Money, Power and HIV: Economic Influences and HIV Among Men who have Sex with Men in Sub-Saharan Africa

Andrew Scheibe, Brian Kanyemba, Jennifer Syvertsen, Sylvia Adebajo, Stefan Baral

Abstract

Despite consistent evidence, effective interventions and political declarations to reduce HIV infections among men who have sex with men (MSM), coverage of MSM programmes in sub-Saharan Africa (SSA) remains low. Punitive legal frameworks and hostile social circumstances and inadequate health systems further contribute to the high HIV burden among MSM in SSA. The authors use the Modified Social Ecological Model to discuss economic influences in relation to HIV and MSM in SSA. Nigerian, South African and Ugandan case studies are used to highlight economic factors and considerations related to HIV among MSM. The authors argue that criminalisation of consensual sexual practices among adults increases the frequency of human rights violations contributing to the incidence of HIV infections. Furthermore, marginalisation and disempowerment of MSM limits their livelihood opportunities, increases the prevalence of sex work and drug use and limits financial access to HIV services. Sexual and social networks are complex and ignoring the needs of MSM results in increased risks for HIV acquisition and transmission to all sexual partners with cumulative economic and health implications. The authors recommend a public health and human rights approach that employs effective interventions at multiple levels to reduce the HIV burden among MSM and the general population in SSA. (Afr J Reprod Health 2014; 18[3]: 84-92)

 

Keywords: HIV, men who have sex with men, Africa, key populations, social economic risk factors

 

Résumé 

 

Malgré les preuves cohérentes, les interventions efficaces et les déclarations politiques visant à réduire les infections par le VIH chez les hommes qui ont des rapports sexuels avec des hommes (HSH), la couverture des programmes des HSH en Afrique subsaharienne (ASS) reste faible. Les cadres juridiques punitifs et les circonstances sociales hostiles et les systèmes de santé inadéquats contribuent également à la charge élevée du VIH parmi les HSH en Afrique subsaharienne. Les auteurs utilisent le modèle socio-écologique de modification pour discuter les influences économiques en rapport avec le VIH et les HSH en Afrique subsaharienne. Les études des cas venant  du Nigeria, de l’Afrique du Sud et de l'Ouganda sont utilisées pour mettre en évidence les facteurs économiques et les considérations liées au VIH parmi les HSH. Les auteurs soutiennent que la criminalisation des pratiques sexuelles consenties entre adultes augmente la fréquence des violations des droits de l’homme qui contribuent à l'incidence des infections du VIH. En outre, la marginalisation et de l'impuissance de HSH limite leurs moyens de subsistance, augmente la prévalence de la prostitution et la consommation de drogues et limite l'accès financier aux services liés au VIH. Les réseaux sexuels et sociaux sont complexes et en ignorant les besoins des HSH dans les résultats des risques accrus de contracter le VIH et la transmission de tous les partenaires sexuels ayant des implications économiques et cumulatifs sur la santé. Les auteurs recommandent une approche de la santé publique et les droits de l'homme qui emploie des interventions efficaces à plusieurs niveaux afin de réduire le fardeau du VIH parmi les HSH et la population entière en Afrique subsaharienne. (Afr J Reprod Health 2014; 18[3]: 84-92)

 

Mots-clés: VIH, les hommes qui ont des rapports sexuels avec des hommes, Afrique,  populations clés,  facteurs de risque socioéconomiques

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