Men who have Sex with Men (MSM) in Lesotho
Submitted by Macarena Garcia on 4 October 2012
It's been nearly two years since I've been posted to Lesotho as the USAID PEPFAR Program Director and in my time here I have heard the term 'MSM' (Men who have Sex with Men) only in passing among my Ministry counterparts. Size estimations and bio-behavioral data on Most At Risk Populations (MARP) are still lacking in Lesotho. There are several reasons for this, and although size estimations and bio-behavioral studies are in the plans for Female Sex Workers (FSW), we still know very little about other MARP groups, such as MSM. Many believe that the MSM population in Lesotho is marginal in relation to the generalized HIV epidemic in the country (standing approximately at 23%). Is that true? As I finalized my doctoral research and prepared manuscripts for consideration in inter-disciplinary peer reviewed journals I had the pleasure of communicating with a lead expert in HIV-related MARP studies, Dr. Stefan Baral from the Johns Hopkins University. According to Baral, who published the *only* study of MSM populations in Lesotho (Baral et al. 2011), it was not difficult to recruit MSM for the study. In fact, using snowball sampling the researchers accrued over 250 respondents with 75% of these reporting having a regular male sex partner. Nearly three quarters of all respondents hailed from the urban centers (cities with a population of 100,000 or more). Again, what does this mean?
MSM do exist in Lesotho, and in spite of stigma against this sub-population, they can be 'found' and recruited for studies. It also means that the MSM that do exist in Vietnam are at risk of HIV infection because a majority of those sampled in the Baral et al. (2011) study reported having a regular male sex partner. There are huge data gaps, though, that need to be filled. For instance, what is the size estimation of this population? What is the HIV and STI prevalence rate among MSM in Lesotho? What are their sexual behaviors (i.e. do they have sex with both men and women, do they wear condoms, do they have transactional sex, do they engage in multiple and/or concurrent sexual partnerships, do they have more sex partners on average than heterosexual men)?
When one of my Basotho colleagues read my recently published article on HIV prevalence and risk behaviors among MSM in Vietnam, he asked me, 'why didn't you research this same issue in Lesotho?" Although that is a valid question, the facts are that not enough data exists to actually conduct a systematic review of anything related to MSM in Lesotho. What's required are original studies on HIV and MSM in Lesotho in order to build a body of knowledge that can then be systematically reviewed and analyzed. Unfortunately, I think we are at least a decade away from a point in which enough bio-behavioral data (such as HIV prevalence and HIV-related risk behaviors) will be available to review systematically.
Macarena Garcia, USAID PEPFAR Program Director, Lesotho