Public health facilities are ill-equipped to meet the needs of men who have sex with men (MSM), missing an opportunity to reduce HIV transmission, say researchers behind a new study.

The study is the first ever Southern African study looking at HIV prevention needs of male-male partnerships. The research was conducted by the Human Sciences Research Council (HSRC) in South Africa and in Namibia in partnership with the Gay and Lesbian Network in KZN and Positive Vibes in Namibia.

Respondents in the study related experiences which drove them to hide their identity or seek services elsewhere. Stigma experienced by MSM when accessing public health-care facilities may take the form of explicit discrimination, or implicit micro-aggressions.

Interviews with 27 MSM couples (16 in Namibia and 11 in South Africa), interviewed simultaneously but separately to maintain the integrity of their responses, shows clearly how negative experiences, and the fear repeating them, inhibits MSM from exercising their right to access available services intended to reduce the transmission of HIV.

Notably, the negative experience most reported was hostility and judgemental attitudes towards same-sex desire and behaviour by health-care workers. Participants suggested that inadequate sensitisation training and ignorance about creating same-sex friendly spaces or providing services appropriately was the cause.

Participants also experienced health-care facilities as ‘straight spaces’, where attitudes consistent with the assumption of heterosexuality as the norm was a barrier inhibiting MSM, without a word being spoken.

Experiences of public health-care facilities as discriminatory rather than accepting made participants feel that they needed to ‘act straight’ before they could access services or even have the courage to enter health-care facilities.

Disclosure of same-sex desire and practices to public health-care workers was low, and many reported preferring health-care services at NGOs catering for MSM, suggesting that MSM are less likely to disclose same-sex activity to public health-care workers. This in turn limits MSM’s access to services like PrEP (pre-exposure prophylaxis), screening for HIV and other STIs, and treatment for HIV. This is concerning in the fight against the HIV-transmission generally.

The researchers found that ‘queering the space’ through concerted efforts to integrate and strengthen appropriate, gender-focused curricula at tertiary level and within in-service training/orientation of civil servants, could lead to health-care being delivered more acceptingly, allowing for more inclusive, professional treatment. This could support MSM’s access to public health-care services and enhance national efforts to reduce the spread of HIV.