Homosexuality is a reality in Africa, and the continent's leaders need to include men who have sex with men (MSM) in their national HIV programmes if they are to meaningfully reach all at-risk groups, delegates attending an HIV research conference in the western Kenyan city of Kisumu heard this week.
"We, in Africa, are living in denial about the existence of this phenomenon [men who have sex with men]," said Olive Shisana, founder of the Social Aspects of HIV/AIDS Research Alliance (SAHARA), which organised the conference. "If we deny them their rights to practice it, then they will simply go underground and continue to spread and contract the virus without HIV programmes reaching them."
She said South Africa was the only African country that recognised the rights of gays and lesbians in its constitution, which ensured that their rights, including the right to healthcare, were protected.
Some African countries, such as Kenya, have included a component for men who have sex with men in their national HIV strategies, but homosexuality remains a crime. In Kenya it is punishable by up to 14 years in prison, which keeps most of the gay community under the radar and uninformed.
Men who have sex with men are also generally still shunned by wider society. "I have heard of this habit [homosexuality], and it is unacceptable to us," said Adera Osawa, deputy secretary-general of the Luo Council of Elders, a cultural body that represents the ethnic community. "We will never accept it; we do not know about it in our culture."
However, other delegates at the conference said people who continued to deny the existence of same-sex relationships were burying their heads in the sand.
"People pretend that homosexuality does not exist in society, but it has been a reality, even within our own African cultures, for a very long time," said Serigne Mbodj, who heads a Senegalese organisation, 'And Ligeey' ('Let's work together' in the main language, Wolof), a gay rights advocacy group.
Due to the extreme stigma attached to homosexuality in African society, as many as 80 percent of gay men have relationships with women to conform to societal norms but secretly have homosexual encounters, putting more people at risk of contracting HIV. "Men who have sex with men can make a meaningful contribution to controlling HIV," Mbodj added.
Research by his organisation and Senegal's Cheikh Anta Diop University had demonstrated the risks posed to HIV programmes when gay men were not fully involved, a fact accepted in principle by the country's national HIV strategy, Mbodj said. Nevertheless, stigma was the main factor keeping gay men away.
Adult HIV infection in Africa is almost universally attributed to heterosexual transmission but, increasingly, homosexual transmission and injected drug use are being recognised as risk factors.
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