Men Who Have Sex With Men Profile

In a snapshot: living life under the radar—out of fear, shame, and necessity.

According to UNAIDS, men who have sex with men (MSM) are those men who have sex with other men, regardless of whether they also have sex with women, and regardless of whether they have a personal or social identity associated with same-sex sexual behavior (such as being gay, bisexual, or transgender). Many MSM face criminalization, stigma, and abuse from all corners of society, including their own families. Many MSM trust no one, including their MSM peers, due to fear of exposure by association. Ashamed and often afraid for their safety, many turn to a life in hiding, drawing as little attention to themselves as possible to evade discrimination and violence.

MSM face discrimination, stigmatization, and violence from nearly every part of society—and often live a life of extreme secrecy as a result.

Homosexuality is widely stigmatized across sub-Saharan Africa and criminalized in many countries. 1 ^, 2 MSM also face extrajudicial threats; a 2011 report from the Kenya Human Rights Commission showed that harassment, riots, beatings, lynching, and mob justice are common, as is harassment at the hands of state officials. 3

Due to these serious risks and pressures, MSM often live in secrecy, experiencing persistent feelings of fear and self-loathing. Many want to remain invisible. 4 The 2012 Global Men’s Health and Rights study, for example, found that MSM practice secrecy in all aspects of their lives, working to keep their sexuality invisible; similarly, a series of qualitative interviews across Southern Africa in 2015 noted that many MSM marry women in order to hide their sexuality or because of familial pressure. 4 ^, 5

Secrecy makes it difficult for MSM to maintain healthy and supportive relationships. 5 Suffering silently and alone can lead MSM to internalize shame and lower their self-worth, which can manifest in depression, anxiety, and engagement in sexually risky behaviors. For MSM, it has been found that experiencing homophobic abuse is associated with a higher likelihood of being infected with HIV, which is no wonder given that the injury that MSM’s social and interpersonal relationships suffer undermines their health-seeking behaviors. 6 This was also confirmed in the 2014 UNAIDS Gap Report, which found that the fear of being identified as homosexual deters many men from accessing HIV services. 7

Despite facing discrimination from healthcare workers, MSM place a priority on their health—and are concerned about HIV.  

According to OPTIONS research conducted in 2017, 58 percent of MSM surveyed are very concerned about their health. Additionally, a high number worry about becoming infected with HIV and sexually transmitted infections—a rate on par with female sex workers. In response to these fears, many MSM practice safe sex, which they are more likely to practice than any other high-risk group. Respondents in the OPTIONS research reported the following rates of preventive practices in Kenya. 8

• Using condoms (52 percent)
• Going for regular checkups (37 percent)
• Knowing their partners’ status (33 percent)
• Taking PEP (31 percent)

MSM have a higher-than-average awareness of their own HIV risk, and stronger-than-average condom use overall (although specific countries and locations vary widely). 

While MSM in the OPTIONS research identified condoms as a key preventive measure, there is still a general need to increase condom use and consistency with this audience—and local investigation is always necessary, as MSM have different identities, motivations, and types of relationships.

A sense of “liberation” may be a resonant, motivational message for MSM to use PrEP. 

Awareness may be high for this group: The OPTIONS research found that 81 percent of MSM reported awareness of PrEP, and 84 percent of those reported knowing someone in their close circles that uses PrEP. 8 Importantly, this level of awareness may vary and should be confirmed in each context with more research. However, as the benefits of PrEP may already be well understood, there is a real opportunity to normalize the use of PrEP and encourage uptake. According to a report from a 2016 meeting on “PrEP for MSM in Africa,” the benefits of PrEP include additional security, improving overall health, and a sense of liberation. 9

A more detailed, comprehensive version of this audience profile, including the relationship between MSM and high-risk activities and sexual and reproductive health, can be downloaded here.

For a sample demand creation strategy and information on the best media and tactics to reach MSM, check out the Communications Fast Tracker.