Same sex relationships and HIV/AIDS in Africa: Need for Research and programmatic focus

Abstract

Several reports indicate that sub-Saharan Africa has continued to maintain a high prevalence rate and remains the epi-centre of the current HIV/AIDS pandemic. To date, Africa accounts for up to 68% of the total number of people living with HIV/AIDS, for 90% of orphans and for a large percentage of the total number of morbidity and deaths from the disease in the world1. It is now increasingly recognized that for significant progress to be made, efforts to curtail the virus in the continent must be prioritized for at-risk and highly vulnerable populations.
At the onset, reports suggested that heterosexual intercourse was the principal mode of transmission of the virus in Africa2. This was a marked difference from the pattern in high income countries where homo-sexual (same-sex) relationships, especially men having sex with men (MSM) was a dominant mode of transmission. However, in recent times increasing reports of high prevalence rates of same sex relationships accounting for HIV/AIDS in Africa have been documented in the literature3. Current estimates from parts of Africa suggest that MSM account for between 10-15% of new cases of sexual transmission of HIV/AIDS in Africa.
Increasingly, consensual same sex relationships are being reported in various parts of Africa including same sex marriages, lesbianism, bisexuality, gay and trans-gender (LGBT) relationships.
Despite this increasing rate of same sex relationships in Africa, there has been little research and documentation of the pattern and trends in the related practices, which would permit an empirical elucidation of how HIV prevention and care can be specifically targeted at this high risk population. This lacuna is largely due to a prevailing culture of denial, stigmatization and even criminalization associated with same sex relationships in many parts of the continent. Reports suggest that same-sex relationship is currently shrouded in secrecy in many African countries5, and in communities where some openness has started to emerge, it has been followed by outright condemnation, vitriolic attacks and even criminalization. Surely, this has done little to address the problem, while it has further driven the practice underground and reduced the ability of countries to target approppriate policies and interventions. It is within this context that the editorial board
of the African Journal of Reproductive Health
accepted to publish its first research paper on same sex relationships in Africa in this edition of the journal. The paper by Adebajo and her colleagues from the office of the Population Council in Nigeria4, describes an innovative approach for identifying men who have sex with men, and reports the results of interviews with this category of men to determine their experiences and perceptions of internalized homophobia.
Okonofua Same Sex Relationships and HIV
This report is groundbreaking in several respects. First, this is one of a few documented studies on LGBT in Nigeria and serves to address the current lack of empirical research on the subject in the country. In recent times, Nigeria has joined other African countries in mounting a debate on same sex marriage and related practices. Unfortunately, the discourse has swayed from the sublime to the ridiculous, with the highest legislative body of the country passing a judgment of illegality on same sex marriage. Therefore, the publication of this paper indicates that all hope is not lost and that it is still possible to open up debate and conduct empirical research in less receptive communities. Indeed, we believe that it is only through research and communication of research findings that traditional beliefs and inappropriate laws and legislations on LGBT can be prevented and modulated.
Secondly, the results of the study which indicate a high prevalence of internalized homophobia among men who have sex with men, have implications for the design of interventions to address the problem. Perhaps, this can result in the development of appropriate behavioral change messages that can lead to safer sex practices and the adoption of more effective methods for the prevention and treatment of HIV/AIDS among men who have sex with men. Thirdly, the research findings would be useful in interrogating with policymakers who often see same sex relationships as biological anomalies rather than a normal pattern within a continuum of sexual behavior. Studies such as this can enable a more informed debate and a better understanding of the nature of the problem, leading to a systematic improved policy environment for addressing the social and development needs of men who have sex with men.
The current lack of information relating to the practice of same sex relationships in the African region is an important unfulfilled research gap in the region. Research is needed to document the prevalence and epidemiology of same sex relationships in various countries in Africa. Given the secrecy that surrounds the problem, innovative research approaches and methods that meet the highest degree of scientific validity and rigor are needed. Additionally, social and anthropological research is needed to identify the main risk factors and determinants of same sex relationships, their life course experiences, their sexual risk taking behavior and how LGBTs access services for the prevention of HIV/AIDS and other reproductive health problems. Indeed, same sex relationship is one issue that would always benefit from baseline research and assessments before interventions are undertaken. In turn, interventions must be purposefully designed with specific and concrete end-points in mind, in order to provide lessons for scaling up and sustaining such interventions.
In conclusion, the criminalization and stigmatization of same sex relationships in many parts of Africa is one of the most challenging social justice and human rights issues relating to sexual and reproductive health in Africa. Researchers, advocates and programmers have a responsibility to draw attention to the problem, and to use evidence-based information to build a systematic understanding and consensus on ways to address the problem.