Introduction: In many countries of Africa, same-sex practicing men are described as ‘hidden’ populations. A common interpretation of this is that it is difficult to find ways of engaging with such men, for example, when pursuing HIV-related research and interventions. Despite the fact that a number of HIV-related studies have been conducted worldwide over the past decades, until recently little had been done to study the lives and circumstances of same-sex attracted men in African settings. Recently conducted studies have indicated that the HIV prevalence in many African countries is disproportionately high among men who have sex with men compared to
other men, while HIV-related programming targeting such men is generally weak or absent. Aim: The overall aim of this study was to obtain insight into how same-sex attracted men in Addis Ababa experience and live their lives, as well as how such men think about and deal with HIV and health.
Study design: The study employed a combination of qualitative research methods.
Methods: The study’s data was collected through the use of several qualitative research methods – mainly, participant observations, dialogic interviews, group discussions, analysis of media materials and online engagement and interactions.
Findings: Men who have sex with men have been only minimally involved in public health research and interventions in Africa. Amongst the reasons for this is that such men have been regarded as hard-to-reach populations. However, this project found that such men in Addis Ababa were, on a daily basis, spending time with ‘everyone else’ in hotels, restaurants, churches, mosques, cafeterias, cinemas, streets, sporting places and at home. When a person, including a researcher (like me), decides to meet them, he/she can, and these men themselves are interested in associating with others. Same-sex attracted men in Addis Ababa have created a subculture of their own, and the social bonds that exist between such men appear to be very strong in many cases. While many men feel happy about the life interactions amongst themselves, many at the same time experience worries and stress because they cannot share the realities of their sexual lives and preferences with their family members. In addition to unhealthy feelings of worry and stress that might be associated with leading a secret sexual life, other health problems commonly raised in discussions for this study included symptoms of the anal area. Nonetheless, discussions about health more frequently came to focus on structural issues related to health care than physical or mental health problems. The lack of friendly health care for same-sex attracted men and, particularly, the fear and experience of stigma and discrimination in health-care settings, is one of the major obstacles to HIV/AIDS prevention and other health service access.
Conclusion: The study found that men who have sex with men are not, in fact, an unreachable population. Though it might not be possible to say that it is visible to everyone, the findings of this study indicate that same-sex attracted men are rather accessible for public health research efforts and interventions. Despite the presence of a criminalizing law, such men were leading an
interactive life amongst themselves and were also connected to the rest of the community in various ways. The perceived stigma and discrimination from the community and health care providers appear to contribute significantly to under-utilisation of preventative and curative health among same-sex attracted men in Addis Ababa. An inclusive and participatory public health programme amongst and in partnership with men who have sex with men could be effectively implemented using the already existing, strong networks of such men.