May 28, 2010
Men who have sex with men (MSM) are not at greater risk of being infected with HIV through unprotected anal sexual intercourse than heterosexual couples using the same method, researchers said.
Delivering a paper on whether Africa needed a rectal microbicide Professor Salim Karim, of the Centre for the Aids Programme of Research in South Africa, said anal sex was common among MSM and heterosexual couples and that a prevention method was needed for all groups.
An anonymous survey done in Cape Town involving 2593 men and 1818 women found that 14percent of men and 10percent of women had reported anal intercourse in the past three months. Only half (50percent) of the women reported condom use during anal sexual intercourse while 67percent of men said they had used condoms.
Another study in KwaZulu-Natal revealed that 42percent of truck drivers reported anal sex with female sex workers.
Studies in other African countries showed that there was a great prevalence of bisexual relationships. A cross sectional study in Malawi found that 34,1percent of MSM reported having wives or a stable female partner while 53percent had male and female sexual partners.
These findings were similar in Egypt and Kampala, Uganda where 73,3percent and 39percent of MSM said they were bisexual respectively.
Karim cited issues such as the decriminalisation of same sex relationships in some African countries as a great challenge.
He said cases such as that of the Malawian couple that was detained for being homosexual worsened the spread of HIV. In Malawi over 21percent of MSMs are infected with HIV.
His presentation showed that MSMs were present and had a high prevalence of HIV infection in Africa. South African MSMs had a prevalence of 14percent while Kenya and Tanzania recorded 10,6percent and 12percent respectively.
In some countries unprotected anal intercourse was associated with various factors including lack of information about the high rate of transmission of HIV through unprotected anal sex, increased alcohol use and not knowing anyone with HIV.
Other findings revealed that some women and men associated anal intercourse with preventing pregnancy as opposed to vaginal intercourse.
Karim said such findings supported the need for a rectal microbicide on the continent, not only for use among MSM but also for heterosexual groups.
He said anal intercourse remained a taboo that people refrained from discussing. He added that a sex education programme in South African schools made no mention of anal sexual intercourse.
"We fought to get the sex education topic in schools and the next leap is to take anal sexual intercourse talk and get people talking about it," he said.
He said even staff in research trials found it difficult to speak to participants about anal sex.
Jim Picket, director of the International Rectal Microbicide Advocates, said in a report that there were too many dangerous misconceptions about anal sex.
"There is still massive denial that anal intercourse happens among heterosexuals. Consequently, an important driver in the global HIV epidemic remains invisible. This silence allows people to entertain dangerous misconceptions from 'anal sex is less risky than vaginal intercourse' to 'you can't get HIV from anal intercourse," said Picket. - Health-e news