Gender identity is a crucial factor affecting HIV risk among men who have sex with men (MSM) in South Africa, and this area of study urgently needs more attention in order to effectively address the HIV epidemic in the MSM population.
This finding is reported in an article recently published by Anova Health Institute authors in the international scientific journal AIDS Care. The article discusses the findings from a study conducted with MSM in Cape Town where it was found that MSM who identified themselves as being female or transgender had a higher level of HIV infection than other MSM, were more likely to have engaged in activities that placed them at high risk of contracting HIV, and were more likely to be unemployed and living in poverty.
These findings are important because they show that within a population that already has a high risk of HIV, individuals’ gender identities may place MSM at an even greater risk of contracting HIV. The article concludes by noting that it is critical for HIV prevention, treatment, and care interventions for MSM to be sensitive to the specific needs of gender non-conforming individuals in order to provide them with effective services.
The article is available here
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Sex workers and men who have sex with men (MSM) are the most at risk populations for HIV acquisition and transmission. The Anova Health Institute, an NGO dedicated to improving the health of all South Africans with particular emphasis on HIV, welcomes the unveiling of the National Sex Worker HIV Plan for 2016 – 2019, as well as the launch of the much-awaited South Africa Health Monitoring Study (SAHMS). The Plan provides for early treatment and the provision of pre-exposure prophylaxis (PrEP) medication. PrEP is a combination of two antiretroviral drugs, which if taken daily by HIV negative individuals, can drastically reduce HIV infection.
Anova was a collaborator in the SAHMS, which is the very first integrated biological and behavioural survey (IBBS) conducted amongst female sex workers (FSWs) in South Africa. The Study revealed that the prevalence of HIV ranges between 40% and 72%. This, despite the fact that condom use with clients is relatively high.
In addition, HIV prevalence among local MSM has been estimated at 10% to 43% in various studies. MSM are at particular risk for HIV acquisition and transmission as biologically, unprotected receptive anal sex is about sixteen times more likely to transmit HIV than unprotected vaginal sex.
Anova, who have recently rolled out their ground-breaking WeTheBrave.co.za campaign in the Western Cape, is of the opinion that PrEP is the most effective form of prevention from HIV and as a result are leading the charge with PrEP demonstration projects in the Western Cape and Gauteng amongst gay men and other men who have sex with men (MSM).
Professor James McIntyre, CEO of Anova, says: “We have been working closely with government in defining policy and urge them to extend access to PrEP to MSM as soon as possible. MSM continue to be at high risk for HIV acquisition in South Africa. The strongest evidence base worldwide for the use of PrEP comes from studies in MSM and Anova believes that this life saving intervention should be made available as soon as possible for all those who wish to use it.”
To this end, WeTheBrave.co.za is the first large scale South African sexual health campaign to specifically address gay men and other men who have sex with men (MSM). Funded by the Elton John AIDS Foundation, the campaign addresses both prevention and treatment issues in an affirming, non-judgemental and sex positive way, which is entertaining and engaging. WeTheBrave.co.za asks MSM to be brave enough to make healthy sexual choices like wearing a condom, taking PrEP, getting tested regularly and knowing their status.
More than 90% of female sex workers (FSWs) working in South Africa’s three largest cities areas – Johannesburg, Cape Town and eThekwini - report having previously tested for HIV; in addition, reported condom use with clients is relatively high, but HIV prevalence ranges between 40% to 72%. Behavioral indicators reveal high levels of unrecognized HIV infections and rates of recent HIV seroconversions, according to the recent South Africa National Health Monitoring Study (SAHMS.)
These are some of the key findings of the very first integrated biological and behavioral survey (IBBS) conducted with FSWs in South Africa. The survey was led by the University of California, San Francisco (UCSF) collaborating with the Wits Reproductive Health and HIV Institute (WRHI), Anova Health Institute, and supported by the U.S. Centers for Disease Control and Prevention, South Africa (CDC-SA) and the US President’s Emergency Plan for AIDS Relief (PEPFAR).
surveyed more than 2,000 FSWs in South Africa’s three largest metropolitan areas to estimate the size of the FSW population in each city, establish HIV and syphilis prevalence, and to determine associated HIV risk factors and determinants of access to and utilization of health programs by FSWs in these areas. The IBBS estimated that there were approximately 7,500 FSWs in Johannesburg, 6,500 in Cape Town, and 9,500 in eThekwini.
Sex workers are highly vulnerable to HIV infection, but little data exist regarding the size of the population and the epidemiological, behavioral, and social factors that drive the epidemic in South Africa. This information is crucial to understanding the burden and scale of the epidemic among a high-risk and marginalized population so that relevant prevention, care and treatment resources are effectively allocated to reduce the rates of HIV infection among FSWs, to ensure adequate services are being tailored to the needs of FSWs – both those who are HIV negative as well as those who are HIV positive – as well as the onward transmission to the general population.
While the results of the study demonstrate that the general and targeted efforts to encourage HIV testing among FSWs have shown some success, they also demonstrate that greater effort is required to mobilize HIV-negative and untested FSWs to test regularly. Moreover, many HIV-positive FSWs are not adequately linked to care, and even fewer are effectively accessing HIV treatment.
At least one in five FSWs have an undiagnosed HIV infection. Of additional concern is the relatively high numbers of new HIV infections observed among FSWs who had tested HIV-negative within the year prior to the survey – 8.8% in Johannesburg, 18.3% in Cape Town, and 8.7% in Durban. “The high rates of new infections in the last year and poor uptake of treatment shows that more must be done to link and retain HIV-positive FSWs in HIV care,” explained principal investigator, Prof. Tim Lane.
“While it is encouraging that the overwhelming majority of FSWs report having previously tested for HIV (over 90% in each site), results still show an extraordinarily high burden of HIV among FSWs, suggesting that HIV is still spreading rapidly among those FSWs who are not infected. The response therefore needs scaling up of a comprehensive package of HIV prevention and treatment services,” said Dr. Nancy Knight, Country Director, Centers for Disease Control and Prevention, South Africa.
Additional challenges facing the community include high rates of alcohol and non-medical drug use, and physical and sexual assault. In all three cities nearly one in five FSWs were survivors of sexual assault in the prior year. Prof. Helen Rees, of the Wits Reproductive Health Institute comments: “These psychosocial factors enhance the risk of acquiring HIV and interfere with care and treatment efforts. South African HIV prevention care, and treatment interventions for FSWs should always incorporate interventions that address these psychosocial co-morbidities.”
The study concludes that, despite the challenges faced by the FSW community, they were highly mobilized and enthusiastic participants and the SAHMS therefore demonstrates the feasibility of conducting second generation HIV and STI surveillance in FSW in South Africa. “Ensuring that a culture of surveillance – including high quality data collection and the timely use of results to inform programs and identify gaps – is an essential component to controlling the HIV epidemic and reaching the 90/90/90 goals,” commented Prof. James McIntyre, CEO, ANOVA Health Institute.