It’s one thing to read about HIV advocacy and prevention and another to experience it first-hand, on the ground, day to day. That’s how Brian Kanyemba experiences it. He is the research assistant at the Desmond Tutu HIV Foundation, a Mapping Pathways partner organization. A core part of Brian’s job involves traveling through South Africa’s villages and cities, talking to people about issues surrounding men who have sex with men (MSM), and what the prevalence of HIV means within this group of people. Of late, his focus has been on putting forward the “meaningfulness of Pre-Exposure Prophylaxis (PrEP)” within the South African context, especially for the MSM community. This is no easy task.
Let’s talk about sex
“South Africa is a really interesting and dynamic place,” says Brian. “We might have gay rights and rights access of services across all sexual orientations, but when you start to talk about MSM, or about PrEP as an intervention among MSM, this is faced by a huge mental wall.” This wall extends to talking about rectal microbocides as well, mostly due to the taboo against anal sex. Currently in development, rectal microbocides, or “topical PrEP”, are ARV-based products that might reduce the risk of HIV infection when used topically in the rectum during anal intercourse. These are in phase II, with an expected phase III to be carried out in Africa and possibly Cape Town (to learn more about rectal microbocides and PrEP click here and here). “No one will come forward to talk about this openly,” says Brian, “because in Africa, anal sex is associated with homosexuality, and homosexuality in Africa is not okay.”
One way Brian goes around this taboo is by using a simple game about sexual pleasure called “Mapping the Body”. While talking to people, he introduces the discussion on rectal microbicides by drawing three images on the board: a simple figure of a man, a woman, and another man. “I say, ‘Guys let’s put stars on areas where one can be sexually stimulated’,” says Brian. “You get amazing ideas from the group. And some people will say to put a star on the anal area, and then from there it is easier to link to PrEP and to introduce rectal microbocides.” By conducting a matter-of-fact discussion focused on pleasure and the body, Brian finds the group is much better able to accept the idea of rectal microbocides as a form of protection.
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