South Africa is a country torn by political violence, sexual violence, and HIV epidemics. Many studies have been done on South African women, dealing with rape, unwanted children, and infection by HIV. But what about the men?

From 2011 to 2012, over 9,000 sexual assaults were reported to the South African Police Services. Many go unreported each year due to the victim's fear of judgment, further threats, and ridicule. These incidences further the spread of HIV and other sexually transmitted infections in women, but when men are victimized, the same can happen.

Homosexuality is criminalized and stigmatized in many African countries. However, these men are still vulnerable to sexually transmitted infections, like HIV, and sexual violence.

In a new study, researchers worked to identify the behavior of the male homosexual population and the prevalence of HIV infections, sexual violence and the availability of help for these men should the need arise.

HIV epidemics in higher-income countries are usually prevalent in the homosexual male population. In South Africa, the male sexual behavior patterns have not been established. Researchers looked for the incidence of consensual male sexual encounters, as well as the incidences where men are sexually victimized by other men.

Out of 1,737 men studied, 97 percent of these men said they had a lifetime of same-sex sexual experiences. five percent of these men said their encounter was consensual, and 10 percent said they had been victimized. Most surprisingly, 85 percent of these men said they had a current female partner, while 30 percent said they had a current male partner. Of the 30 percent with a male partner, 80 percent also had a female partner.

When it came to the prevalence of HIV infection in these men. 17 percent of men who had had no consensual or violent sexual contact with other men had HIV. The highest prevalence of HIV occurred in men reporting consensual or committing sexual violence against another man — 35 percent of these men were HIV-positive. Similarly, of the men with strictly consensual contact with other men, 31 percent of them were HIV-positive. The HIV statuses of these men is similar to the trends observed among women. Women who are rape survivors are not more likely to have HIV; their risk is the same, owing to the lack of awareness about prevention.

It is clear from the high population prevalence in South Africa, HIV prevention efforts should target both men and women, especially given that 80 percent of men with male partners had concurrent female partners.

In the study, questions about sexual orientation were not asked, so more research must be done to identify South African patterns of attraction, sexual identity, and behavior. However, it is clear from this study about men and previous studies about women that HIV awareness and prevention is key, as well as awareness of rape and its eradication from sexual norms in South Africa.

RapeCrisisBlog, a blog run by Rape Crisis, a Cape Town women's initiative to counsel and otherwise help women who have been raped, has reported, "With the classification of South Africa as a middle income country international donors are offering much needed support to poorer African countries or indeed responding to social problems of their own. Government has not adequately gauged the extent violence against women and therefore has not allocated funds adequate to the task of delivering services at the scale that is required." Although this quote is focused on the needs of women, it is clear from the immensity of sexual violence and HIV infections among men that they need the same help as well.

With the information that the researchers have identified about South African men, decriminalization of consensual homosexual behavior will need to be the first step toward the success of any public health research or intervention in this region.

Source: Dunkle KL, Jewkes RK, Murdock DW, Sikweyiya Y, Morell R. Prevalence of Consensual Male-Male Sex and Sexual Violence, and Associations with HIV in South Africa: A Population-Based Cross-Sectional Study. PLOS Medicine. 2013.