Shocking new research has found that one in three men who have sex with men (MSM) in Soweto is HIV positive. This is said to be the first study to examine HIV and the community of men who have sex with men in the South African township.

The researchers, from the University of California, San Francisco (UCSF), found that the highest HIV rate was among MSM who identified as gay, at 33.9 percent.

They further estimated that the rate of HIV infection for bisexual MSM in Soweto to be 6.4 percent and 10 percent for straight identified MSM.

“Our findings clearly indicate that targeted prevention and treatment for men who have sex with men in townships are urgently needed,” said the study’s principal investigator, Tim Lane, PhD, MPH, assistant professor at the UCSF Center for AIDS Prevention Studies.

Of the study’s 378 participants, 34.1 percent identified as gay, 30.4 percent as bisexual and 31.7 percent as straight. All but one of the participants were black South Africans and all of South Africa’s black African ethnic groups were represented in the sample.

The authors say that the study showed that MSM’s sexual identities predicted their sexual behaviour with other men.

Gay identity was highly correlated with the exclusive practice of receptive anal intercourse and straight and bisexual self-identification was highly correlated with the exclusive practice of insertive anal intercourse with male partners.

“With the correlation of sexual identity and sexual practice, control of condom use in same-sex partnerships tends to be in the hands of bisexual and straight MSM. This finding demonstrates the pressing need to promote condom use among bisexual and straight-MSM for same-sex as well as heterosexual relationships,” said Lane.

“…despite South Africa’s legal advances in gay rights, stigma and de facto segregation are reflected in the disproportionate rates of HIV infection.”

The authors also looked at other risk factors and found that HIV infection was also associated with being older than 25, lower incomes, purchasing alcohol or drugs for a male partner in exchange for sex, having receptive anal intercourse and having any unprotected anal intercourse with a man.

HIV infection was significantly less likely among men who have sex with men who were circumcised, smoked marijuana, had a regular female partner or reported unprotected vaginal intercourse with women.

Quite significantly, Lane said that the findings clearly suggest that for this population of MSM, circumcision could be protective and that “MSM should not be excluded from circumcision programs.”

Although the effect of circumcision reducing the rate of HIV infection among heterosexual men has been well demonstrated in various studies in Africa, there has been little research on this issue with regard to MSM.

The Soweto study contradicts US-based research presented last week at the 2009 National HIV Prevention Conference in Atlanta, during which Dr. Peter Kilmarx, of the US Centers for Disease Control and Prevention (CDC) said that circumcision “is not considered beneficial” in the case of anal sex.

Those researchers did admit that their results could have been skewed by the fact that 87% of the US men involved in the study were circumcised (around 80% of American men are circumcised) and they may have had too few uncircumcised men in their sample group.

According to Lane, “Despite South Africa’s legal advances in gay rights, stigma and de facto segregation are reflected in the disproportionate rates of HIV infection.”

The findings are available in the online edition of the journal AIDS and Behavior and are scheduled for publication in an upcoming print issue.

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