Men who have sex with men (MSM) are less likely to be tested or know their HIV status if they live in an African country that criminalizes same-sex behavior, according to a recent study.
The study, published in the Lancet HIV journal, found that levels of testing and HIV status awareness is significantly lower in countries with the most severe anti-LGBTQ+ legislation.
Same-sex relations are criminialized in almost two-thirds of African countries and is punishable by prison sentences or the death penalty.
In addition, stigma and discrimination toward LGBTQ+ people persist.
“Violations include blackmail, violence, reprisals from family and communities, denial of housing, health care, and access to justice,” the study finds.
While some countries such as Seychelles, Mozambique, and Lesotho have decriminalised same-sex relations in recent years, others such as Uganda and Nigeria have increased the severity of their anti-LGBTQ+ legislation. According to Human Rights Watch, Sharia penal codes in northern Nigeria criminalize “sodomy” with caning, imprisonment, or death by stoning.
In Malawi, where same-sex relations are criminalized and punishable with up to 14 years in prison, less than 1% of gay and bisexual men who are HIV-positive know their status. Human Rights Watch reported that “some medical professionals denied people services based on their sexual orientation or gender identity.”
Comparatively, in Namibia, where sodomy is criminalised but the law also not enforced, 60% of MSM who are HIV-positive are aware of their status.
According to the research, which looked at data from 28 African countries, HIV testing is on the rise among men who have sex with men, with the average percentage of MSM ever tested for HIV being 67% — an improvement of nearly 15% from before 2011. Testing rates varied greatly depending on the region, with the highest rates in southern Africa at 80%, and the lowest in northern Africa, at 34%.
Despite significant improvements related to increased HIV testing among MSM in Africa, researchers say a lack of HIV status awareness and access to antiretroviral drugs means additional efforts are needed to reach the UNAIDS 90-90-90 target amongst MSM by 2020.
The ambitious target aims for 90% of all people living with HIV to know their status, 90% of those who know their status to receive antiretroviral therapy (ART), and 90% of those who are on ARTs to have viral suppression, meaning that although HIV remains in a person’s body, it has been suppressed or reduced to an undetectable level.
“However, since levels of diagnosis and antiretroviral therapy access remain low, ART use (24%) and viral suppression (25%) among all MSM living with HIV are critically low, meaning HIV spread within these populations will continue,” the study concludes.
Dr. Kate Mitchell, a research fellow at Imperial College London who co-led the study, told the Telegraph that additional research is needed, particularly on MSM in Africa.
“It would be good to look at countries which have repealed anti-LGBT legislation to find out what difference this has made,” she said.
New research shows that despite improvements in HIV testing among men who have sex with men (MSM) in Africa, many are missing out on HIV treatment.
— Imperial College (@imperialcollege) October 8, 2019
Read more about the study, led by researchers from @ImperialSPH: https://t.co/cqXGjmaMPFpic.twitter.com/wsXTnyTwcp