The term men who have sex with men (MSM) is most commonly used in the public health world because, as the UNAIDS Terminology Guidelines point out, it includes men who have sex with other men “regardless of whether or not they have sex with women or have a personal or social gay or bisexual identity.” In this sense, it includes all gay- and bisexual- identified men in addition to straight- identifying men who might engage in same-sex sexual activity. The category is meaningful because of the increased risk of HIV transmission through unprotected anal intercourse. “Gay” and “bisexual” men, on the other hand, self-identify as having a romantic, emotional, sexual, or other attraction to men.
Studies done within South Africa have put HIV prevalence among MSM as low as 10% and as high as 48.2%. The wide range of estimates arise from the variety of social, racial, economic, and geographical contexts in which the studies were done, and from the variety of sampling methods used by researchers. Nonetheless, most studies point to a markedly higher prevalence of HIV among MSM than among the general male population.
Despite living in a country with one of the most progressive legal environments for sexual minorities, MSM are made more vulnerable by stigma and discrimination in their communities and in government services. In addition, stigma and discrimination contribute to adverse mental health, substance abuse, and risky sexual behaviour among MSM.
As a result, the National Strategic Plan 2012-2016 recognises MSM as a key population. Although there are already many non-governmental organisations that provide services for MSM, many areas of South Africa remain underserved. In fact, many MSM do not have access to condoms and condom-compatible lubricant. There is a pressing need for the scale-up of current efforts, for the improved distribution of prevention commodities, for the provision of pre-exposure prophylactic (PrEP) and post-exposure prophylactic (PEP) for MSM, and for improved efforts to address stigma and discrimination against MSM.