MSM are at particular risk for HIV acquisition and transmission for multi-factorial reasons.6 Biologically, unprotected receptive anal sex is about sixteen times more likely to transmit HIV than unprotected vaginal sex.7 This is due to the friable nature of the rectal mucosa which does not contain mucous-producing cells as compared to the thicker, self-lubricating lining of the vagina.
The vulnerability of MSM is further increased by structural factors such as a lack of funding for MSM-appropriate services, lack of specific skills training of health providers and institutionalised stigma within the public health sector. MSM patients generally avoid being identified as MSM, culminating in their elevated risk of HIV acquisition or transmission being overlooked and no counselling about the risks associated with unprotected anal sex.
Organisations such as the Anova Health Institute, through it’s innovative Health4Men project, and the Desmond Tutu HIV Foundation have been active in addressing these concerns in South Africa. In 2009 the Anova Health Institute, with support from PEPFAR/USAID, launched the first state sector clinic dedicated to MSM in the country. A further six sites have subsequently become operational across multiple provinces. Invaluable lessons have been learned through this process which will undoubtedly serve as a template for ongoing expansion of such services
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