Exploring the factors affecting HIV prevention interventions for men who have sex with men (MSM) in Cameroon : a case study of Alternatives-Cameroun, an NGO based in the city of Douala.
Kalamar, Matthew John.
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In the global HIV/AIDS pandemic, men who have sex with men (MSM) have experienced high levels of infection. Consequently, this population is considered a crucial target for prevention, care, and treatment efforts. In sub-Saharan Africa, however, most HIV transmission occurs via heterosexual intercourse, and 60% of HIV cases are women. African HIV epidemics are thus classified as “heterosexual” phenomena, and MSM are rarely targeted by public health programming. Epidemiological studies now show that African MSM often have greater HIV prevalence than the general population. Behavioral research further indicates elevated sexual risk and low prevention-related knowledge levels among these men. Moreover, denial, stigmatization, and criminalization of male homosexual conduct across Africa have created social climates in which MSM remain “hidden,” fearing rejection or arrest. This has heightened their vulnerability to HIV infection. To counteract this trend, public health advocates call for prevention interventions adapted to the needs of African MSM. In a few countries, local NGOs have begun mobilizing around the “MSM issue.” However, little information exists about HIV prevention among MSM in sub-Saharan Africa and the associations undertaking it. Using a case study of one such association – Alternatives-Cameroun – this project aimed to explore the factors affecting design and implementation of HIV prevention interventions for MSM in Cameroon. Homosexual conduct is illegal in Cameroon, and MSM are frequently harassed and arrested. Nonetheless, Alternatives-Cameroun has launched prevention programming that reaches “hidden” MSM and addresses their unique characteristics. Through qualitative research involving stakeholder interviews and personal observation, this project found that local, national, and international factors all influence choices of intervention content and delivery formats. Interventions are designed by Cameroonian MSM, for Cameroonian MSM, but are also informed by empirical research and outreach principles drawn from other contexts. Implementation is a challenge in Cameroon’s hostile and resource-poor environment: stakeholders bear physical, emotional, and financial burdens during outreach. However, internal dynamics and foreign support help Alternatives-Cameroun mitigate these obstacles. This project reveals that understanding local realities and reinforcing multi-sectoral mobilization around MSM issues are important first steps towards launching HIV prevention interventions for MSM in sub-Saharan Africa.