Layered stigma and HIV/AIDS: Experiences of men who have sex with men (MSM) in South Africa

Abstract

The first cases of AIDS in the Republic of South Africa were diagnosed primarily in young men who had sex with men. Although HIV has spread heterosexually from neighboring countries and established a generalized HIV/AIDS epidemic, men who have sex with men (MSM) remain according to recent evidence a significant population affected by AIDS in South Africa. Moreover, issues of homophobia, cultural definitions of masculinities, and AIDS stigma have created barriers to reaching MSM for HIV prevention, testing, and treatment services. This chapter examines the stigma and discrimination experiences of MSM within South Africa's generalized HIV/AIDS epidemic. Results from a qualitative study show a layering of stigmatization regarding homosexuality and HIV/AIDS, further complicating efforts to engage gay and bisexual men living with HIV/AIDS. Although health-care services like HIV testing and other services are freely available at public health-care facilities, research findings suggests that MSM are reluctant to access HIV prevention, treatment, care, and support services. A lack of MSM-friendly health-care facilities, combined with previous experiences of stigma and discrimination may deter MSM from seeking out health-care services. Stigma associated with having same sex desires and a fear of being HIV positive serve as barriers to making use of the available voluntary HIV testing and counseling services. In addition, stigma and discrimination experiences of MSM may impede disclosure of HIV positive status and thus lead to further transmission of HIV. From a human rights perspective, all people in South Africa who are infected with HIV should be treated with life-prolonging medications without discrimination. Reaching MSM however for the provision of testing and treatment services requires specialized attention given the invisibility of this population.