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A population based estimate of the number of MSM sex-workers in Inner City Johannesburg, South Africa: implications for HIV prevention
S. Kellerman1, B. Bagnol2, Z. Fipaza3, F. Scorgie3, S. Geibel4
1Population Council, HIV and AIDS, New York, United States, 2University of Witswatersrand, Anthropology, Johannesburg, South Africa, 3Population Council, HIV and AIDS, Johannesburg, South Africa, 4Population Council, HIV and AIDS, Nairobi, Kenya
Background: MSM in Africa are disproportionately affected by HIV (22% prevalence among MSM in Dakar Senegal, 25% in coastal Kenya, 35% in Soweto, Johannesburg), are largely hidden throughout most of the continent, and many demonstrate considerable HIV risk behaviors. While greater attention has been focused on MSM populations in Africa in recent years, subgroups of MSM, such as MSM sex-workers are generally not considered in HIV prevention planning despite documented significantly higher risk behaviors amongst these men.
Methods: Using Capture-recapture (CR) methodology, we obtained a population-based enumeration of MSM sex-workers (i.e., any man who accepts money or goods in exchange for sex with another man) in inner-city Johannesburg (Hillbrow, Berea, Yeoville, Braamfontein) from April-May 2009. With a 30-member team of enumerators familiar with these neighbourhoods, we mapped areas where MSM sex-workers congregate (bars, cruising spots, parks and 2 brothels). For the CR, the team approached individuals in these areas, determined whether they were MSM sex workers, and offered a distinctive “tag” (i.e., key chain) to those who assented, on 2 separate nights, one week apart.
Results: We counted 424 (95% CI: 377-471) MSM sex-workers, 163 the first week, 141 the second week, with 88 re-captures. Most MSM sex workers were found in 28 bars, night clubs and taverns, or around 20 cruising spots in area streets and parks. Anecdotally, enumerators reported MSM sex-worker clients are non-gay identified men who want “no strings attached anonymous sexual encounters”.
Conclusions: We identified a surprisingly large population-based estimate of MSM sex-workers working in inner city Johannesburg. While we were not able to obtain behavioral information from these men, previous research suggests that HIV prevention behaviors are largely absent. This project documents the existence of an important HIV risk group in South Africa that is not currently targeted by existing HIV prevention programs.
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