Friday, April 17, 2009

HIV is the Problem, Except for Everything Else

The received view about men who have sex with men (MSM) and women who have sex with women (WSW) in African countries is that it is not common and certainly not as common as outside Africa. I have yet to come across any evidence that these phenomena are really less common in Africa than in other continents. However, most African countries have laws against such practices.

In Kenya, Tanzania and Uganda, for example, MSM have been persecuted. WSW are even less often talked about, but they face many dangers and often have to go to great lengths to keep their sexuality hidden. Thus, MSM and WSW often get married, to pretend they are heterosexuals. In marriage, some repress their sexuality, some don’t.

And that’s where some of the mystery about the numbers of non-heterosexuals in African countries arises. It’s not that long ago that in Western countries, non-heterosexuals would pretend to be heterosexual and behave accordingly, at least for some of the time. In East Africa numbers are a matter of speculation, really. People who choose to be frank about their sexuality face abuse, even imprisonment.

Those who choose to keep their sexuality a secret, and who could blame them, also face dangers. They may follow their sexuality and put their partner and themselves at risk; they may be exposed at any time, etc.

In countries where HIV prevalence is high, everyone needs to be careful. As an advertising campaign pointed out, if you sleep with someone, you also sleep with all that person’s partners. MSM, WSW, intravenous drug users (IDU) and other groups who face special risks are not as neatly compartmentalised as such acronyms may suggest. As to the percentage of people who are actively bisexual, either through orientation or necessity, it’s anyone’s guess.

HIV is often exceptionalised as if it were more threatening than any other health issue. This is not the case; sexual health in developing countries is a much bigger issue. HIV is only a small part of sexual and reproductive health, which itself is only a small part of the health of whole populations. And more people’s lives and welfare are threatened by the manipulation of a few rich multinationals than by HIV; the same could be said for the manipulation of a few international institutions, a few rich countries, global warming, etc.

One of the problems with exceptionalising HIV is that other important messages get lost. In some age groups in Kenya, nearly half of all sexually active people have herpes simplex virus (HSV), many others have various sexually transmitted infections (STI) and there are so many reproductive health problems, why concentrate on HIV at the expense of all others?

There’s a particularly horrifying statistic about human papilloma virus (HPV) among gay men in Asutralia; nearly 80% of them were found to have some form of HPV in a recent study. This virus causes anal cancer, although anal cancer is rare. HPV is particularly common among those already infected with HIV, standing at 94% in the Australian study. One wonders what the prevalence of HPV is among gay men in African countries. The same question could be asked about other STIs that are associated with anal sex, especially where gay men either need to or choose to sleep with women as well.

Things must be very different in Australia. Non-heterosexuals are free to express their sexuality, there are laws against discrimination and persecution, they have access to health services, legal protection and support of various kinds. This is not the case in East African countries, where men in Uganda who protested recently about the lack of HIV services for gay men were arrested. Non-heterosexuals continue to be excluded from HIV prevention and other services that are aimed at almost entirely at heterosexuals.

In addition to decriminalising commercial sex work (discussed elsewhere), those who are not heterosexual and who wish to express their sexuality need the protection of the law. They need access to health services, especially sexual health services. They are not isolated ‘groups’. They are, ultimately, an integral part of the whole network of people that make up a country. Their sexual health is everyone’s sexual health, just as the sexual health of the heterosexual community is also part of the sexual health of non-heterosexuals.

Persecuting people for their sexuality, denying them the protection of the law and access to health and social services, is as damaging as persecuting commercial sex workers and denying them some of their most basic human rights. The moral crusade against whatever target happens to present itself is doing more to spread HIV than the groups of people who are being targeted.


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