This piece from NPR about the challenge of targeting gay men in Kenya for HIV prevention messaging (NB: at least while in Malawi I typically just read the columns on NPR stories since getting the audio to load is pretty much a pipe dream on my current internet connection).
The thing about MSM (men who have sex with men, which is the academic term for gays since the latter is an identity that many do not share) in Africa is that we have no idea how common the practice is because it’s heavily stigmatized and often illegal. That matters a lot – in the US, where MSM is relatively common (something like 7% of men have ever had sexual contact with another man), they are important for the HIV epidemic. In Africa we don’t know because we can’t measure this stuff accurately.
In the article they say: “But the rate among men who have gay sex is more than three times the national average.” There’s no way they know that. Most studies I’ve seen of MSM in Africa use the “snowball” approach, which means that the researcher approached a set of gay friends, had them contact their friends, and so forth. This is useful for finding marginalized populations, but is terrible if what you want is a representative sample. The reason for doing it is that any technique that gives you a probability sample of the population will almost surely cause people to lie about having same-sex sexual contact. This article even admits that most MSM in Kenya keep their same-sex partners a secret. Lacking statistics on MSM that are representative of the population means we can’t get meaningful measures of the prevalence of the practice or of the relative HIV risk for MSM. We also can’t study their importance in driving the heterosexual epidemic (which is an issue since many MSM have female partners as well). And as this article notes we also have trouble identifying them for interventions. All of these factors tend to make the HIV epidemic worse, even for women and men who are exclusively heterosexual.
Discriminating against men who have sex with men isn’t just morally reprehensible – it has practical negative consequences for everybody else.
Hat tip: Nancy Marker