Skip to main content
SpringerLink
Log in

Struggles for Inclusion: Incorporating Same-Sex Practising Men into National HIV Prevention and Surveillance in African Countries, 2000–2020

  • Chapter
  • First Online:
Male Same-sex Sexuality and HIV in Sub-Saharan Africa

Part of the book series: Social Aspects of HIV ((SHIV,volume 7))

  • 170 Accesses

Abstract

The global HIV policy environment changed dramatically for same-sex practising men from 2000 to 2020. These changes were especially pronounced in African countries, where research, prevention, and surveillance focused almost exclusively on heterosexual transmission for the previous 20 years. In stark contrast to the beginning of the century, by 2020, nearly all African countries identified same-sex practicing men as key populations in need of targeted HIV prevention and surveillance to control their epidemics. Drawing on a rich collection of archival, qualitative interview, and quantitative data, this chapter illuminates the global policy changes and initiatives that facilitated the recognition of the burden of HIV among same-sex practising men in African contexts, examines whether and when African countries have integrated same-sex practising men into the national HIV responses, and identifies key drivers of both inclusion and resistance to inclusion of same-sex practising men in the national HIV responses of African countries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    See also the Follow-up to the 2001 United Nations General Assembly Special Session on HIV/AIDS (WHO, 2002).

  2. 2.

    The Board is comprised of representatives from select donor and recipient countries, NGOs, and private donors.

  3. 3.

    However, funded proposals in the reserve funding stream were 50% less likely to provide for treatment or care activities.

  4. 4.

    Interviews conducted in Malawi between 2010 and 2012 suggest that some countries likely acted strategically to gain access to new funds and/or to maintain existing relationships with funders (Currier & McKay, 2017; Angotti et al., 2019).

  5. 5.

    As of 2016, very few African countries had integrated men who have sex with men into HIV prevention and surveillance in an ongoing basis.

  6. 6.

    The cultural practices that Hrdy (1987) includes run the gamut from female circumcision, ritual scarification, group circumcision of boys at adolescence, to shared medical injection paraphernalia and contact with nonhuman primates.

  7. 7.

    These early understandings of HIV transmission in African contexts have been durable over the course of the epidemic. Debates specifically around the role of higher levels of concurrency driving HIV transmission in African countries were revived in the mid- and late 2000s through work that revisited this earlier line of research (Epstein, 2007; Halperin & Epstein, 2004). Evidence supporting the concurrency theory is limited, however, and several empirical studies present conflicting evidence (Reniers & Watkins, 2010; see also for review Lurie & Rosenthal, 2010). See Epprecht (2008) for in-depth discussion of how constructions of African AIDS were based on entrenched understandings of African sexuality that had solidified much earlier in colonial racial projects and African nationalism.

  8. 8.

    Speaking at the Commonwealth Heads of Government Meeting in Perth, Australia, in 2011, Prime Minister of the United Kingdom (UK) David Cameron announced that countries receiving UK aid should “adhere to proper human rights” and that the UK would withdraw bilateral aid from countries that did not reform legislation banning homosexuality (BBC News, 2011). Two months after Cameron’s announcement, the Obama Administration also decided to integrate recognition and the protection of rights of sexual minorities into foreign aid, assistance, and development programs and tasked these programs with ensuring “swift and meaningful response to serious incidents that threaten the human rights of LGBT persons abroad” (Obama, 2011, p. § 4; Clinton, 2011). During this period, US State Department officials working on the continent understood their tasks during this period to include openly promoting decriminalization of same-sex sex and providing rapid responses to negative rhetoric from national governments (Interview, 2017).

  9. 9.

    Interview, 2017

  10. 10.

    Interview, 2016

  11. 11.

    Interview, 2017

  12. 12.

    African countries that have conducted IBBS/BBS focusing on men who have sex with men include Angola (2011), Botswana (2012), Burkina Faso (2017), Burundi (2014), Cameroon (2011, 2015–2016), Ghana (2011, 2017), Kenya (2010–2011), Lesotho (2013), Liberia (2013, 2018), Mali (2015), Mauritius (2010), Mozambique (2011), Namibia (2014), Nigeria (2010), Senegal (2018), South Africa (2014–2015), Togo (2017), and Uganda (2012–2013).

  13. 13.

    Interview, 2017

  14. 14.

    Notably, Lambda’s efforts here date back to the mid-2000s but were not included in official information before 2016.

  15. 15.

    Interview, 2017

  16. 16.

    Interview, 2017

  17. 17.

    Interview, 2017

  18. 18.

    Interview, 2017

  19. 19.

    Interview, 2017

  20. 20.

    Interview, 2017

  21. 21.

    Interview, 2017

  22. 22.

    Interview, 2017

  23. 23.

    Interview, 2017

  24. 24.

    Interview, 2017

  25. 25.

    Interview, 2017

References

  • Angotti, N., McKay, T., & Robinson, R. S. (2019). HIV interventions, LGBT visibility, and anti-gay backlash in African countries. Sociology of Development, 5(1), 71–90.

    Article  Google Scholar 

  • Anyamele, C., Lwabaayi, R., Nguyen, T.-V., & Binswanger, H. (2005). Sexual minorities, violence and AIDS in Africa. The World Bank Africa Region Working Paper Series, 84, 1–35.

    Google Scholar 

  • Austin, S. B. (1989). AIDS and Africa: United States media and racist fantasy. Cultural Critique, 14, 129–152.

    Article  Google Scholar 

  • 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 Medicine, 4, 1901–1911.

    Article  Google Scholar 

  • BBC News. (2011). Cameron threat to dock some UK aid to anti-gay nations. BBC News. Retrieved October 9, 2012, from http://www.bbc.co.uk/news/uk-15511081

  • Bhalla, N. (2019, October 10). Uganda plans bill imposing death penalty for gay sex. Reuters.

    Google Scholar 

  • Boyd, L. (2013). The problem with freedom: Homosexuality and human rights in Uganda. Anthropological Quarterly, 86(3), 697–724.

    Article  Google Scholar 

  • Broqua, C. (2016). Islamic movements against homosexuality in Senegal. In A. van Klinken & E. Chitando (Eds.), Public religion and the politics of homosexuality in Africa (pp. 163–179). Routledge.

    Google Scholar 

  • Caceres, C. F., Konda, K., Segura, E. R., & Lyerla, R. (2008a). Epidemiology of male same-sex behaviour and associated sexual health indicators in low- and middle-income countries: 2003–2007 estimates. Sexually Transmitted Infections, 84(suppl 1), i49–i56.

    Article  Google Scholar 

  • Caceres, C. F., Pecheny, M., Frasca, T., Rios, R. R., & Pocahy, F. (2008b). Report to the joint united review of legal frameworks and the situation of human rights related to sexual diversity in low and middle income countriesations programme on HIV/AIDS. Joint United Nations Programme on HIV/AIDS.

    Google Scholar 

  • Cerullo, M., & Hammonds, E. (1988). AIDS in Africa: The Western imagination and the dark continent. Radical America, 21, 21.

    Google Scholar 

  • Chin, J., & Mann, J. M. (1988). The global patterns and prevalence of AIDS and HIV infection. AIDS, 2(suppl 1), s247–s252.

    Article  Google Scholar 

  • Clinton, H. R. (2011, December 6). Remarks in recognition of International Human Rights Day. Retrieved October 9, 2012, from U.S. Department of State: http://www.state.gov/secretary/rm/2011/12/178368.htm

  • Currier, A. (2010). Political homophobia in postcolonial Namibia. Gender and Society, 24(1), 110–129.

    Article  Google Scholar 

  • Currier, A. (2012). Out: LGBT organizing in Namibia and South Africa. University of Minnesota Press.

    Google Scholar 

  • Currier, A., & Cruz, J. M. (2014). Civil society and sexual struggles in Africa. In E. Obadare (Ed.), The handbook of civil society in Africa (pp. 337–360). Springer.

    Google Scholar 

  • Currier, A., & McKay, T. (2017). Pursuing social justice through public health: Gender and sexual diversity activism in Malawi. Critical African Studies, 9(1), 71–90.

    Article  Google Scholar 

  • Englander, D. (2011). Protecting the human rights of LGBT people in Uganda in the wake of Uganda’s “Anti Homosexuality Bill, 2009”. Emory International Law Review, 25, 1263–1316.

    Google Scholar 

  • Epprecht, M. (2008). Heterosexual Africa? The history of an idea from the age of exploration to the age of AIDS. Ohio University Press.

    Google Scholar 

  • Epstein, H. (2007). The invisible cure: Why we are losing the fight against AIDS in Africa. Picador.

    Google Scholar 

  • Esacove, A. (2016). Modernizing sexuality: U.S. HIV prevention in Sub-Saharan Africa. Oxford University Press.

    Google Scholar 

  • Fay, H., Baral, S. D., Trapence, G., Motimed, F., Umar, E., Iipinge, S., et al. (2011). Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana. AIDS and Behavior, 15(6), 1088–1097.

    Article  Google Scholar 

  • Ferguson, J. (2006). Global shadows: Africa in the neoliberal world order. Duke University Press.

    Google Scholar 

  • Gettleman, J. (2014 йил 1–August). Uganda anti-gay law struck down by court. New York Times.

    Google Scholar 

  • Global Fund. (2007a). Sixteenth board meeting, 12–13 November. The Global Fund to Fight AIDS, Tuberculosis and Malaria.

    Google Scholar 

  • Global Fund. (2007b). The global fund strategy in relation to sexual orientation and gender identity. The Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

    Google Scholar 

  • Global Fund. (2010). Report of the technical review panel and the secretariat on round 10 proposals. Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, Technical Review Panel.

    Google Scholar 

  • Global Fund. (2011). Analysis of rounds 8, 9 and 10 Global Fund HIV proposals in relation to men who have sex with men, transgender people and sex workers. Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

    Google Scholar 

  • Government of Malawi. (2003). Follow up to the declaration of commitment on HIV/AIDS (UNGASS): Country report for Malawi, January–December 2002. Government of Malawi.

    Google Scholar 

  • Government of Rwanda. (2006). Rwanda: Follow-up to the declaration of committment on HIV/AIDS (UNGASS). Government of Rwanda.

    Google Scholar 

  • Government of the Central African Republic. (2005). Central African Republic: UNGASS report 2003–2005. Government of the Central African Republic.

    Google Scholar 

  • GPA. (1988). Progress report number 4. The World Health Organization, Global Programme on AIDS.

    Google Scholar 

  • Grossman, G. (2015). Renewalist christianity and the political saliency of LGBTs: Theory and evidence from Sub-Saharan Africa. Journal of Politics, 77(2), 337–351.

    Article  Google Scholar 

  • Gurkin, A., Graham, A., & Seale, A. (2011). Analysis of Rounds 8, 9 and 10 Global Fund HIV proposals in relation to men who have sex with men, transgender people and sex workers. Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.

    Google Scholar 

  • Hakim, A. J., MacDonald, V., Hladik, W., Zhao, J., Burnett, J., Sabin, K., et al. (2018). Gaps and opportunities: Measuring the key population cascadethrough surveys and services to guide the HIV response. Journal of the International AIDS Society, 21(s5), e25119.

    Article  Google Scholar 

  • Halperin, D. T., & Epstein, H. (2004). Concurrent sexual partnerships help to explain Africa’s high HIV prevalence: Implications for prevention. The Lancet, 364, 4–6.

    Article  Google Scholar 

  • Hrdy, D. B. (1987). Cultural practices contributing to the transmission of human immunodeficiency virus in Africa. Reviews of Infectious Diseases, 9(6), 1109–1119.

    Article  CAS  Google Scholar 

  • Initiative for Equal Rights. (2015). Report on human rights violations based on real of perceived sexual orientation and gender identity in Nigeria. Initiative for Equal Rights.

    Google Scholar 

  • Johnson, A. M., & Laga, M. (1988). Heterosexual transmission of HIV. AIDS, 2(suppl 1), s49–s56.

    Article  Google Scholar 

  • Kitzinger, J., & Miller, D. (2003 [1992]). ‘African AIDS’: The media and audience beliefs. In P. Aggleton & P. M. DAvies (Eds.), AIDS: Rights, risk and reason (pp. 28–52). RoutledgeFalmer.

    Google Scholar 

  • Lane, T., Osmand, T., Marr, A., Shade, S. B., Dunkle, K., Sandfort, T., et al. (2014). The Mpumalanga Men’s Study (MPMS): Results of a baseline biological and behavioral HIV surveillance survey in two MSM communities in South Africa. PLoS One, 9(11), e111063–e111063.

    Article  Google Scholar 

  • Lurie, M. N., & Rosenthal, S. (2010). Concurrent partnerships as a driver of the HIV epidemic in sub-Saharan Africa? The evidence is limited. AIDS and Behavior, 14(1), 17–24.

    Article  Google Scholar 

  • MAP. (2005). Male-male sex and AHIV/AIDS in Asia. The Monitoring the AIDS Pandemic Network.

    Google Scholar 

  • McIntyre, J. (2018). The HIV epidemic in MSM in South Africa. Microbicide trials network regional meeting. Cape Town.

    Google Scholar 

  • McKay, T. (2016). From Marginal to marginalised: The inclusion of men who have sex with men in global and national AIDS programmes and policy. Global Public Health, 11(7–8), 902–922.

    Article  Google Scholar 

  • McKay, T., & Angotti, N. (2016). Ready rhetorics: Political homophobia and activist discourses in Malawi, Nigeria, and Uganda. Qualitative Sociology, 39(4), 397–420.

    Article  Google Scholar 

  • Obama, B. (2011, December 6). Presidential memorandum—International initiatives to advance the human rights of lesbian, gay, bisexual, and transgender persons. Retrieved October 9, 2012, from The White House, Office of the Press Secretary: http://www.whitehouse.gov/the-press-office/2011/12/06/presidential-memorandum-international-initiatives-advance-human-rights-l

  • Packard, R. M., & Epstein, P. (1991). Medical research on AIDS in Africa: A historical perspective. In E. Fee & D. M. Fox (Eds.), AIDS: The making of a chronic disease (pp. 346–376). University of California Press.

    Google Scholar 

  • Park, J. N., Papworth, E., Kassegne, S., Moukam, L., Billong, S. C., Macauley, I., et al. (2013). HIV prevalence and factors associated with HIV infection among men who have sex with men in Cameroon. Journal of the International AIDS Society, 16(4S3), 18752.

    Article  Google Scholar 

  • Parker, R., Caceres, C. F., Khan, S., & Aggleton, P. (2002). Reaching men who have sex with men. In P. R. Lamptey & H. D. Gayle (Eds.), HIV/AIDS prevention in resource-constrained settings: A handbook for the design and management of programs (pp. 259–280). Family Health International.

    Google Scholar 

  • Patton, C. (1999). Inventing ‘African AIDS’. In P. Aggleton & R. Parker (Eds.), Culture, society and sexuality: A reader (1st ed., pp. 387–404). University College London Press.

    Google Scholar 

  • Piot, P., & Carel, M. (1988). Epidemiological and sociological aspects of HIV-infection in developing countries. British Medical Bulletin, 44, 68–88.

    Article  CAS  Google Scholar 

  • Piot, P., Kreiss, J. K., Ndinya-Achola, J. O., Ngugi, E. N., Simonsen, J. N., Cameron, D. W., et al. (1987). Heterosexual transmission of HIV. AIDS, 1, 199–206.

    CAS  PubMed  Google Scholar 

  • Quinn, T. C., Mann, J. M., Curran, J. W., & Piot, P. (1986). AIDS in Africa: An epidemiologic paradigm. Science, 234(4779), 955–963.

    Article  CAS  Google Scholar 

  • Reniers, G., & Watkins, S. C. (2010). Polygyny and the spread of HIV in Sub Saharan Africa: A case of benign concurrency. AIDS, 24(2), 299–307.

    Article  Google Scholar 

  • República de Moçambique. (2016). Resposta Global à SIDA: Relatório do Progresso, 2016: MOÇAMBIQUE. Conselho Nacional de Combate ao SIDA.

    Google Scholar 

  • Robinson, R. S. (2017). Intimate interventions in global health: Family planning and HIV prevention in Sub-Saharan Africa. Cambridge University Press.

    Google Scholar 

  • Sabatier, R. (1988). Blaming others: Prejudice, race and worldwide AIDS. PANOS Institute.

    Google Scholar 

  • 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(6), 425–429.

    Article  CAS  Google Scholar 

  • Serwadda, D., Swankambo, N. K., Carswell, J. W., Bayley, A. C., Tedder, R. S., Weiss, R. A., et al. (1985). Slim disease: A new disease in Uganda and its assoctiation with HTLV-III infection. The Lancet, 326(8460), 849–852.

    Article  Google Scholar 

  • Smith, A., Tapsoba, P., Peshu, N., Sanders, E. J., & Jaffe, H. W. (2009). Men who have sex with men and HIV/AIDS in sub-Saharan Africa. The Lancet, 374, 416–422.

    Article  Google Scholar 

  • Treichler, P. (1991). AIDS and HIV infection in the third world: A first world chronicle. In E. Fee & D. M. Fox (Eds.), AIDS: The making of a chronic disease (pp. 377–401). University of California Press.

    Google Scholar 

  • U.S. Department of State. (2015). Uganda 2015 human rights report. Government of the United States of America.

    Google Scholar 

  • UN. (1995). Report of the Committee of Co-sponsoring Organizations of the Joint and Co-sponsored United Nations programme on HIV/AIDS (E/1995/71). United Nations, Economic and Social Council.

    Google Scholar 

  • UN. (2001a). Declaration of commitment on HIV/AIDS. United Nations General Assemblty.

    Google Scholar 

  • UN. (2001b). United Nations system strategic plan for HIV/AIDS for 2001–2005. United Nations.

    Google Scholar 

  • UNAIDS. (1999). The UNAIDS report. Joint United Nations Programme on HIV/AIDS.

    Google Scholar 

  • UNAIDS. (2000 [1997]). AIDS and men who have sex with men: UNAIDS technical update. Joint United Nations Programme on HIV/AIDS.

    Google Scholar 

  • UNAIDS. (2001). The global strategy framework on HIV/AIDS. The Joint United Nations Programme on HIV/AIDS.

    Google Scholar 

  • UNAIDS. (2003). AIDS epidemic update: December 2003. The Joint United Nations Programme on HIV/AIDS and the World Health Organization.

    Google Scholar 

  • UNAIDS. (2005a). Intensifying HIV prevention. Policy position paper, Joint United Nations Programme on HIV/AIDS, Geneva.

    Google Scholar 

  • UNAIDS. (2005b). Men who have sex with men, HIV prevention and care: Report of a UNAIDS stakeholder consultation. Joint United Nations Programme on HIV/AIDS (UNAIDS). Retrieved March 5, 2011, from UNAIDS.

    Google Scholar 

  • UNAIDS. (2006). HIV and sex between men: Policy brief. Retrieved March 5, 2011, from UNAIDS: http://www.unaids.org/en/media/unaids/contentassets/dataimport/publications/irc-pub07/jc1269-policybrief-msm_en.pdf

  • UNAIDS/WHO. (2000). Guidelines for second generation HIV surveillance. Joint United Nations Programme on HIV/AIDS and the World Health Organization, Working Group on Global HIV/AIDS and STI Surveillance.

    Google Scholar 

  • UNAIDS/WHO. (2014). Guidelines for second generation HIV surveillance: An update: Know your epidemic. UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. World Health Organization.

    Google Scholar 

  • van Klinken, A. (2013). Gay rights, the devil and the end times: Public religion and the enchantment of the homosexuality debate in Zambia. Religion, 43(4), 519–540.

    Article  Google Scholar 

  • Velasco, K. (2019). A growing queer divide: The divergence between transnational advocacy networks and foreign aid in diffusing LGBT policies. International Studies Quarterly, 64(1), 120–132.

    Google Scholar 

  • Vorhölter, J. (2012). Negotiating social change: Ugandan discourses on Westernization and neo-colonialism as forms of social critique. Journal of Modern African Studies, 50(2), 283–307.

    Article  Google Scholar 

  • Wal Fadjri. (2009, January 19). Pour obtenir la libération des neuf homosexuels condamnés au Sénégal: Le maire de Paris écrit aux autorités sénégalaises [To obtain release of the nine homosexuals condemned in Senegal, mayor of Paris writes to Senegalese authorities. Wal Fadjri (Senegal).

    Google Scholar 

  • Watney, S. (1989). Missionary positions: AIDS, ‘Africa’, and race. Critical Quarterly, 31(3), 45–62.

    Article  Google Scholar 

  • Weiss, M. L., & Bosia, M. J. (2013). Global homophobia: States, movements, and the politics of repression. University of Illinois Press.

    Google Scholar 

  • WHO. (1986, November 11–13). Report of the first regional conference on AIDS in Africa. World Health Organization, Special Program on AIDS, Brazzaville.

    Google Scholar 

  • WHO. (2002). Follow up on the United Nations General Assembly special session on HIV/AIDS: Work of WHO. World Health Organization, Department of HIV/AIDS.

    Google Scholar 

  • WHO. (2004). Rapid assessment and response adaptation guide on HIV and men who have sex with men. World Health Organization, Department of HIV/AIDS.

    Google Scholar 

  • WHO, CDC, UNAIDS, FHI 360. (2017). Biobehavioral survey guidelines for popula-tions at risk for HIV. World Health Organization.

    Google Scholar 

  • WHO/UNDP. (2009). Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender populations: Report of a technical consultation, 15–17 September 2008. Meeting report. World Health Organization and the United Nations Development Programme, Geneva.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vanderbilt University, Nashville, TN, USA

    Tara McKay

Authors
  1. Tara McKay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tara McKay .

Editor information

Editors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA

    Theo Sandfort

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McKay, T. (2021). Struggles for Inclusion: Incorporating Same-Sex Practising Men into National HIV Prevention and Surveillance in African Countries, 2000–2020. In: Sandfort, T. (eds) Male Same-sex Sexuality and HIV in Sub-Saharan Africa. Social Aspects of HIV, vol 7. Springer, Cham. https://doi.org/10.1007/978-3-030-73726-9_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-73726-9_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-73725-2

  • Online ISBN: 978-3-030-73726-9

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation