Criminalisation of gay and bisexual men in Africa linked to low HIV testing rates

The results of a huge online survey of gay and bisexual men shows the damage that discriminatory laws and policies are doing to the HIV response in many African countries. 

What is the research about? 

The research looked at the link between homophobic laws, HIV policies and HIV testing rates among men who have sex with men. The findings are based on responses from 3191 gay and bisexual men in 44 sub-Saharan African countries who took part in the 2019 Global LGBTI Internet Survey. 

Why is this research important? 

Gay and bisexual men are at increased risk of HIV. A 2019 study found that HIV prevalence among men who have sex with men in sub-Saharan Africa was five times greater than HIV prevalence among men in the general population. 

Many African countries still criminalise homosexuality. And some have not adopted World Health Organization (WHO) recommendations to ensure their HIV policies include specific provisions for gay and bisexual men. 

Evidence is limited on testing rates among gay and bisexual men, and why they may be reluctant to test. This is precisely because gay and bisexual men are stigmatised, and risk arrest or abuse if they make themselves visible.  

What did they find out? 

Overall, 86% of respondents had ever tested for HIV. And 66% had tested in the last six months. These testing rates are higher than previous studies have found. This may be due to who took part in the survey. Most respondents lived in cities and had a high level of education. 

Living in a country where homosexuality was legal doubled the likelihood of ever testing for HIV. Living in a country with HIV policies targeted at men who have sex with men was linked with a two-fold increase in ever testing.  

Researchers did not find a significant link between the legal climate and/or the existence of targeted HIV policies with testing in the last six months. 

Most participants identified as gay men (71%). One quarter identified as bisexual men (24%), and one-quarter were unsure about their sexuality (25%).  

Of the 44 countries included in the study, same-sex relationships were legal in 19 (45%). Thirty-two countries (72%) had targeted interventions for gay and bisexual men in their national HIV policies. However, none included all the WHO-recommended strategies. All 32 countries provided condoms, but only 23 provided lubricant. Only 19 provided community-based counselling and testing. And only eight countries provided harm reduction. 

What does this mean for HIV services? 

Elimination of discriminatory laws and policies is essential for increasing HIV testing among gay men and other men who have sex with men. This is vital for preventing HIV infections among gay and bisexual men and their partners, which is essential for these communities and wider public health.  

An enabling legal and policy environment appears to be important for getting gay men to test at least once. But the findings suggest that the decision to test regularly may be more linked to experiences of stigma. This shows how important it is to ensure healthcare workers and community-based workers who carry out HIV testing are trained on how to treat all people with equal dignity and respect.