Gay men or men who have sex with men in township areas like Soweto are less likely to seek health care in the public sector as a result of the inhumane treatment that they often endure at the hands of public health care workers. According to Dr Michael Laurino, clinical manager of Health4Men, a dedicated clinical and psychological service for men who have sex with men in Johannesburg, this has been documented in a few studies.

‘€œThere have been qualitative narrative surveys around their experience of accessing primary health care clinics. There’€™s clear evidence that people are subjected to prejudice, they are often ridiculed. It can be quite demeaning or humiliating disclosing one’€™s sexuality. And disclosing one’€™s sexual practices can often be met with hostility and ridicule’€, Dr Laurino says.

‘€œMSM are very wary about presenting to services and telling the health care providers that they are gay or that they are MSM. One of our participants in one of our studies said ‘€˜they treat you as a different thing’€™. They don’€™t treat them as people’€, adds Dr James McIntyre, Chief Executive Officer of Anova Health Institute, which runs the Health4Men service.

Tshepiso, a 28-year old Soweto gay man, paints a picture of a government health sector staff that is not empathetic towards gay men and their clinical needs, in particular.

‘€œPeople working there are not as welcoming. They are not as empathetic as they should be’€, says Tshepiso.

‘€œEven walls’€¦ walls are not that thick. And then you get helped by a nurse who is going to hand you over to somebody else. And closing that door, before handing you over, they are talking to themselves. And as thin as the walls are, and irresponsible of them, they talk about you and they don’€™t refer to you as ‘€˜Mr So and So’€™ who is coming for this and this. It’€™s that gay boy or that stabane that came for this. I mean, that is humiliation even if it’€™s not direct to me. But already it plays something in my emotions ‘€“ that they are talking about me and they are not referring to me respectfully as Mr So and So, but instead they are referring to me as the gay boy or that stabane that’€™s in the queue’€, he adds.

This is demonstrated in how nurses in the public sector fail to recognise that the clinical needs of gay men or men who have sex with other men are different from that of heterosexual men.        

‘€œSexually transmitted infections may present differently. If they are having anal intercourse they can get STIs that involve the rectum and anus. There are possibilities of oral STIs as well. Hepatitis is a problem that is not unique to MSM, but just because of some sexual practices and anal intercourse can be more common’€, says Anova’€™s Dr McIntyre.  

He says because of the marginalisation by health care workers, in addition to the treatment they endure from broader society, men who have sex with men often avoid seeking care when having health problems. As a result, many are depressed and end up seeking solace in substance abuse, which then places them at heightened risk of HIV infection and illness.

‘€œWe find a high rate of alcohol and drug abuse. Those are the issues that intersect with risk for HIV infection and with treatment. That can affect adherence issues; that can affect the risk of being infected, in the first place. And we are also finding in our clinical services a number of other mental health issues ‘€“ depression, things that are not really easily diagnosed in fleeting interactions with a health care worker unless they are looking out for them a bit more’€.

McIntyre says some studies suggest that HIV infection among men who have sex with men in some metropolitan areas of the country is as high as almost 40%.

‘€œThere have been rates of 33%, 40% in one study. In the Soweto men study in young gay men under the age of 25, the rates were very high. We were approaching 40%. They looked almost like the rate that you see in young women, whereas, in general, young men in South Africa have a much lower rate of HIV’€.

This suggests that public health care providers need to be sensitised and trained in order to respond to the needs of men who have sex with other men.

‘€œRaising awareness around sexual diversity, sexuality, sexual practices. Not all MSM identify as gay. Many MSM are actually in conventional heterosexual relationships, but are having sex with men on the side. So, it’€™s very important that all health care providers have an understanding of how to best manage men who have unconventional sexual practices’€, Dr Laurino says.

But while that is important, it will not happen overnight.

‘€œIt’€™s going to take a process. Some people need to go back and re-think why they became the nurses that they are. All service centres have to be client-centred. They have to take the client as something that is very important’€, says Tshepiso.