A survey of adult South African men published in this week’s PLOS Medicine, shows that while overlapping sexual relationships with women appear to be common, roughly one in 20 men reported consensual sexual contact with a man, approximately one in ten reported being sexually assaulted by another man, and around 3% reported perpetrating such an assault.

These findings highlight the need for HIV prevention messages regarding male on male sex in South Africa to be mainstreamed with prevention messages for the general population, and also that sexual health interventions and HIV prevention interventions for South African men should explicitly address male-on-male sexual violence.

The researchers (also the authors of the paper), led by Rachel Jewkes from the South African Medical Research Council, reached these conclusions by conducting a survey involving 1700 adult men from randomly selected households in the Eastern Cape and KwaZulu-Natal provinces of South Africa. The survey used technology that created a completely private and anonymous environment and included questions about the respondents’ lifetime history of same-sex experiences.

The authors found that 92 (5.4% of participants) reported consensual sexual activity (such as anal or oral sex or masturbation) with another man at some time during their life; 9.6% (162 men) reported that they had been forced to have sex with another man and 3% reported that they had perpetrated sexual violence against another man. Furthermore, most of the men who reported consensual sex with men also stated that they had a current female partner. And men who reported consensual oral or anal sex with a man were more likely to be HIV positive than men without such a history.

The authors say: “Our estimates of any consensual sexual activity between men, including consensual oral or anal sex, are consistent with reports from other developing countries although we were unable to locate comparable population-based data from Africa.”

They continue: “Male–female concurrency was common among [men who have sex with men] in these data, suggesting that prevention messaging about the risks associated with male–male sex needs to be mainstreamed into HIV prevention messaging for the general population in a way that does not invite homophobic stigmatization.”

The authors add: “Also required are further efforts to promote access to post-rape services for male survivors of sexual violence.”

In an accompanying Perspective, Jerome Singh (uninvolved in the study) from the University of Kwazulu-Natal, says: “[This] paper highlights several important findings, including that HIV prevalence amongst South African [men who have sex with men] also has public health implications for South African women, given high levels of bisexuality and sexual concurrency amongst South African [men who have sex with men].

Singh adds: “Assuming these findings are generalizable to the rest of sub-Saharan Africa, addressing the health needs of African [men who have sex with men] will require policymakers to meaningfully address significant socio-cultural and legal barriers that hinder access by [men who have sex with men] to HIV-related health services.

###

Research Article

Funding: This research was funded by the UK Department for International Development (DFID), and the grant was managed by their local partner, Human Life Sciences Partnership (HLSP). KLD and DWM were supported by the Emory Center for AIDS Research (P30 AI050409), with additional support for DWM from the Laney Graduate School at Emory University. RM received assistance for participation in the project from the National Research Foundation in South Africa. No funder had any role in: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Competing Interests: RJ is a member of the Editorial Board of PLOS Medicine. No other competing interests exist.

Citation: Dunkle KL, Jewkes RK, Murdock DW, Sikweyiya Y, Morrell R (2013) Prevalence of Consensual Male–Male Sex and Sexual Violence, and Associations with HIV in South Africa: A Population-Based Cross-Sectional Study. PLoS Med 10(6): e1001472. doi:10.1371/journal.pmed.1001472

###

Jerome A. Singh
Centre for the AIDS Programme of Research in South Africa (CAPRISA)
Howard College School of Law
King George V Ave
University of KwaZulu-Natal
Durban, 4001
SOUTH AFRICA
-2604559
.(JavaScript must be enabled to view this email address)