The shroud of silence and denial surrounding male sex workers in Africa has left them unable to access services addressing HIV/AIDS and their sexual health needs, researchers say.
According to a study presented on Tuesday at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), HIV/AIDS programmes targeting men who sell sex in Africa were "lagging behind", if not virtually non-existent.
Key barriers included official denial about their existence, social marginalisation and a lack of information about their needs and concerns, Aruma Chinebuah, one of the researchers involved in the study, told delegates.
The Population Council's Horizon project and the International Centre for Reproductive Health conducted the investigation, after male sex workers in Mombasa, Kenya, expressed a desire to see interventions that targeted them - and not just female sex workers.
An estimated 532 male sex workers were reported to be working in Mombasa, the study found. But this was just the tip of the iceberg, a Kenyan delegate warned.
"We need to acknowledge that men who have sex with men exist in Africa. The reality is that they are doing it, these numbers should be higher," he remarked after the presentation.
Workshops and interviews held with male sex workers revealed that the majority of this population were young males who did not consider themselves at risk of HIV/STI infection. Despite this low risk perception, the participants admitted to frequently experiencing STIs.
Moreover poor knowledge of HIV/AIDS and inconsistent condom use further increased their vulnerability.
Hostile and discriminatory attitudes from health-care workers made them reluctant to use existing health services, the report noted.
"They told us that if they were to walk into a clinic with something like anal gonorrhea, it would be the talk of the day. That is why they resorted to self-medication for STIs," Chinebuah said.
Male sex workers were also severely harassed by police, who did not respond to their complaints when their clients had sexually abused them.
Study participants called for increased community solidarity and the training of peer educators, particularly in counselling skills.
"The psychological impact of sex work, whether male or female, can definitely not be ignored. This group suffers from low self-esteem and support services need to take this into account," the International Centre for Reproductive Health's Mark Hawden pointed out.
Other recommendations made by the male sex workers involved in the study include the training of health care providers to become more sensitive to their needs, increased advocacy campaigns in the community, and similar campaigns targeting the police force.
The next step for the Mombasa study is to design an intervention project focusing on the needs of male sex workers. "To reach our target population, we must ensure that male sex workers are fully involved," Chinebuah said.
She called for "urgent and appropriate" programmes that would curb the spread of HIV/AIDS and STIs in this group.
"Male sex workers are hidden and neglected, we've got to wake up and open our eyes to the problem because it is a problem," she concluded.