Black African men who have sex with men

Between 2004 and 2009, there were 273 newly diagnosed black African men whose HIV was probably acquired through sex with another man. This amounts to 1.7% of all the diagnoses made in men who have sex with men; 1.8% of all diagnoses made in black African people; and 5.1% of diagnoses made in black African men.^1,2 Although these may seem to be low numbers, they serve to demonstrate that a simplistic representation of a heterosexual black African epidemic that is distinct from a white gay epidemic is misleading.

In the 2008-2009 BASS Line study, 7.8% of men reported having both male and female sexual partners in the previous year and 3.5% reported having only male sexual partners. However it should be noted that these figures may be overestimates, given the survey’s recruitment methods. Nonetheless it is interesting that around half of the men who had had sex with men reported only being attracted to women, which may show a mismatch between sexual desire and sexual behaviour. Moreover, this suggests that HIV prevention interventions targeted at gay or bisexual men will not necessarily reach black African men who have sex with men.

Compared to other men, men who had sex with both men and women were the most likely to report having multiple partners, sex outside a relationship, unprotected sex with someone of a different HIV status and condom failure. Men who only had sex with other men were the most likely to be diagnosed with HIV or another sexually transmitted infection.³

This is not the only research which suggests that black and minority ethnic men who have sex with men are more likely to test for HIV (and be diagnosed with it) than other men who have sex with men.⁴

Many black African MSM were brought up in countries where same-sex relationships are not accepted and are criminalised. Moreover there is often stigma around same-sex behaviour in black African communities in the UK.^5,6 This makes disclosure of sexuality extremely difficult; many live double lives in order to live up to cultural expectations. It is likely that there are far more same-sex relationships in African communities than are openly acknowledged, leaving needs unmet.

Men in a qualitative study of African MSM living with HIV described the constant juggling required to balance the complex and sometimes contradictory realities of life as a gay/bisexual man, an African and an HIV-positive person. Actual and perceived stigma was a key barrier to accessing appropriate practical and emotional support from families, social networks and religious organisations.⁷

The MESH (sexual health of ethnic minority MSM in Britain) project conducted research among MSM in Britain, focusing on minority ethnic groups. It found that not only did MSM from minority ethnic groups have a higher rate of HIV infection but they were also marginalised within the gay community. There is stigma and discrimination based on a sense of moral failure, promiscuity and ‘otherness’. MESH found that 37% of minority ethnic MSM in the study had experienced verbal racist attacks, while 11% reported having been physically attacked.⁸ Hostility from within the British community is often overshadowed by the loss of identity and stability caused by stigma from within the African community itself. Stigmatising attitudes are sometimes linked to religious beliefs and as a result many black African MSM do not go to faith communities for support.⁴