A necessary new vision of HIV/AIDS in Men who have Sex with Men

As South Africans, we are all AIDS fatigued . It’s been around for so long that without blushing in  shame, we can ‘fess up  that we don’t enjoy condoms,  and that we don’t really use them reliably and consistently. And now that bio medical technology is here, why bother?
A brief history of HIV/AIDS in South Africa.
In 1982 the first case of AIDS in South Africa was reported in a homosexual man who had contracted the virus whilst visiting California, USA. Thereafter  250 random blood samples were then taken from homosexual men in Johannesburg – 12.8% were infected.  In 1985 the first deaths from AIDS occurred.
By 1990 about 74,000-120,000 South Africans were living with HIV. In the same year a national antenatal survey was conducted and found 0.8% of pregnant women were infected. By July 1991 the number of AIDS cases contracted through heterosexual sex was equal to those contracted through Men having Sex with Men (MSM). From then onwards heterosexual sex became the dominant mode of transmission in South Africa.
Let’s skip forward – past Thabo Mbeki and his Aids denialism , past Jacob Zuma and his alleged rape and shower debacle, Let’s be mindful of the many billions of rands –   spent on condom campaigns and so called sexuality education in the schools: ABC :  Abstain> Be Faithful>Condomize. The numbers of HIV/AIDS kept rising.
n 1987 Zidovudine, the first treatment for HIV,  was introduced. Bio medical technology kicked in and the world sighed with relief. Although no cure was possible, treatment and management were now possible.  In 1997 Highly Active Antiretroviral Therapy (HAART) became the new treatment standard. In 2002 the first rapid HIV diagnostic test was FDA approved. By 2010 there were up to 20 different treatment options and generic drugs.
South Africa needed a kick up their bums and this was given in good measure in 2003  by Zachie Achmat and the Treatment Action Campaign who marched their way into Parliament demanding ARV’s (Anti Retro Viral ) drugs for all.
In 2019 almost one on e in five (17% ) of South African adults aged between 15-49 have HIV – a five point % increase from 2000. A total of 5.3 million South Africans under the age of 50 are HIV- positive.. According to Unicef, 34% of HIV positive people in East and Southern Africa and 60% of people in West and Central Africa are not currently on treatment. Low funds, low compliance, wicked side effects and yes, you still need a condom , inhibit ARV availability and use.
This means that we have a whole lot of very vulnerable people, specifically MSM,  who are not on bio medical technology, and thus are  susceptible to transmitting and transmission .
Let me unpack  bio medical technology for you .
> ARV’s (Anti Retroviral)’s, –   drugs that lower the viral load, taken correctly , can make your viral load almost undetectable, and so difficult to infect someone else. They are supposed to be freely available to every infected person in the country. #dreamon.
> PEP (Post Exposure Prophylactics )  In 2005 Post-exposure prophylaxis (PEP) is short-term antiretroviral treatment to reduce the likelihood of HIV infection after potential exposure, either occupationally, like  a needle injury,  or through sexual intercourse, sharing needles, , was introduced.
> In 2012 Truvada, a Pre-exposure prophylaxis (or PrEP) was aapproved by the FDA. 

It is administered when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. PrEP can stop HIV from taking hold and spreading throughout your body. It is highly effective for preventing HIV if used as prescribed, but it is much less effective when not taken consistently.

As of 2018, numerous countries have now approved the use of PrEP for HIV/AIDS prevention,

Yet despite these previously  unimaginable bio medical technogical breakthroughs, the incidence of new cases  increases.  Most significantly in marginalised populations , such as Men who have Sex with Men.  (MSM)  This includes all men who identify as gay, bisexual,, occasionally/regularly have sex with men even while identifying as heterosexual.  Why, I ask, is it  this is happening?

I was fascinated with the research presented by Dr Trevor Hart, Director of the HIV Prevention Lab., Ryerson University, Ontario, Canada,  at the recent SSTAR  meeting(Society for  Sex Therapy and Research )  I attended in Toronto.
He spoke about the additive effect of multiple health problems on HIV –  and called it a “syndemic”. This means that is a syndromic epidemic, that it is the additive effect of psychosocial health problems that causes the risk taking behaviour in Men who have Sex with Men (MSM)  , and results in the high incidence of HIV/AIDS in this group of people.
If you are a MSM, come closer , listen up and share your thoughts on this research finding. Be brutally honest as you consider your psychosocial health.

In the past, HIV/AIDS  focus has been on risk reduction – condoms, condoms , condoms. People never stopped to consider the man behind the penis.  Especially the  MSM man who has a host of bothersome and troublesome emotions  and psychosocial health problems that drive him into high risk situations and make him vulnerable to HIV infections. Just because we have  a  free Constitutional pass to express our sexual orientations however and with whom  ever, does not mean that MSM people are protected In Real Life from the slings and arrow that  a still intolerant society throws at them.

Managing these slings and arrows can be exhausting, socially  isolating, depressing  and anxiety provoking. Add in some  old fashioned childhood sexual abuse, already a huge vulnerability factor for depression , drug abuse, anxiety , and partner violence ,  and the desire to escape these feelings requires lots of courage and assistance.

Bring in the firefighters, scream your brain . And so it is that drugs, sex and alcohol are needed to numb out what might feel like, difficult emotions. Add in the hassle and raw vulnerability , of condom negotiation, possible rejection- well, you can see how this   may not be  a priority when all you long for is social acceptance, anxiety free sex, and an escape from loneliness.

Now that bio medical  technologies exist, surely the incidence of HIV/AIDS will  diminish? Right? no wrong.

A study done by Trevor Hart, highlighted the psychosocial health problems and increased vulnerability to HIV/AIDS among urban MSM. Inspite of availability of Pep, PrEP, ARV’s.

Seems as if MSM have  a higher prevalence of substance abuse, partner violence, depression, childhood sexual abuse than in comparison with other community based samples of men . These health problems  in MSM are interrelated. There is a bilateral relationship with these health problems and risk of HIV Infection . In other words, there is a connection in relationships between HIV infection and partner violence, childhood sexual abuse and depression. And there is interconnection between  these three psychosocial health problems themselves.

in other words, the MSM populations experience multiple serious health problems, HIV/AIDS is only the most recognised. These named  health problems result in  increased vulnerability  to HIV infection .According to Dr Hart’s research, it  is the ADDITIVE INTERPLAY of these  psychosocial  health problems that magnifies the vulnerability of the  MSM  population to serious health conditions such as HIV/AIDS.

If you are a MSM, and  have any of these psychosocial health problems, how does it impact on your sexuality?

  • Do you take more risks?
  • Use condoms irregularly and incorrectly?
  • Depend on bio medical technology to avoid transmission ?
  • Chemsex?
  • Polydrug use.?
  • Depression ?
  • Partner violence (been stalked, verbally threatened, kicked, hit, forced to have sex,?
  • Childhood sexual abuse ?
  • Feel as if you are having disempowered sex?

According to Dr Hart the solution is to work more broadly with MSM . Health Care providers must work  in tandem with organisations addressing mental health,  partner violence  substance abuse and problems within the community., while working with sexual risk taking.  Basically he calls for a recognition of the psychosocial health problems from which MSM people  suffer.

Perhaps then there will be higher compliance to the magic of PrEP. and other bio medical technologies.

Contact me for further information .

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