Health4Men have launched an innovative new campaign that caters to men who have sex with men in townships in the Cape Town area. This comes in reaction to survey results indicating that up to one third of men who have sex with men may be HIV positive.
Official South African health policy recognises that men who have sex with men (MSM) are one of the most at-risk populations in terms of HIV infection. Yet because comparatively more heterosexual people are affected by HIV, services and interventions for MSM have been almost non-existent in South Africa.
The term ‘MSM’ rather than ‘gay’ is used by health agencies worldwide to include men who have sex with other men but would not openly call themselves gay. This is particularly common in conservative societies that are deeply opposed to homosexuality – a trait that is common to many South African communities. As a result, it is not uncommon that MSM are also in heterosexual relationships. Campaigns that are explicitly “gay” or “too gay” thus often neglect the sexual health needs of these men by alienating them.
Now Health4Men, a project run by the Anova Health Institute, that caters to the sexual health needs of MSM are attempting to bridge this gap with a new initiative known as Ukwazana (Xhosa: “getting to know each other”). The campaign is expected to present a breakthrough in terms of the design, implementation and evaluation of its finely nuanced messaging targeting MSM in under-resourced township environments.
“One of the critical problems in trying to craft prevention strategies is that there is very little data about MSM in South Africa,” explains Health4Men director Glenn de Swardt. Health4Men offers free sexual health services to men who have sex with men.
A baseline survey of over 300 MSM from the targeted area indicated that 33% of participants who agreed to undergo an HIV screening tested positive. These results, according to Dr Andrew Tucker of the University of Cambridge who has helped implement and monitor the programme, “should be cause for urgent interventions and prevention messaging to this sector of society.”
Tucker uses the “ecologies of risk” theory to explain how the social environment within which these interactions occur significantly increases the risk of HIV for MSM. Given South Africa’s deeply homoprejudiced society, sex between men is likely to take place in hurried situations, and involve alcohol or substance abuse – leaving little room for negotiating safe sex. The overall condemnation of homosexuality also means that there is almost no mention of risks associated with anal sex in traditional safer sex campaigns.
Health4Men are seeking to empower MSM to better manage their risks of contracting HIV by sustainably altering the social environment with their Ukwazana programme. This requires a rigorous assessment of the factors that create risky “ecologies” for MSM, including substance and alcohol abuse, prejudice and stigma. This makes the campaign a two-pronged intervention, with messaging aimed not only directly at MSM, but also at their wider community of family, friends and peers.
The power of the campaign clearly is its inclusivity. “A team of volunteers, whom we refer to as our ‘Ambassadors,’ have been actively involved in every aspect of the planning for the programme over a two-year period. They also chose the name ‘Ukwazana,’ ” explains de Swardt.
The campaign materials, including posters and brochures, are based on meticulous research that was collected over two years. The Ambassadors have been invaluable to this process, helping to design messaging and imagery that will pass as socially acceptable in environments that tend to be hostile towards homosexuality.
“This alone represents an innovative development of posters which will be targeted at both gay- and straight-identifying MSM, as well as their communities,” says de Swardt.