MSM IN SOUTH AFRICA AFRICA MSM IN SOUTH MSM IN SOUTH AFRICA Data Triangulation Project Data Triangulation Project Triangulation Data Cover with spine.indd 1 2015/05/21 12:58 PM Table of Contents List of Figures ........................................................................................................................... iii List of Text Boxes ....................................................................................................................... v Preface ......................................................................................................................................vi Acknowledgements ................................................................................................................. viii Acronyms .................................................................................................................................. x Key Terms ................................................................................................................................ xii Executive Summary ................................................................................................................. xiii 1. Background ........................................................................................................................ 1 2. Rationale ............................................................................................................................ 6 3. Limitations .......................................................................................................................... 7 4. Methods ............................................................................................................................. 8 5. Findings ............................................................................................................................ 13 5.1. National picture ..................................................................................................................... 14 5.1.1. Snapshot ..................................................................................................................................... 14 5.1.2. Hypothesis .................................................................................................................................. 22 5.2. Gauteng ................................................................................................................................. 25 5.2.1. Snapshot ..................................................................................................................................... 25 5.2.2. Hypothesis .................................................................................................................................. 29 5.3. Western Cape ......................................................................................................................... 30 5.3.1. Snapshot ..................................................................................................................................... 30 5.3.2. Hypothesis .................................................................................................................................. 34 5.4. KwaZulu-Natal ........................................................................................................................ 35 5.4.1. Snapshot ..................................................................................................................................... 35 5.4.2. Hypothesis .................................................................................................................................. 39 5.5. Eastern Cape .......................................................................................................................... 40 5.5.1. Snapshot ..................................................................................................................................... 40 5.5.2. Hypothesis .................................................................................................................................. 42 5.6. Free State ............................................................................................................................... 44 5.6.1. Snapshot ..................................................................................................................................... 44 5.6.2. Hypothesis .................................................................................................................................. 46 5.7. Limpopo ................................................................................................................................. 47 5.7.1. Snapshot ..................................................................................................................................... 47 5.7.2. Hypothesis .................................................................................................................................. 49 5.8. Mpumalanga .......................................................................................................................... 50 i 5.8.1. Snapshot ..................................................................................................................................... 50 5.8.2. Hypothesis (Gert Sibande and Ehlanzeni districts) ..................................................................... 54 5.9. North West Province .............................................................................................................. 55 5.9.1. Snapshot ..................................................................................................................................... 55 5.9.2. Hypothesis .................................................................................................................................. 57 5.10. Northern Cape ...................................................................................................................... 58 5.10.1. Snapshot ................................................................................................................................... 58 5.10.2. Hypothesis ................................................................................................................................ 60 6. Data Gaps ......................................................................................................................... 61 7. Conclusions ...................................................................................................................... 62 8. Recommendations ............................................................................................................ 65 9. References ........................................................................................................................ 70 10. Appendix: TWG Terms of Reference .................................................................................. 77 ii List of Figures Figure 1 MSM data triangulation time-frame ............................................................................. 9 Figure 2 Overview of key triangulation activities ...................................................................... 10 Figure 3 HIV prevalence among MSM compared to HIV prevalence among males..................... 15 Figure 4 Prevalence of STIs among MSM in South Africa, 2008-2013 ......................................... 16 Figure 5 Unprotected anal intercourse among MSM in South Africa, 2008-2013 ....................... 17 Figure 6 Alcohol use in relation to sexual contacts among MSM in South Africa, 2008-2013 ..... 18 Figure 7 Sexual violence among MSM in South Africa, 2008-2013 ............................................. 19 Figure 8 HIV testing practices among MSM in South Africa by province, most recent data ........ 20 Figure 9 HIV testing practices among MSM in South Africa, 2008-2013 ..................................... 21 Figure 10 MSM programming in South Africa, 2008-2013 ......................................................... 22 Figure 11 HIV prevalence among MSM in Gauteng, 2008-2013 ................................................. 26 Figure 12 Risk behaviours among MSM in Gauteng .................................................................. 27 Figure 13 MSM programming in Gauteng, 2008-2013 ............................................................... 28 Figure 14 HIV prevalence among MSM in Cape Town 2008-2013 .............................................. 31 Figure 15 HIV-related risk factors among MSM in Cape Town, 2008-2013 ................................. 32 Figure 16 MSM programming in the Western Cape, 2012-2013 ................................................ 33 Figure 17 HIV and STI prevalence among MSM in KwaZulu-Natal, 2008-2013 ........................... 36 Figure 18 Risk factors and health-seeking practices among MSM in KwaZulu-Natal, 2008-2013 37 Figure 19 MSM-focused programming in KwaZulu-Natal, 2012-2013 ........................................ 38 Figure 20 HIV prevalence and risk practices among MSM in the Eastern Cape, 2008-2013 ........ 41 Figure 21 HIV programming for MSM in the Eastern Cape, 2012-2013 ...................................... 42 Figure 22 HIV programming for MSM in the Free State, 2012-2013 ........................................... 46 Figure 23 HIV programming for MSM in Limpopo, 2012-2013 ................................................... 49 iii Figure 24 Risk factors for HIV among MSM in Mpumalanga, 2013 ...........................................