PRIDE and PREJUDICE Gay men who are HIV-positive fear 'double discrimination'

South Africa’s Constitutional protections against discrimination for sexual orientation afford countless opportunities to bring men who have sex with men (MSM) out of the shadows and into the reach of public health interventions. Fear of disclosing sexual orientation remains commonplace, with MSM experiencing a sense of vulnerability that they could fall victim to stigmatisation and discrimination. The pressing concealment of sexual orientation also creates barriers to seeking healthcare, and AIDS stigmas add a layer of concealment that ultimately propagates the spread of HIV. This study by ALlANISE CLOETE and co-authors, examined the stigma and discrimination experiences of MSM living with HIV/AIDS .

Currently, it is unknown how many people living with HIV in South Africa are MSM, and even less is known about the stigmatisation and discrimination suffered by HIV-positive MSM.

This study examined the stigma and discrimination experiences of MSM living with HIV/AIDS in South Africa.

Anonymous venue-based surveys were collected from 92 HIV-positive MSM and 330 HIV-positive men who only reported sex with women (MSW). Internalised stigma was high among all HIV-positive men who took part in the survey, with 56% of men reporting that they concealed their HIV status from others.

Stigma and discrimination

Previous research has found that black African South African MSM are highly vulnerable to HIV infection, and also revealed that fear of being HIV-positive and fear of being assumed to be gay present barriers to making use of the available voluntary HIV testing and counselling services.

Although South African MSM are recognised as at risk for HIV/AIDS, this population remains marginalised and to a large extent neglected in current HIV/AIDS-prevention campaigns and research.

This study found that HIV-positive MSM generally experienced more discrimination related to their HIV status than their non-MSM counterparts. It therefore appears that HIV-positive MSM suffer double or multiple discrimination, or 'superdiscrimination'.

However, contrary to our hypotheses, there were no differences between MSM and MSW on the internalised stigma items.

Taking up the challenge

Interventions are needed that can assist HIV-positive MSM to better adapt and adjust to their condition and the social environment. In particular, coping efficacy training to address managing social stigma and reducing internalised stigma should be developed and tested. In the development of risk-reduction interventions for HIV-positive MSM, a component focusing on reducing the use of injection drugs is also important in tailoring the intervention for HIV-positive MSM.

HIV-positive MSM may also benefit from interventions designed to broaden and strengthen their social support networks. For example, support groups, which are already common in South Africa, especially among MSM living with HIV/AIDS, may be used as a starting point for the development of social support interventions.

However, the ultimate solution to HIV/AIDS stigma, especially among MSM, does not lie in the hands of HIV-positive men alone. Structural interventions are needed to change both the social climate of HIV/AIDS and sexual politics around sexual practices of MSM. Reducing the combined HIV/AIDS and MSM stigmas at the societal level could impact on the internalised stigmas that are clearly magnified in MSM living with HIV/AIDS.

Authors: Allanise Cloete, Leickness Simbayi and Nomvo Henda, HIV/AIDS, STIs and TB research progamme, HSRC; Seth Kalichman, Department of Psychology, University of Connecticut, Storrs, USA.