality a criminal offence.^{3 4} Laws differ markedly both between countries and within countries.⁵ Imprisonment is the most common punishment, the term of which can vary dramatically depending on the country or even region; for example from 10 days in Eritrea to a life sentence in Sierra Leone. Other punishments include the death penalty, flogging and imprisonment with hard labour or a fine. The type of punishment and its severity is ruled in accordance with the details of an offence (e.g. public/private act, with a minor, against ‘the will’ of another person, a repeated act, whether the act involved actual intercourse or ‘gross indecency’). In countries that do not have laws against homosexuality, social stigma and discrimination still occur and in some cases men who have sex with men are still subject to arrest for crimes such as vagrancy.⁶

back to top Living as a gay man in Africa

For many gay men in Africa, life is a constant struggle. Some men choose to hide their sexuality and are condemned to a life of secrecy. As a result, a significant number of African gay men are also married and in some cases have children.⁷

Men who choose to live an open life or who are exposed as being gay are often subject to unrelenting stigma and discrimination to such an extent that they can be denied a normal life.^{8 9 10 11} This can have profound effects on their life and general health.^{12 13 14 15} Attacks, random arrests, murder, and even the desecration of gay men after they have died have been reported across the African continent.^{16 17 18} Such an environment reinforces feelings of fear and insecurity among the gay community, which can prevent men who have sex with men from accessing HIV prevention, treatment and care services.

“Most of us choose to stay home and wait for our fate rather than go to hospital and face discrimination”¹⁹ Anonymous homosexual man living in Kenya.

Ugandan newspaper headline

Over the last ten years there have been increasing reports of hostility towards gay men in Africa, with a particularly high number of incidences occurring throughout 2009 and 2010.

In 2009 Member of the Ugandan Parliament, David Bahati, tabled a draft bill in an attempt to punish same sex acts with the death penalty.²⁰ Following this, there was a notable rise in homophobia throughout Uganda and other African countries, such as Kenya. Prior to the ‘Bahati Bill’ African gay men living in Mtwapa, Kenya had been able to live relatively openly.²¹ However, after the bill, community hostility and attacks upon gay men increased.²²

Another widely publicised incident took place in December 2009, when two men in Malawi were arrested after holding an engagement ceremony. The men were reportedly beaten and one was forced to undergo an anal examination as part of efforts to prove they had engaged in same-sex acts.²³

It is feared that a rise in hostility towards men who have sex with men will result in this group becoming harder to reach and unlikely to access sexual health services.²⁴

back to top Impact of homophobia on HIV and AIDS in Africa

The extent that this group contributes to the transmission of HIV in Africa cannot be fully assessed, due to the low number of studies that have been carried out on gay men living in African countries. Nevertheless, studies that exist make it clear that if HIV prevention, treatment and care services exclude gay men, efforts to prevent new HIV infections are undermined. The limited HIV data available on gay men in Africa shows that HIV prevalence is often high among this group.^{25 26 27 28 29}

HIV prevention, treatment and care services are essential to prevent further HIV infections. However, it is very difficult for gay men in Africa to access these services, due to widespread intolerance towards them.³⁰ As a group at risk of becoming infected with HIV, this is very harmful both to them and society.

Homophobia as a barrier to healthcare and HIV services

The risk of arrest, violence, harassment and social discrimination associated with coming out as a gay man in Africa often prevents men who have sex with men (MSM) from openly expressing their sexual orientation. This can make it difficult for service providers to deliver essential services, such as information about how to prevent the transmission of HIV and other STDs, to men that need them.

As information for gay men is not widely available, especially in traditional heath settings, this situation can lead to a lack of knowledge about how to practice anal sex safely and how to access HIV treatment and care.^{31 32}

Moreover, non-governmental organisations that deliver basic sexual health education, HIV services and resources to gay men are often at risk of harassment, particularly in countries that criminalize same-sex partnerships. Numerous accounts of HIV and lesbian, gay, bisexual and transgender (LGBT) organizations and their staff being targeted by the authorities have been reported.^{33 34 35 36 37} After the high-profile arrest of nine HIV prevention workers in Senegal for “acts against nature”, many MSM no longer felt safe attending educational meetings. Social networks, vital for the mental health and well-being of people who may feel marginalised by society, fell apart:

“MSM dare not receive or go to talks or to seek condoms. They continue to have unprotected sex…our association fell apart”  Member of an association for MSM in Senegal³⁸

Gay men who are infected with HIV often face discrimination not only on the grounds of their sexual identity but also because of their HIV status.^{39 40} By ostracising gay men from services the risk of them becoming infected with HIV or infecting others becomes greater.

“many gay men in Africa have been refused health care due to their sexuality”

Reports show that HIV information is not reaching gay men in Africa.^{41 42} This is concerning as a lack of knowledge about HIV and other sexually transmitted diseases can lead to increasing HIV infections.⁴³ For example, in a Nigerian study of more than a thousand men who have sex with men, 31 percent of men believed that HIV is less likely to be transmitted during sex between men, than during sex with a woman.⁴⁴ Low use of condoms and the use of lubricants such as hair cream, Vaseline, soap, baby oil and saliva (which can damage condoms)⁴⁵ was also reported.

It has been found that for many men who have sex with men, free condoms and lubricant (which are often too expensive to purchase) are difficult to access.⁴⁶ Furthermore, some gay men report that finding water-based lubricants can also be difficult.⁴⁷

In the absence of education about HIV and how high-risk behaviour can increase the risk of becoming infected, gay men in Africa are often unaware that having many partners and not practicing sex safely consistently can lead to a higher risk of HIV transmission. A study of 142 MSM in Cameroon found 57 percent had engaged in unprotected anal intercourse with a male partner in the last 6 months, 44 percent of men reported sex with 2 to 4 partners in the last 6 months and 21 percent reported 5 or more partners in the last six months.⁴⁸

In addition to the problems with accessing information, gay men in Africa often face barriers when they try to access health care. Many health providers discriminate against and stigmatise gay men.⁴⁹ For example, reports from across a number of countries reflect that many gay men in Africa:⁵⁰

• Have been refused health care due to their sexuality
• Distrust health care providers
• Are rarely open with their health care providers
• Do not access health care due to fears of discrimination

These factors can result in STDs and HIV among gay men remaining undiagnosed and untreated. This places men who are not infected with HIV at risk of becoming infected and among those that are already infected with HIV at risk of early progression to AIDS or of infecting others.⁵¹

Homophobia: The impact upon society

African governments that maintain an environment that excludes gay men from health information and services are putting the health not only of gay men but of the wider population at risk. Complex sexual networks mean that HIV can be transmitted both from the heterosexual population to gay men and from gay men to the heterosexual population.^{52 53 54} For example, it is evident that many African gay men also have wives or girlfriends.^{55 56 57}

This was reflected in a Cameroon study, which found 49 percent of participants also reported sex with a woman in the last 6 months, 29 percent had at least one child and 13 percent were married.⁵⁸ This tendency is supported by other studies, for example a 2006 study in Kenya of men attending VCT clinics found that of 88,738 men, 780 had sex with men and of these 69 percent also had sex with women.⁵⁹ Therefore, only delivering essential health care and information about preventing HIV to certain groups within society undermines efforts to prevent the transmission of HIV throughout the general population.

Other high-risk behaviour among gay men in Africa

Some gay men also inject drugs and/or are sex workers.^{60 61 62} In some cases this may be a result of stigma and discrimination, which can sometimes lead to gay men becoming socially, economically and emotionally vulnerable. For example, they may lose their jobs, their homes, and be forced out of their communities and therefore revert to sex work for financial reasons. Gay men who engage in these practices are at risk of becoming infected with HIV if they do not take preventative measures such as using condoms or clean needles consistently.

back to top Why do people discriminate against gay men in Africa?

Throughout Africa, it is widely believed that homosexuality is a western evil; an imported concept that is ‘un-African’. This belief is often used to justify homophobia. However, studies suggest that this is a misconception and that there is evidence of homosexuality existing in African societies prior to colonialism.^{63 64 65 66} Some claim that many Africans have forgotten that sex between men was a part of their culture and that in many countries, it was anti-gay laws initially enforced by colonial powers, that encouraged intolerance of gay men in Africa.^{67 68}

Religion is also used as a basis for justifying homophobia. Many religious leaders claim that sex between men is “sinful, abnormal or immoral”.^{69 70} Their position of power and influence among communities has meant that this view is rarely, if ever, opposed.⁷¹ As leaders of anti-gay marches⁷² , petitioners for anti-gay bills⁷³ and outspoken critics⁷⁴ of political leaders who support the rights of African gay men, religious leaders (from Africa and abroad^{75 76 77 78} ) have become one of the main drivers of homophobia in Africa.^{79 80}

It is evident that public opinion can have an impact on Government decision-making.^{81 82} For reasons discussed above, in most countries popular opinion is largely against the rights of gay men and the continued existence of anti-gay laws reflects this.⁸³ However, governments that maintain anti-gay laws are legitimising the stigma and discrimination of gay men. Moreover, politicians that actively encourage intolerance of gay men are contributing directly to the recent rise in homophobia.^{84 85}

“ Show me where Christ said, "Love thy fellow man, except for the gay ones." Gay people, too, are made in my God's image”

- Archbishop Emeritus of Cape Town, South Africa, Desmond Tutu

A result of governments endorsing homophobia is that the media are under pressure to also endorse it.⁸⁶ Media is a powerful tool through which public opinion can be formed and currently the media are at the forefront of the victimisation of gay men in Africa.^{87 88 89 90}

Whilst those who oppose sex between men have voiced their opinions the loudest, it is important to recognise that not all governments, politicians and religious leaders in Africa believe homosexuality is wrong.⁹¹ Some religious leaders who support the rights of gay men are members of organisations, for example ‘The Other Sheep,' that confront the stigma and discrimination of individuals based on their sexual orientation.⁹²

A prominent advocate for the rights of homosexuals is the Archbishop Emeritus of Cape Town, South Africa, Desmond Tutu. In 2010 he said: “Show me where Christ said, "Love thy fellow man, except for the gay ones." Gay people, too, are made in my God's image”.⁹³ Similarly, homosexuality is not opposed in all countries or by all politicians.⁹⁴ At the end of 1996 South Africa legalised same-sex marriage⁹⁵ and in 2010, Kenyan MP Esther Murugi voiced her support for the health rights and needs of gay men at a symposium on HIV/AIDS.^{96 97}

back to top Conclusion

It is widely acknowledged that in order to deliver HIV prevention, treatment and care to gay men in Africa, a number of steps must be taken both by African governments and by international and local organisations.

Rainbow Flag: The 20th annual Johannesburg Gay Pride

The abolishment of anti-gay laws, the formulation of legislation which punishes the discrimination of gay men and enforces their rights, and a reference to sexuality in human rights frameworks have been identified as essential changes to be made by governments.^{98 99 100 101}

The effectiveness of HIV prevention campaigns in reducing risky behaviour among gay men has been shown.¹⁰² Governments should ensure that these are successful and reach gay men. This can be achieved by including gay men in nationwide HIV surveys and strategies and by making resources available for men who have sex with men specific HIV prevention, treatment and care programmes.^{103 104 105} Including gay men in the design and implementation of prevention programmes has been successful and it is suggested that network based interventions and involving gay men as peer educators should be adopted to improve the reach and design of programmes.^{106 107 108}

Also, in order to change social attitudes to gay men, individuals should be educated on the rights and needs of gay men. This should happen through school programmes, training for health care workers and workshops for media organisations.^{109 110 111 112}

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References back to top

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