African same-sex sexualities and gender diversity : a framing note

This article introduces the concept of African same-sex sexualities and gender diversity which refers to variation pertinent to gender expressions and identities, sexual expression and sexual orientation. The article describes the emerging and evolving African scholarly production evident in the last two decades and explains key underlying themes that bring together this special issue.The HIV Center for Clinical and Behavioral Researchhttps://journals.sagepub.com/home/sexhj2020Psycholog

Gender expression and mental health in Black South African men who have sex with men: further explorations of unexpected findings

Unlike studies conducted in Western countries, two studies among Black South African men who have sex with men (MSM) found no support for the association between gender nonconformity and mental distress, even though gender-nonconforming men experienced more discrimination and discrimination was associated with mental distress (Cook, Sandfort, Nel, & Rich, 2013; Sandfort, Bos, Knox, & Reddy, 2016). In Sandfort et al., gender nonconformity was assessed as a continuous variable, validated by comparing scores between a categorical assessment of gender presentation (masculine, feminine, no preference). Using the same dataset, we further explored this topic by (1) testing differences between gender expression groups in sexual minority stressors, resilience factors, and mental distress; (2) testing whether the impact of elevated discrimination in the feminine group was counterbalanced by lower scores on other stressors or higher scores on resilience factors; and (3) exploring whether relationships of stressors and resilience factors with mental distress varied between gender expression groups. Controlling for demographics, we found several differences between the gender expression groups in the stressors and resilience factors, but not in mental distress. We found no support for the idea that the lack of differences in mental distress between the gender expression groups was a consequence of factors working in opposite directions. However, internalized homophobia had a differential impact on depression in feminine men compared to masculine men. In our discussion of these findings, we explored the meaning of our participants’ self-categorization as it might relate to gender instead of sexual identities.A Grant from amfAR (106973; Principal Investigator: Theo Sandfort, Ph.D.) with additional support from a Grant from the National Institute of Mental Health (R01-MH083557; Principal Investigator: Theo Sandfort, Ph.D.).http://link.springer.com/journal/105082019-11-01hj2018Humanities EducationPsycholog

South African men who have sex with both men and women and how they differ from men who have sex with men exclusively

The label “men who have sex with men” (MSM) is used to categorize a diverse population exclusively on the basis of its sexual behavior. Understanding the diversity that this label comprises is critical for the development of health interventions that effectively reach the various populations subsumed under this label. In this cross-sectional study of South African MSM (N = 480) recruited through respondent-driven sampling (RDS), we explored differences between men who had sex with both men and women (MSMW) and men who had sex with men exclusively (MSME). We found significant differences between these two groups in terms of sexual attraction, sexual identity, sexual preferences, sexual histories, and current sexual practices. MSMW were more likely to be confused about their same-sex attraction, to experience internalized homophobia, and to have paid for sex in the previous year, while MSME were more gender nonconforming and more likely to have been forced to have sex in the previous year. These findings underscore that the MSM label comprises a diverse population and that exclusive sexual engagement with other men is a critical distinction to take into account in understanding this diversity and fully grasping the lived experiences of men who have sex with men.http://www.tandfonline.com/loi/hjsr202019-03-05hj2018Humanities EducationPsycholog

Sexual violence experiences among black gay, bisexual, and other men who have sex with men and transgender women in South African townships : contributing factors and implications for health

This study examined experiences with sexual violence among black African gay, bisexual, and other men who have sex with men and transgender women in townships surrounding Pretoria, South Africa. Of 81 gay, bisexual, and other men who have sex with men and transgender women interviewed, 17 reported to have experienced sexual violence perpetrated by other men. Qualitative analysis of interviews revealed the social and relational contexts of these experiences as well as their psychological and health consequences. The described context included single- and multiple-perpetrator attacks in private and public spaces, bias-motivated attacks, and violence from known partners. Several participants reported refusing propositions for sex as a reason for being victimized. HIV-positive individuals were overrepresented among survivors compared with the sample as a whole. Following victimization, participants described feelings of pain, fear, anger, and self-blame. The results demonstrate the need for interventions designed to (a) prevent sexual violence against gay, bisexual, and other men who have sex with men and transgender women in this population, and (b) reduce the negative psychological and health outcomes of sexual victimization. The discussion also highlights the need to examine more closely the link between experiences of sexual violence and the risk for HIV infection.An NIMH Grant (R01 MH083557; PI: Theo Sandfort, PhD) and an NIMH center Grant (P30 MH43520; PI: Robert Remien, PhD). Dr Kaighobadi was supported by an NIMH training Grant (T32 MH19139, Behavioral Sciences Research in HIV Infection; PI: Theo Sandfort, PhD).http://journals.sagepub.com/home/saphj2019Psycholog

HIV and sexually transmitted infection knowledge among women who have sex with women in four Southern African countries

Women who have sex with women in Southern Africa, where HIV prevalence is high, are often presumed to have minimal risk for sexually transmitted infections (STI) and HIV despite research documenting female-to-female transmission. This study examined the demographic and social factors contributing to female-to-female STI/HIV transmission knowledge among Southern African women who have sex with women using an integrated model of health literacy. In collaboration with community-based organisations in Botswana, Namibia, South Africa and Zimbabwe, data were collected through anonymous surveys (N = 591). Multivariable stepwise forward logistic regression assessed independent associations between participant characteristics and high vs. low knowledge using five items. Overall, 64.4% (n = 362) of women had high knowledge; 35.6% (n = 200) had low knowledge. Higher education (adjusted odds ratio [aOR]: 2.24, 95% confidence interval [CI]: 1.48, 3.40), regular income (aOR: 2.14, 95% CI: 1.43, 3.21), residence in Botswana (aOR: 3.12, 95% CI: 1.15, 8.48) and having ever received tailored STI/HIV information (aOR: 2.17, 95% CI: 1.41, 3.32) predicted significantly higher odds of high knowledge in the final multivariable model. Results suggest opportunities for peer-led sexual health programming and expanded HIV prevention campaigns addressing women who have sex with women.The Open Society Initiative for Southern Africa (PI: Vasu Reddy), with additional support from the United Nations Development Programme and the Open Society Foundations who also participated in the study. Margaret Paschen-Wolff was supported by a training grant (T32 MH019139; PI: Theodorus Sandfort) from the US National Institute of Mental Health at the HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute and Columbia University (P30-MH43520; PI: Robert Remien).http://www.tandfonline.com/loi/tchs202020-07-26hj2019Psycholog

Southern African lesbian and bisexual women responses to symptoms of sexually transmitted infections

Sexually transmitted infections (STI) in lesbian and bisexual women is a relatively unexplored topic, particularly for women from low and middle-income countries. Despite perceptions that women who have sex with women (WSW) are at negligible risk for contracting STI, existing research demonstrates that WSW do become infected with STI. Given the opposition between assumptions of invulnerability and the observed risks, we explored how WSW would respond to symptoms of STI (i.e., wait until symptoms passed, see a medical doctor, and inform sexual partners). We used data collected as part of a collaboration between academic researchers and community-based LGBTQ organizations in Botswana, Namibia, South Africa, and Zimbabwe. Chi-square tests were used to test whether participants’ responses to hypothetical STI symptoms varied in relation to several intrapersonal, interpersonal, and structural factors. Multivariable logistic regression (backward) was used to assess whether these variables were independently associated with women’s responses. Most women would be proactive in response to potential STI symptoms and would see a medical doctor. However, most women would not inform their sexual partner of symptoms of STI. Findings demonstrate several intrapersonal, interpersonal, and structural factors that influence WSW’s health agency, and show a clustering of high-risk factors among women who would not be proactive about their health. Our findings suggest the need for improved health and health care of WSW in Southern Africa.The Open Society Initiative for Southern Africa (PI: Vasu Reddy, Ph.D.), with additional support from the United Nations Development Programme, and Open Society Foundations; these organizations also participated in the study. Additional support came from a NIMH-center grant (P30-MH43520; PI: Robert Remien, Ph.D.) and a NIMH-training grant (T32-MH19139; PI: Theo Sandfort, Ph.D.).http://link.springer.com/journal/105082020-10-12hj2019Psycholog

Sexuality disclosure among Black South African MSM and responses by family

Although South Africa protects sexual orientation in its Constitution, homosexuality is socioculturally contested and unaccepted. This lack of acceptance may impact the coming-out process of men who have sex with men (MSM). This study explored diverse factors that influenced whether Black South African MSM disclosed their sexual practices and identities to their families, how their families responded, and how family responses affected them. In-depth interviews were conducted with 81 Black MSM from four Tshwane townships about their sexual and gender identities, sexual practices, social networks, and familial relationships. Interview transcripts were analyzed with ATLAS.ti using a priori codes and inductive coding. Most participants disclosed their sexual identities to at least one person in their families or assumed their families knew despite no explicit disclosure about their sexual identity; a significant minority had not disclosed. Families of those who disclosed were either supportive, in denial, confused, or unsupportive in their responses. Whether or not family was supportive, silence around the participants’ same-sex sexualities was prevalent within families. Family responses affected how participants perceived their sexuality and their confidence. Further studies are required to better understand the underlying processes of coming out for Black South African MSM and how these processes impact health outcomes and social well-being.The National Institute of Mental Health.http://www.tandfonline.com/loi/hjsr20hj2020Humanities EducationPsycholog

Breakage is the norm : use of condoms and lubrication in anal sex among Black South African men who have sex with men

This paper explores condom use and lubrication practices among Black men who have sex with men in South African townships. Results are from 81 in-depth individual interviews conducted among a purposive sample from four townships surrounding Pretoria as part of a larger qualitative study. Awareness that condoms should be used to have safer anal sex was ubiquitous. Fewer men reported that lubricants should be used to facilitate anal intercourse. Partner pressure and partner distrust were the most common barriers cited for not using condoms and lubricants. Knowledge about condom-lubricant compatibility was rare. Condom problems were a norm, with widespread expectations of condom failure. Men’s subjectivities – their perceptions of and preferences for specific brands, types and flavours of condoms and lubricants – influenced engagement with such safer-sex technologies. However, what was available in these settings was often neither what men needed nor preferred. Findings show the need to enhance access to appropriate and comprehensive: safer-sex supplies, health services and health education, and underline the importance of efforts to develop targeted programmes relevant to experiences of men who have sex with men in the South African context.Cet article examine l’usage du préservatif et les pratiques de lubrification chez les hommes noirs qui ont des rapports avec des hommes dans des townships sud-africains. Les données sont celles de 81 entretiens individuels en profondeur conduits auprès d’un échantillon ciblé de participants basés dans quatre townships entourant Pretoria, dans le cadre d’une étude qualitative de plus grande envergure. Les connaissances sur l’utilité du préservatif lors des rapports anaux à moindre risque ont été omniprésentes. Le nombre d’hommes rapportant que les lubrifiants doivent être utilisés pour faciliter les rapports anaux a été moins important. Les obstacles les plus courants à l’utilisation des préservatifs et des lubrifiants à avoir été rapportés sont la pression exercée par les partenaires et leur manque de confiance. Les connaissances sur la compatibilité nécessaire entre préservatifs et lubrifiants étaient rares. Les problèmes avec les préservatifs se sont révélés comme étant une norme, l’échec des préservatifs étant très souvent attendu. Les subjectivités des hommes – leurs perceptions et leurs préférences des/pour les marques, types et parfums des préservatifs et des lubrifiants – avaient une influence sur leur recours à ces technologies du sexe à moindre risque. Cependant, les technologies disponibles dans ces environnements n’étaient ni celles dont les hommes avaient besoin ni celles qu’ils préféraient. Les résultats montrent la nécessité de renforcer l’accès à des outils pour le sexe à moindre risque, à des services de santé et à une éducation à la santé appropriés et exhaustifs, et de souligner l’importance des efforts de mise en place de programmes ciblés tenant compte de l’expérience des hommes qui ont des rapports avec des hommes dans le contexte sud-africain.El presente artículo examina el uso de condones y las prácticas de lubricación experimentadas por hombres negros que tienen sexo con hombres en los municipios de Sudáfrica. Los resultados surgidos de 81 entrevistas individuales realizadas a partir de un muestreo intencional en cuatro municipios de las afueras de Pretoria forman parte de un estudio cualitativo más amplio. En este sentido, se constató que entre los participantes existe amplio conocimiento de que los condones deben ser usados para tener sexo anal seguro. Fueron menos los hombres que declararon que los lubricantes deben usarse para facilitar el sexo anal. Entre las razones más argumentadas para justificar el no uso de condones y lubricantes se encuentran la presión y la desconfianza de la pareja. Por otra parte, se evidenció que el conocimiento en torno a la compatibilidad entre condones y lubricantes es escaso. Los problemas que surgen a la hora de usar condones son comunes, existiendo elevadas expectativas de que estos fallarán. La subjetividad de los hombres —sus percepciones y preferencias por ciertos tipos, sabores y marcas de condones y lubricantes— inciden en sus prácticas sexuales empleando tales tecnologías de sexo seguro. Sin embargo, a menudo, en este contexto los productos disponibles no responden a lo que los hombres necesitan o prefieren. Al respecto, los hallazgos del estudio dan cuenta de la necesidad de mejorar el acceso apropiado y amplio a los productos de sexo seguro, a los servicios de salud y a la educación sobre la salud. Asimismo, las conclusiones recalcan la importancia que tiene promover la creación de programas enfocados en —y pertinentes para— las vivencias de hombres que tienen sexo con hombres en Sudáfrica.The National Institute of Mental Health [grant number P30MH43520, R01-MH083557].http://www.tandfonline.com/loi/tchs20hj2018Humanities Educatio

Safer sex intentions modify the relationship between substance use and sexual risk behavior among black South African men who have sex with men

Due to the global burden of HIV, a better understanding of the relationship between substance use and HIV risk behavior is a public health priority, particularly among populations with high rates of HIV infection. The current study explored the moderating effects of psychosocial factors on the relationship between substance use and sexual risk behavior. Among 480 black South African men who have sex with men recruited using respondent-driven sampling, a cross-sectional survey was conducted that included questions about their last sexual event that involved anal sex. Substance use was not associated with unprotected anal intercourse (UAI) (P = 0.97). The effect of substance use on UAI was modified by safer sex intentions (P = 0.001). Among those with higher safer sex intentions, substance use was positively associated with UAI (aOR = 5.8, 95%CI = 1.6–21.3, P < 0.01). This study found that among men who have sex with men with high intentions to engage in safer sex, substance use was associated with increased risky sexual behavior.https://journals.sagepub.com/home/stdhj2020Psycholog