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Could North Africa and the Middle East be a new hotspot for HIV in gay men?
Gus Cairns, 2012-08-10 09:40:00
HIV experts are concerned that the largely Islamic countries of the middle east and north Africa may be set to follow east and south-east Asia in seeing sharp rises in HIV infections in gay men and men who have sex with men. Studies presented at the 19th International AIDS Conference in Washington recently found relatively low HIV prevalence, but low rates of condom use in men who have sex with men (MSM).
One study from Marrakech and Agadir in Morocco found that a high proportion of men ‘never’ used condoms in anal sex with men, and in the case of Marrakech, not in vaginal sex with women either. Meanwhile, a pioneering outreach project in the more conservative environment of Cairo, Egypt, found low rates of condom use and high rates of drug injection. A third, qualitative study from Beirut in Lebanon also found low rates of condom use and found that men who were uncomfortable with their sexuality had considerably lower rates of condom use and of testing for HIV but more sex partners.
The Maghreb culture has prohibitions against homosexuality (as it does against adultery and sex work), and yet also has a history of relative tolerance of same-sex activity. It may have been protected against HIV in the past due to low background prevalence, universal male circumcision, and conservative sexual customs. However it also means that researching into men who have sex with men is fraught with difficulty. These studies therefore all featured highly selected groups of MSM, unlike the Thai study also reported at Washington.
The Morocco study recruited men by ‘respondent-driven sampling’ whereby volunteers recruited other MSM contacts; the Beirut study also did this but in addition adjusted recruitment in order to ensure a balance between over- and under-25s.
The Egyptian study was of men attending novel (for the area) HIV centres for high-risk populations and were recruited ‘deniably’. In other words, while they could be referred overtly by other MSM, they could also be referred by other groups of men who knew of the centre and who were defined in one way or another as being at high risk of HIV, such as drug injectors or taxi drivers, but disclosures of sexuality did not have to happen until participants were assured of confidentiality.
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