Honesty ‘best policy’ to reduce gay‚ bisexual male HIV rates
This is one conclusion from the Human Sciences Research Council's study‚ called Together Tomorrow‚ into South African and Namibian same-sex male couples.
Gay and bisexual men have a higher risk of contracting HIV through unprotected sex than straight people.
"Overseas data shows they usually get HIV within relationships‚" Together Tomorrow project leader Zaynab Essack said.
As a result‚ Essack explained that South African researchers‚ with the support of two US universities‚ the Gay and Lesbian Network and Namibian NGO Positive Vibes‚ did the first study on gay couples and HIV prevention in the region ever.
At first‚ researchers did in-depth interviews with 27 couples‚ interviewing each person separately but at the same time‚ so that they could not plan their answers together.
They then interviewed 220 couples from Namibia and South Africa with a standardised survey to ask about stigma‚ healthcare experiences‚ knowledge of HIV prevention and agreements about outside partners.
Essack explained that in the survey of 220 people‚ 78% of men reported being in monogamous relationships.
She explained that it is known overseas that some gay men have "explicit" agreements about having outside partners‚ and deciding how to use protection when choosing to have an additional partner. They may use condoms outside of the relationship.
This lowers their risk of HIV. Essack explained: "Having a conversation means we are both in agreement – and we both know whether we are protected or not."
But the study found that in South Africa and Namibia‚ when there was an explicit agreement between partners about having an extra person on the side‚ the extra partner was only allowed to be a woman.
This may be the case when one man identifies as "straight"‚ has a wife or girlfriend‚ and may have a secret relationship with his male partner.
In most cases in Namibia and South Africa‚ there was an "implicit" unspoken agreement that the relationship was monogamous‚ she said.
Partners interviewed separately sometimes gave different answers on whether the couple was monogamous or not.
Essack said couples needed to be able to talk openly about the possibility of additional sexual partners. "Developing the skill for open communication about can enhance relationships‚ trust and honesty."
There is no national figure of HIV rates in gay and bisexual men‚ but small studies show a prevalence in gay men can vary from 10% to 50%‚ she said. The prevalence of HIV among South Africans aged 15 to 49 is 17%.
Only a third of those surveyed knew that there was a preventative drug called Truvada that reduces the risk of contracting HIV by at least 90%‚ if taken daily. Only 2% of the respondents used it.
Truvada is popular among gay men in San Francisco and was the subject of court case in Britain that compelled the National Health Service to provide it.