A review highlights the fact that despite being a high risk group for HIV infection, homosexual men often fails to access vital services because of religious, political and social stigma.
Dr Adrian D Smith writes in the review that the HIV/AIDS community needs to take vital steps to address this crisis.
The review by University of Oxford experts also points out that an effective response to HIV/AIDS requires improved strategic information about all risk groups, including men who have sex with men (MSM).
The authors say: "African MSM bear a considerably higher burden of HIV than do other men, and draw attention to an unmet need for prevention, treatment, and care."
Using data reported between 2003-09, the authors say that HIV prevalence among African MSM is generally considerably higher than among adult men in the general population.
They further write that in some West African countries, HIV prevalence in MSM is over 10 times that estimated in the male general population.
According to them, the difference varies substantially, but prevalence in most countries studied was higher in MSM populations.
The authors say: "Important conclusions from behavioral studies of African MSM are that unprotected anal sex is commonplace, knowledge and access to appropriate risk prevention measures are inadequate, and that, in some contexts, many MSM engage in transactional sex.
Stigma, violence, detention, and lack of safe social and health resources are widely reported."
Discussing some of the challenges and misconceptions faced by the MSM community, the authors say that condoms and lubricants for safe sex are usually not available or prohibitively expensive.
They also say that messages about prevention targeted to heterosexual populations might seem irrelevant to MSM, for MSM might not consider same-sex encounters to be sex at all because this word can also infer reproduction.
The authors point out that MSM face family rejection, public humiliation, harassment by authorities, and ridicule by health workers, and most of them conceal their behavior for fear of these repercussions.
The authors conclude: "In the early 1980s, silence equals death became a rallying cry for MSM activists in the USA to draw attention to a frightening new disease that was largely ignored or denied by government officials and the general public. Nearly three decades later in sub-Saharan African the silence remains, driven by cultural, religious, and political unwillingness to accept MSM as equal members of society.
And the effect of silence is the same; the continued denial of MSM from effective HIV/AIDS prevention and care is harmful to national HIV/AIDS responses, the consequence of which is borne not only by MSM, but by everyone. The challenge now is to break that silence, recognize the problem, and begin to move forward in the development and implementation of the prevention and care programs that are so urgently needed."
The review appears in the Lancet.
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