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

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

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.

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Fig. 4.1
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Fig. 4.3

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

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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

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