Disclosure decisions and HIV positive men who have sex with men (MSM) in Cape Town, South Africa

Objectives: Secrecy and concealment of either sexual orientation or HIV positive status characterizes many gay relationships in the context of homosexuality's taboo nature in many African societies. Both these characteristics have implications on safer sex behaviour. Therefore research focusing on disclosure of HIV positive status for MSM becomes important in the context of the prevention of the further spread of HIV. The primary objective of this study was to inform the adaptation and development of a risk reduction intervention for HIV positive MSM in Cape Town, South Africa. Method: Anonymous venue based surveys were collected from 92 HIV positive MSM. MSM were purposefully sampled from venues where gay men congregate as identified by HIV positive MSM key informants. 51% of the sample were 25 years old or younger, 33% described themselves as indigenous African, and the average number of years since testing HIV positive was 2.7. Results: Sixty eight of the 92 MSM living with HIV reported anal sex with more than one partner who were unaware of their HIV positive status. Almost 60% of the respondents indicated that it was difficult for them to tell other people about their HIV positive status. MSM did report experiencing discrimination (64%) resulting from being HIV positive, including loss of housing or employment (45%). Of interest is that 11% of the MSM reported that they were currently married. Whilst 36 of the 92 MSM indicated that they had unprotected vaginal sex more than once in the previous 3 months with partners who were unaware of their HIV positive status. Conclusions: Disclosure should be understood within a framework of Aids related stigma and discrimination experiences. In developing risk reduction interventions for HIV positive MSM a strong component focusing on disclosure decisions needs to be included. In addition to this structural changes for protections against discrimination are needed for HIV positive MSM in South Africa.