Findings of The MSM Ethnographic Study Undertaken in the Mopani District Kabelo Maleke Health4Men  The Health4Men project aims to improve MSM sexual health through prevention and access to appropriate healthcare services. Reasons For The Study:

 Limited research with regards to MSM and HIV/AIDS in rural settings

 Studies carried out by Anova Health Institute: Soweto Men Study, UCSF Empowerment programme

 HIV prevalence among Black, peri-urban “township MSM” was estimated at 13%, and 34% among the sub-set of gay-identified men

 Health4 Men project decided to carry out an MSM Study in particularly the Mopani District

Methodology

 3 Community Participatory Mapping exercises

 15 Key Informant Interviews

Catchment Area

Giyani • • • • • kgapane WHO IS MSM

Female-Looking?

Modern Warrior-Looking? Who Is MSM?

 Gay Identifying MSM Drag-queens Queens (effeminate gay men) Masculine-looking gay men

None Gay Identifying MSM Bisexual Straight (After-nines)

Community perceptions

All expressed difficulty with the community not being very accepting of gay men. Discrimination mostly directed at overly effeminate men. Big Cities are more accepting No one reported a homophobic attack on them or other MSM they know. Social and Sexual Networks These networks spread across Mopani and the whole province.

 Online Networks:  Smiggle.mobi, Mambaonline, 2go, Gumtree, Mig33, Facebook  Social Venues:  Ga Judas, Steelworks, Sunshine, Mphenama, Bona Pub, Mzansi and Carlo’s Pub. Condoms available at social venues

MSM and Relationships

 A few of our participants were in transactional relationships  This may affect decision-making power in the relationship

“I expect R500 or more, because I need to pay rent, especially when I'm in Johannesburg. If what I'm doing is considered as selling sex, then I'm not ashamed of it, because at the end of the day, I need money to survive. I refuse to sleep with someone I'm not committed to for free”  Fewer are in committed relationships

“I'm still young, I don’t want to commit, I just want to F**k around and have fun.”  Men are compelled to have sex upon their first encounter. “Sometimes you get a guy who is an afternine, or maybe straight free spirited people and then they want to have sex and they want to have sex with you there and then before you change your mind, so you will get there and use anything you find, some use salvia.”

 Only one participant reported ever experiencing violence with a one night stand. MSM and Health Care

 Most prefer using private doctors Feel that confidentiality will be breached in public facilities – esp. HIV Some have been mistreated and humiliated by nurses Its become a general perception. Will not use public healthcare facilities if they have STI symptoms in or around the anus.

Most were not forthcoming as to how regularly they test for HIV. Reports of a person getting on and off ARV’s so as to stay on the social grant. Water-based Lubricant use

9% (N=2) stated that they don’t know what water-based lubricants are 91% (N=21) said that they know what water-based lubricants are 23% (N=5) stated that they don’t use them regularly because they cannot always afford them. Water-based lubricants

• “Well I use condoms without lube, I have only used lube twice, ‘cause if he uses lube then I feel like the person is going to thrust a lot because it’s slippery. Then the sex will be rough and I don’t like it rough.”

Condom Use

4% (N=1) of the participants stated that he doesn’t use condoms because he says condoms make sex painful and uncomfortable. The remaining 96% stated that they know about the dangers of contracting HIV and other STI’s so they use condoms regularly.

Condom Use

• “If the penis is big then the condom will hurt you, but if it’s just the right size for you then it won’t hurt.” • Danger widespread ideology. • Sex almost always occurred at the insertive partner’s house and the condom and lube responsibilities laid with them. Thus tilting power-dynamics with regards to safer-sex negotiations.

• “Sometimes it’s much easier to be open to someone you don’t know. According to what I have seen and heard I wouldn’t go there [public hospital] for an HIV test because I remember a couple of years ago some girl died of an HIV related sickness and people from the hospital went and spread it without informing the girl's parents, they were the last to know. So I would not want my whole business to be out there. I would go to the mobile testing clinics they usually have in town”.

• “I used to have a neighbour who was in the closet. He got anal warts and he sat at home with them. I realised that there was something wrong with him and I asked him and he explained and said that he was not going to the doctor or clinic. I later convinced him to go to the doctor and he got help. He is fine now and he appreciates me for keeping his secret. He was not going to go if it wasn’t for me because he was scared of discrimination”. Recommendations

The MSM in the Mopani District’ towns fail to form communities because the majority of them are still closeted and the ones that are out of the closet do not appear to share a sense of community with their peers. Empower the gay community to openly express their sexual orientation without fear of being discriminated or prejudiced Recommendations…

 It is apparent that there are major challenges in the prevention of STI and HIV amongst the MSM community, which range from stigma, discrimination, acceptance, economic empowerment and the lack of confidence in the public healthcare system; hence a multi- level approach is needed to deal with this.

 Apart from MSM needing to take personal responsibility for their health, the public healthcare system needs to be an environment that will aid MSM in doing just that. The administration of healthcare in a non-discriminatory environment coupled with the provision of free water-based lube, condoms and safer-sex education will go a long way in HIV risk reduction amongst MSM, especially in underprivileged communities.

Thank You http://www.health4men.co.za/ Kabelo Maleke Researcher [email protected]