Meeting the Sexual Health Needs of Men Who Have Sex With Men in Senegal

Published in September 2002, this 25-page resource presents findings from a study in Senegal that investigated the needs, behaviours, knowledge, and attitudes of men who have sex with men (MSM).

This study was carried out in response to the observation that, while MSM are vulnerable to HIV and other sexually transmitted infections (STIs) (UNAIDS 1998), they receive little attention in HIV/AIDS programming and service delivery in Africa because of widespread denial and stigmatisation. Through face-to-face interactions with MSM and those close to them, the research team - the Institute of Environmental Sciences (Cheikh Anta Diop University), Senegal National AIDS Control Council (CNLS), and Horizons/Population Council - hoped to better understand the lives of MSM in Senegal so that appropriate STI/HIV interventions could be developed to meet their needs.

Available in both English and French, this resource details the research methods and findings. The researchers used ethnographic and survey methods to elicit information from MSM 18 years of age or older from several neighbourhoods in Dakar. The team recruited informants by visiting areas frequented by MSM and by making contact and building trust with MSM and MSM leaders. Informants received a small stipend to cover travel costs, information on STIs and HIV/AIDS, and a referral for a free medical consultation and treatment. In the ethnographic phase, the researchers conducted group discussions and interviews with MSM and people who interact with them, such as bartenders, female sex workers, and taxi drivers. The researchers then surveyed a convenience sample of 250 MSM.

Following this discussion of methodology, the resource presents key findings; highlights include:

• MSM have distinct identities and social roles that go beyond sexual practices - for instance, Ibbis are more likely to adopt feminine mannerisms and be less dominant in sexual interactions; Yoos are generally the insertive partner during sex and do not consider themselves to be homosexuals.
• The first sexual experience often occurs with an adult during adolescence; a third of the sample reported that the adult was part of the respondent's extended family.
• Sex with men is driven by many reasons, including love, pleasure, and economic exchange.
• The vast majority of MSM have had sex with women: 88% of the survey sample reported ever having vaginal sex, and nearly a fifth had had anal sex with a woman.
• The lives of many MSM are characterised by violence and rejection - e.g., 43% had been raped at least once outside the family home; nearly half had experienced verbal abuse from their family; and many reported physical abuse by family and community members and the police. Numerous MSM emphasised the importance of keeping sexual inclinations and relationships a secret because of the consequences of such exposure.
• Many MSM are at high risk of HIV because of unprotected sex, a history of STI symptoms, and poor knowledge of STIs. For instance, at last sex, only 23% of those reporting insertive anal sex said they used a condom (37% said they used a condom the last time they had sex with a woman); according to one informant, "If a Yoos doesn't want to use a condom, there's not much an Ibbi can say." Despite this, almost all the MSM surveyed knew that HIV/AIDS could be contracted through sexual intercourse and 80% cited condoms as a way to prevent the disease. However, when asked about the causes of penile discharge or burning (symptoms of STIs), most respondents mentioned such non-viral or bacterial causes; more than a third said they had no idea of the cause.
• Health-seeking behaviour for STI symptoms frequently involves delay and concealment due to health centre staff treating them with scorn, ignoring them completely, or failing to respect their confidentiality (MSM noted that they are particularly resistant to the idea of revealing anal symptoms because they risk exposing their homosexuality).

According to the publisher, the findings from this study were distributed at a meeting held in April 2001 in Dakar and have catalysed awareness of the public health importance of developing non-stigmatising interventions for MSM. As a result, a task force of non-governmental organisations (NGOs) and the United States Agency for International Development (USAID) Mission, under the auspices of the CNLS, was formed to develop and coordinate services for MSM in Dakar.

Click here to download the English version of the full report as a PDF document.

Click here to download the French version of the full report as a PDF document.