UGANDAN AIDS activist and medical doctor, Paul Semugoma, 42, said that rectal microbicides have a potential to save the unnecessary loss of lives among men who have sex with men in Uganda and across Africa. According to a study titled, "HIV Infection among Men Who Have Sex with Men in Kampala, Uganda – A Respondent Driven Sampling Survey," it is estimated that the adult male HIV prevalence in Kampala is 4.5 per cent but the prevalence estimates among men who have sex with men (MSM) is 13.7 per cent. Most MSM still have sex with women, many are married, co-habit with women, and have biological children. MSM in Kampala appear firmly embedded in the general population.
Semugoma, who recently opened up about his sexual orientation after living in a closet for the best part of his life said that rectal microbicides are intuitive and therefore conducive to anal sex.
“The best part is that lubrication is required anyway for anal sex, and having a lube which also serves as a microbicide will help to save the lives of men who have sex with men. A lube will be fantastic because lube is always associated with penile anal sex,” said Semugoma, who is also a medical doctor.
Semugoma said that putting a rectal microbicides on the market in Uganda will be an uphill task due to the hostility against gay men in the country.
“I am a gay man; I’ve not been living openly as a gay person because the environment in my country is very hostile to people of such an orientation,” he said in an interview with Citizen News Service (CNS) at the XIX International AIDS Conference in Washington DC, US.
Semugoma said that he publicly announced his sexual orientation through a post on his Facebook wall on his forty second birthday.
“Even though I was not open about my sexual orientation, I did quite a lot of work on LGBTI related issues,” he said, adding that gay bashing is very common in Uganda. “There is a lot of gay bashing by churches and the government and you can’t talk about being gay. Police raid meetings and organisations that work with gay people are under constant threat.”
Due to the shadow of ever-present violence, gay people in Uganda live underground which means that they cannot access health and other services.
“Most gay people are closeted because of the risk of violence; it is a risk to come out because you might be lynched,” he said.
Despite the fact that HIV transmissions are high among gay men in the country, the Uganda government is in denial of the practice to the extent that anti-homosexuality bill is currently under discussion. MSM’s inadequate access to HIV and STI related services contributes significantly to the overall burden of HIV disease in Uganda.
“Historically, gay men have a high risk of HIV; this is something that we’ve known since the epidemic started – it’s an epidemiological fact, and the trend is consistent among men who have sex with men in Uganda,” said Semugoma.
“When I started working with gay men in Uganda, most of them erroneously believd that they could not get HIV through anal sex. Most of the men were using condoms with oil based lubricants.” Male condoms are not compatible with oil based lubricants and those men and women who practice anal sex need water based lubricants.
Semugoma said that the HIV prevention community in Uganda barely knew anything about the HIV transmission rates among gay men nor their specific needs to stem the spread of the epidemic and unnecessary loss of lives.
“The epidemic in Africa is characterized as sexual, and there is nothing about anal sexual, which is a big problem. It’s something that needs to be addressed,” said Jim Pickett, founding Chair of IRMA, which has been spearheading the development of rectal microbicides as a HIV prevention tool among MSM. “Creating something that is African-specific has been very key so that people know about anal sex and anal health.”
Semugoma said that it will be highly impossible for rectal microbicide research to be conducted in Uganda due to the hostility against gays.
“It will be very hard for research to be allowed; there’s research for vaginal microbicides but I’m not sure that rectal microbicides research will be allowed. What needs to happen is to mobilize the gay community and make them aware that oil based lubricants are not very safe and that rectal microbicides are currently under development so that there is something to look forward to,” he said.
(The author, born in Zimbabwe, is an Editor, a children's writer, poet, playwright, journalist, social activist and publisher. He has extensively written on health. His first published book, 'The Dream Of Stones', was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)