Unreal as it may sound, Elias contracted HIV from the male partner he has been in a sexual relationship with.
He says it all began when he contracted a Sexually Transmitted Infection (STI) and visited a public health facility.
“The health worker I met told me to strip so he could see. I lay on the examination bed and heard him calling a friend to come and see ‘mwikho’ (an abomination). I was helpless because I wanted assistance,” he recalls.
But, unfortunately, all the health workers preached the word of God to him, telling him to repent.
Unfortunately, Elias and his partner tested positive to HIV but were not initiated on Antiretroviral(ARV) drugs immediately because, at that time, it was only those whose immunity (CD4 count) had gone down who were initiated on treatment.
Elias is one of the many Men who have Sex with fellow Men (MSMs) who probably contracted HIV due to low knowledge of the disease.
The findings of a study which the College of Medicine, Centre for the Development of People, and Johns Hopkins University released in 2015, titled ‘HIV Prevalence and Social Behavioral Characteristics among MSM in Seven Sites of Malawi’ indicate that most MSMs’ HIV infections remain undiagnosed.
“MSMs were less likely to know that HIV is transmitted through anal intercourse at higher rates than through vaginal sex,” reads part of the report.
According to the report, eleven per cent of the MSMs were married or cohabiting and 33 percent reported having three female partners.
Another research titled ‘HIV Prevalence, Risks for HIV Infection, and Human Rights among MSM in Malawi, Namibia, and Botswana’, published on PlosOne (medical journal) on March 26 2009 notes that MSMs are a high-risk group for HIV infection and human rights abuses in Malawi, Namibia, and Botswana.
It says concurrency of sexual partnerships with partners of both genders may play important roles in HIV spread in these populations.
“In all the three countries, MSM had more male sexual partners than female sexual partners with a mean of between 1-1.5 female sexual partners in last six months, again positively skewed.
“Active bisexual practices were common across all three countries, but again, was most common in Malawi,” reads part of the research findings.
One of the MSM peer educators based in Blantyre, (name withheld) has no kind words for public health facilities after he was ill-treated because of his sexual orientation.
“We are facing a lot of problems. I have been treated very badly and been insulted. Health workers don’t seem to understand who we are,” he said.
Since that moment, he decided to do something about it. Luckily, he was chosen to be a peer educator. He is so excited to reach out to them (MSMs) with appropriate information on STIs, HIV and safe sex.
Now his job revolves around sharing messages of HIV and STIs, giving out condoms, lubricants and encouraging MSMs to go for HIV testing.
The World Health Organisation, in a publication titled ‘HIV and Young MSMs: A Technical Brief’ of 2015 explains that the major reason for high vulnerability to HIV among this group is that unprotected anal sex carries a higher risk of transmission than vaginal sex.
Malawi Network of Aids Service Organisations Board chairperson, Maziko Matemba, says the prevalence rate among MSM is higher than in the general population due to lack of capacity and awareness of the county’s health systems to provide adequate services to the key populations.
“We need to adopt a holistic approach in dealing with epidemics that have an effect to the entire population,” Matemba suggests.
The Global Fund’s 2017-2019 modular approach (the way of organising programmatic and financial information for each grant, sorting budget lines and performance targets according to set categories) outlines comprehensive prevention programmes for MSMs.
Deputy Director of HIV and Aids in the Ministry of Health, Thokozani Kalua, says the ministry provides comprehensive prevention, care and treatment packages in an environment that all can access.
Kalua assures that high quality training in the management of STIs and other conditions is always provided, adding supervisions and mentorship exercises that ensure that healthcare workers are adhering to standards and protocols are part of this.
“Through this, healthcare workers are trained to provide care to all, without discrimination according to sex, age, sexual orientation, sexual practices, religion, among others.”
Solicitor General, Janet Banda, is on record to have said the government is receiving some pressure on the issue, hence it wants to get views of Malawians.