Sexuality & Culture

, Volume 15, Issue 3, pp 279–309 | Cite as

Homosexuality and HIV in Africa: An Essay on Using Entertainment Education as a Vehicle for Stigma Reduction

  • Anthony M. SallarEmail author
  • Domegoure Aurelie Kpagnane Somda
Original Paper


HIV transmission in sub Saharan Africa has been consistently reported to be heterosexual. The existence of Men who have Sex with Men (MSM) has been denied and the epidemic among them ignored although homosexuality in the continent has been documented. Consequently, limited research has been conducted among Africa’s MSM. Homophobia has been reported as one of the key forces driving Africa’s epidemic because stigma and discrimination may make MSM a hard-to-reach group for HIV prevention and early treatment services. We conducted searches in journals, newspapers, UNAIDS and MSM web sites to read laws, abuse, and discrimination of MSM. We reviewed literature on entertainment education and its success in addressing social, political, and health issues worldwide in order to propose a solution to the issue. Fifty-five percent of African countries have laws against sex between men. Penalties range from fines, imprisonment, or death. Official harassments, state sponsored homophobia and threats against MSM have been documented. Stigmatization can create barriers to testing, restrict utilization of prevention programs, condom use, and failure to disclose HIV status to sexual partners. This paper suggests a communication strategy such as entertainment education to raise awareness and tolerance and to promote action in the fight against HIV/AIDS epidemic and related stigmatization among Africa’s MSM. Entertainment Education which derives from various theories can be disseminated through radio or TV and can bring behavior and social change by offering the audience an opportunity for social learning. It has been effective worldwide and examples include Grey’s Anatomy, ER, Philadelphia, Soul City, Eastenders, and the telenovela Simplemente Maria and can pave way for HIV prevention and treatment in a vulnerable population.


HIV/AIDS MSM Stigma Human rights Entertainment education 


  1. Accra Daily Mail. (2006). Stiff opposition for gays, lesbians in Takoradi. Ghanaweb. Retrieved from
  2. Ahmed, S. A., & Kheir, A. H. (1992). Sudanese sexual behavior, socio-cultural norms and the transmission of HIV. In T. Dyson (Ed.), Sexual behaviour and networking: Anthropological and sociocultural studies on the transmission of HIV (pp. 303–314). Liege, Belgium: Editions Derouaux-Ordina.Google Scholar
  3. Allman, D., Adebajo, S., Myers, T., Odumuye, O., & Ogunsola, S. (2007). Challenges for the sexual health and social acceptance of men who have sex with men in Nigeria. Culture Health Sexuality, 9, 153–168.CrossRefGoogle Scholar
  4. Anonymous. (2006). It’s tough being queer in Africa, but Nigerians begin organizing. Contemporary Sexuality, 40, 8–9.Google Scholar
  5. Asiimwe, A., Koleros, A., & Chapman, J. (2009). Understanding the dynamics of the HIV epidemic in Rwanda: Modeling the expected distribution of new HIV infections by exposure group. Kigali: National AIDS Control Commission, MEASURE Evaluation.Google Scholar
  6. Azuah, U. (2006). The near nullity of nollywood. Vanguard Newspaper, Lagos, Nigeria. Retrieved from
  7. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  8. Baral, S., Sifakis, F., Cleghorn, F., & Beyrer, C. (2007). Elevated risk for HIV infection among men who have sex with men in low- and middle income countries 2000–2006: A systematic review. PLoS Med, 4(12), e339.CrossRefGoogle Scholar
  9. Baral, S., Trapence, G., Motimedi, F., Umar, E., Iipinge, S., Dausab, F., et al. (2009). HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS ONE, 2009(4), e4997.CrossRefGoogle Scholar
  10. Beyrer, C., Trapence, G., Motimedi, F., Umar, E., Iipinge, S., Dausab, F., et al. (2010). Bisexual concurrency, bisexual partnerships, and HIV among Southern African men who have sex with men. Sexually Transmitted Infections, 86, 323–327.CrossRefGoogle Scholar
  11. Blakley, J. (2001). Entertainment goes global: Mass culture in a transforming world. The Norman Lear Center. Retrieved
  12. Brooks, R. A., Etzel, M. A., Hinojos, E., Henry, C. L., & Perez, M. (2005). Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination and homophobia: Perspectives of providers. AIDS Patient Care STDS, 11, 737–744.CrossRefGoogle Scholar
  13. Butler, A. H., & Astbury, G. (2008). The use of defense mechanisms as precursors to coming out in post-apartheid South Africa: A gay and lesbian youth perspective. Journal of Homosexuality, 55, 223–244.CrossRefGoogle Scholar
  14. Centers For Disease Control and Prevention CDC. (2009). Health marketing: Entertainment education. Retrieved from the CDC website Accessed on 03/17/2011.
  15. Chronicle. (2003a). CHRAJ wont advocate gay rights—short. Ghanaweb. Retrieved from
  16. Chronicle. (2003b). Anglican church opposed to any form of unnatural carnal behaviour. Modern Retrieved from
  17. Chronicle. (2006). Christian council calls for aluta as, gay, lesbian adventure catches fire. September 5, 2006
  18. Cloete, A., Simbayi, L. C., Kalichman, S. C., Strebel, A., & Henda, N. (2008). Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa. AIDS Care, 9, 1105–1110.CrossRefGoogle Scholar
  19. CNN. (2009). Lawmakers approve same-sex marriage in N. H. Maine. Retrieved from
  20. Coleman, L.P., Palmer, A., & Bharath, U. (1997). Etertainment-education and social change. A report on the 2nd international entertainment education conference in Athens, Ohio. Retrieved from
  21. Croucher, S. (2002). South Africa’s democratization and the politics of gay liberation. Journal of Southern African Studies, 28, 315–330.CrossRefGoogle Scholar
  22. Dahoma, M., Johnston, L. G., Holman, A., et al. (2011). HIV and related risk behavior among men who have sex with men in Zanzibar, Tanzania: Results of a behavioral surveillance survey. AIDS Behavior, 15, 186–192.CrossRefGoogle Scholar
  23. Daily Graphic. (2007). British sodomite to be deported. Retrieved from
  24. De Fossard, E. (1996). How to write a radio serial drama for social development. A Script Writer’s Manual. Population Communication Services. Center for Communication Programs. Baltimore: The Johns Hopkins University School of Public Health.Google Scholar
  25. Ehlers, V. J., Zuyderduin, A., & Oosthuizen, M. J. (2001). The well being of gays, lesbians and bisexuals in Botswana. Journal of Advanced Nursing, 35, 848–856.CrossRefGoogle Scholar
  26. Foreman, M. (1999). AIDS and men: Taking risks or taking responsibilities?. London: Panos & Zed.Google Scholar
  27. Geibel, S., van der Elst, E. M., King’ola, N., Luchters, S., Davies, A., Getambu, E. M., Peshu, N., Graham, S. M., McClelland, R. S., Sanders, E. J. (2007). Are you on the market? A capture-recapture enumeration of men who sell sex to men in and around Mombasa, Kenya. AIDS, 21(10), 1349–1354.CrossRefGoogle Scholar
  28. Gelmon, L., Kenya, P., Oguya, F., Cheluget, B., & Haile, G. (2009). Kenya: HIV prevention response and modes of transmission analysis. Report presented at the Kenya National AIDS Control Council on March, 2009.Google Scholar
  29. Gentleman, J (2010). Kenyan police disperse gay wedding New York times. February 12, 2010
  30. Gevisser, M. (1995). A different fight for freedom: A history of South African lesbian and gay organisation from 1950s to 1990s. In M. Gevisser & E. Cameron (Eds.), Defiant desire: Gay and lesbian lives in South Africa (pp. 14–86). New York: Rutledge.Google Scholar
  31. Ghana News Agency. (2005). Students dismissed for homosexuality. Retrieved from
  32. Ghana News Agency. (2006a). Charismatic churches support ban on homo conference. September 6th 2006
  33. Ghana News Agency. (2006b). Muslims hail decision to stop homo conference. September 5, 2006
  34. Ghana News Agency. (2006c). Sixty two percent of Ghanaian gays indulge in heterosexual activities. Ghanatoday. Retrieved from
  35. Ghana News Agency. (2010). GEC condemns attempts to promote homosexuality. Ghanaweb. Retrieved from
  36. Ghanaian Observer. (2008). Sodomy cases rise in prisons. Retrieved from
  37. Ghanaian Times. (2006). Research showed homosexuality is real in Ghana. Ghanaweb. Retrieved from
  38. Griensven, F. V. (2007). Men who have sex with men and their HIV epidemics in Africa. AIDS, 21, 1361–1362.CrossRefGoogle Scholar
  39. Gye Nyame Concord. (2007). Gay Prostitutes invade Accra Adabraka, Tesano, Paloma and Osu—hotspots. Ghanaweb. Retrieved from
  40. Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100(3), 452–459.CrossRefGoogle Scholar
  41. Hether, H., Huang, G. C., Beck, V., Murphy, S. T., & Valente, T. W. (2008). Entertainment-education in a media-saturated environment: Examining the impact of single and multiple exposures to breast cancer storylines on two popular dramas. Journal of Health Communication, 13, 808–823.CrossRefGoogle Scholar
  42. Johnson, C. A. (2007). Off the map. How HIV/AIDS programming is failing for same sex in Africa. Retrieved from
  43. Kajubi, P., Kamya, M. R., Raymond, H. F., Chen, S., Rutherford, G. W., Mandel, J. S., et al. (2008). Gay and bisexual men in Kampala, Uganda. AIDS and Behaviour, 12, 492–504.CrossRefGoogle Scholar
  44. Kennamer, J. D., Honnold, J., Bradford, J., & Hendricks, M. (2000). Differences in disclosure of sexuality among African American and White gay/bisexual men: Implications for HIV/AIDS prevention. AIDS Education and Prevention, 12, 519–531.Google Scholar
  45. Kovac, A. L. (2002). Africa’s rainbow nation. Journal of Southern African Studies, 28, 90–92.Google Scholar
  46. Lane, T., Magale, T., Struthers, H., McIntyre, J., & Kegeles, S. M. (2008a). They see you as a different thing: The experience of men who have sex with men with healthcare workers in South African township communities. Sexually Transmitted Infections, 84, 430–433.CrossRefGoogle Scholar
  47. Lane, T., Mcintyre, J., & Morin, S. (2006). High risk sex among black MSM in South Africa: Results from the Guateng MSM survey. Paper presented at the international conference on AIDS, in Toronto, Canada. Retrieved from
  48. Lane, T., Raymond, F. H., Dladla, S., Rasethe, J., Struthers, H., McFarland, W., & McIntyre, J (2009). High HIV prevalence among men who have sex with men in Soweto, South Africa: results from the Soweto men’s study. AIDS and Behavior. doi: 10.1007/s10461-009-9598-y.
  49. Lane, T., Shade, S. B., McIntyre, J., & Morin, S. F. (2008b). Alcohol and sexual risk behaviour among men who have sex with men in South African township communities. AIDS and Behaviour, 12, 78–85.CrossRefGoogle Scholar
  50. Lowndes, C. M., Alary, M., Belleau, M., Bosu, W.K., Kintin, D, F., Nnorom, J.A., Seck, K., Victor-Ahuchogu, J., & Wilson, D. (2008). West Africa HIV/AIDS epidemiology and response synthesis: implications for prevention. Retrieved from on 03/15/2011.
  51. Lunt, S. (2005). The diffusion and application of community radio in developing countries: The democratization of “small” broadcasting. Comms 607 – small broadcasters, 1–20.Google Scholar
  52. Massoud, M. F. (2003). The evolution of gay rights in South Africa. Peace Review, 15, 301–307.CrossRefGoogle Scholar
  53. Montgomery, J. P., Mokotoff, E. D., Gentry, A. C., & Blair, J. M. (2003). The extent of bisexual behavior in HIV-infected men and implications for transmission to their female sex partners. AIDS Care, 15, 829–837.CrossRefGoogle Scholar
  54. National Research Council. (1996). Preventing and Mitigating AIDS in Sub-Saharan Africa. Washington, DC: Academy Press.Google Scholar
  55. Ndiaye, H. D., Toure-Kane, C., Vidal, N., Niama, F. R., Niang-Diallo, P. A., Dièye, T., et al. (2009a). Surprisingly high prevalence of subtype C and specific HIV-1 subtype/CRF distribution in men having sex with men in Senegal. Journal of Acquired Immune Deficiency Syndromes, 52, 249–252.CrossRefGoogle Scholar
  56. Ndiaye, H. D., Toure-Kane, C., Vidal, N., Niama, F. R., Niang-Diallo, P. A., Dièye, T., et al. (2009b). Surprisingly high prevalence of subtype C and specific HIV-1 subtype/CRF distribution in men having sex with men in Senegal. Journal of Acquired Immune Deficiency Syndrome, 52, 249–252.CrossRefGoogle Scholar
  57. Niang, C. I., Tapsoba, P., Weiss, E., Diagne, M., Niang, Y., Moreau, A. M., et al. (2003). It is raining stones: Stigma, Violence and HIV vulnerability among men who have sex with men in Dakar, Senegal. Culture, Health & Sexuality, 5, 499–512.CrossRefGoogle Scholar
  58. Ntata, P. R., Muula, A. S., & Siziva, S. (2008). Socio-demographic characteristics and sexual health related attitudes and practices of men having sex with men in central and southern Malawi. Tanzania Journal Research, 10, 124–130.Google Scholar
  59. Ottosson, D. (2010). State-sponsored homophobia. A world survey of laws prohibiting same sex activity between consenting adults. 2010 ILGA, The International Lesbian, Gay, Bisexual, Trans and Intersex Association
  60. Parker, R., Khan, S., & Aggleton, P. (1998). Conspicuous by their absence? Men who have sex with men (MSM) in developing countries: Implications for HIV prevention. Critical Public Health, 8, 329–346.CrossRefGoogle Scholar
  61. Parry, C., Petersen, P., Carney, T., Dewing, S., & Needle, R. (2008). Rapid assessment of drug-related HIV risk among men who have sex with men in three South African cities. Drug and Alcohol Dependence, 95, 45–53.CrossRefGoogle Scholar
  62. Porter, R., Cobbina, M. D., Hanson, K., Dupree, J. D., Akanlu, G., Kaplan, M., Foreit, K., & Loganathan, R. (2006). An exploratory study of MSM social networks in urban Ghana. A paper presented at the international conference on AIDS in Toronto, Canada.Google Scholar
  63. Ravesi, G., Tabengwa, M., Awuah, M., Klindera, T., Bruun, T., Holcomb, B.B., & Stegling, C. (2006). We exist! sexual health workshops for LGBTIs: the example of LeGaBiBo/BONELA/HIVOS in Botswana. A paper presented at international conference on AIDS in Toronto, Canada.Google Scholar
  64. Rees, T. (2009). Whats the connection between religion and homophobia?
  65. Rimer, B., & Glanz, K. (2005). Theory at a Glance. A guide for health promotion practice (2nd ed.). Bethesda, Maryland: NIH Publications.Google Scholar
  66. Rostosky, S. S., Riggle, E. D. B., Horne, S. G., & Miller, A. D. (2009). Marriage amendments and psychological distress in lesbian, gay and bisexual (LGB) adults. Journal of Counseling and Psychology, 56(1), 56–66.CrossRefGoogle Scholar
  67. Rowatt, C. W., LaBouff, J., Johnson, M., Froese, P., & TsangJ, A. (2009). Associations among religiousness, social attitudes, and prejudice in a national random sample of American adults. Psychology of Religion and Spirituality, 1(1), 14–24. doi: 10.1037/a0014989.CrossRefGoogle Scholar
  68. Sallar, A. M. (2009). HIV prevention in Ghana: The need to include MSM as a sub population. A paper presented at the 137th American public health association’s annual meeting in Philadelphia, PA, USA. Retrieved from
  69. Sanders, E. J., Graham, S. M., Okuku, H. S., Van der Elst, E. M., Muhaari, A., Davies, A., et al. (2007). HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS, 21, 2513–2520.CrossRefGoogle Scholar
  70. Sandfort, T. G., Nel, J., Rich, E., Reddy, V., & Yi, H. (2008). HIV testing and self-reported HIV status in South African men who have sex with men: results from a community-based survey. Sexually Transmitted Infections, 84, 425–429.CrossRefGoogle Scholar
  71. Satcher, A. J., Durant, T., Hu, X., & Dean, H. D. (2007). AIDS cases among women who reported sex with a bisexual man, 200-2004-United States. Women and Health, 46, 23–40.CrossRefGoogle Scholar
  72. Sharma, A., Bukusi, E., Gorbach, P., Cohen, C. R., Muga, C., Kwena, Z., et al. (2008). Sexual identity and risk of HIV/STI among men who have sex with men in Nairobi. Sexually Transmitted Diseases, 35, 352–354.CrossRefGoogle Scholar
  73. Shigwedha, A. (1997). Namibian gays want apology from Nujoma for his offensive remarks. The Star.Google Scholar
  74. Singhal, A., & Rogers, E. M. (1999). Entertainment-education a communication strategy for social change. Mahwah, New Jersey: Lawrence Erlbaum Associates.Google Scholar
  75. Skovdal, M., Mwangi, E., & Meegan, M. (2006). An investigation of violence and discrimination among men who have sex with men in Kenya. A paper presented at the international conference on AIDS in Toronto, Canada.Google Scholar
  76. Smith, A. D., et al. (2009). Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Lancet, 374, 416–422.CrossRefGoogle Scholar
  77. Sood, S., Menard, T., & Witte, K. (2004). The theory behind entertainment education. In A. Singhal, M. J. Cody, E. M. Rogers, & M. Sabido (Eds.), Entertainment-education and social change. History research and practice (pp. 117–135). New Jersey: Lawrence Erlbaum Associates.Google Scholar
  78. Standing, H., & Kiskeka, M. N. (1989). Sexual behaviour in Sub-Saharan Africa: A review and annotated bibliography. London: Overseas Development Administration.Google Scholar
  79. Tapsoba, L. P., Moreau, A., Ly, A., Diagne, M., Diop, A. K, & Niang, C.I. (2006). Sexual health services for men who have sex with men in an African environment: Challenges and experiences. A paper presented at international conference on AIDS in Toronto, Canada. Retrieved from
  80. Tufte, T. (2004). Entertainment education in HIV/AIDS communication-beyond marketing, towards empowerment. In Carlsson, U., Van Feilitzen, C. (eds.), Year book of the UNESCO international clearinghouse on children, youth and media. Goteborg, Sweden: Goteborg University.Google Scholar
  81. UNAIDS. (2006). Report on the global AIDS epidemic by UNAIDS. Retrieved from
  82. UNAIDS. (2007). State of homophobia: A world survey of laws prohibiting same sex activity between consenting adults. Retrieved from
  83. UNAIDS. (2009a). AIDS responses failing men who have sex with men and transgender populations. Retrieved from
  84. UNAIDS. (2009b). UNAIDS welcomes historic decision by Delhi high court to annul the law that criminalizes adult homosexual relations. Retrieved from
  85. UNAIDS. (2010c). Global Report. Fact Sheet. North America and Western Europe.
  86. UNAIDS. (2010e). Global Report. Fact Sheet. Middle East and North Africa.
  87. UNAIDS. (2010f). Global Report. Fact Sheet. Eastern Europe and Central Asia.
  88. UNAIDS. (2010g). Global Report. Fact Sheet. Central and South America.
  89. UNAIDS. (2010k). Global Report. Fact Sheet. The global AIDS epidemic.
  90. Wade, A. S., Toure Kaneb, C., Niang Diallo, P., Diop, A. K., Gueye, K., Ndoye, M., et al. (2005). HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS, 19, 2133–2140.CrossRefGoogle Scholar
  91. Wakabi, W. (2007). Homophobia is fuelling the AIDS epidemic in Africa. Canadian Medical Association Journal, 177, 1017.Google Scholar
  92. Wang, H., & Singhal, A. (2009). Entertainment education through digital games. A chapter in Ute Ritterfield. In M. Cody & P. Vorderer (Eds.), Serious games: Mechanisms and effects (pp. 271–292). NY: Routledge.Google Scholar
  93. Wetherell, I. (1995). Mugabe cracks down on gay rights. Mail and Guardian.Google Scholar
  94. Whitley, B. (2009). Religiosity and attitudes toward lesbians and gay men: A meta-analysis. International Journal for the Psychology of Religion, 19(1), 21–38. doi: 10.1080/10508610802471104.CrossRefGoogle Scholar
  95. Zulu, K., Bulawo, N. D., & Zulu, W. (2006). Understanding HIV risk behaviour among men who have sex with men in Zambia. A paper presented at international conference on AIDS in Toronto, Canada.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Anthony M. Sallar
    • 1
    Email author
  • Domegoure Aurelie Kpagnane Somda
    • 2
  1. 1.Department of Social and Public Health, College of Health Sciences and ProfessionsOhio UniversityAthensUSA
  2. 2.Department of Social and Public Health, College of Health Sciences and ProfessionsOhio UniversityAthensUSA

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