Dance music pumps from large speakers while a half dozen shirtless young men serve drinks at a bar bathed in pink light. It is the last weekend of Gay Pride in Cape Town, South Africa, and men of all ages have come to a "fetish party" to launch a safe-sex campaign, "Play Nice", targeting men who have sex with men (MSM).
Whether bound in black leather straps or attired in khakis and collared shirts, everyone here is bombarded by projected images of gay men, many nude, carrying messages about HIV, safe sex and treatment; posters with more messages liberally adorn the walls.
The campaign is run by Health4Men, a programme of the Perinatal HIV Research Unit (PHRU) of the Johannesburg-based Witwatersrand University aimed at men in underserved populations, including MSM and unemployed young men, and is the first large-scale campaign specifically geared to get HIV-related messaging to the MSM community.
The MSM community has historically had a very low profile in the HIV/AIDS conversation in Africa, despite having an HIV prevalence rate two to three times higher than the heterosexual population.
Glenn De Swardt, co-director of Health4Men and a leading expert on gay issues in South Africa, said the project could not have come at a better time. "Even though they have the information, they’re not practicing safe sex consistently - we know it and they know it - so we’re tying to make safe sex messaging sexier."
Using the internet, mobile phone technology, traditional media and direct campaigns, Play Nice hopes to reach various groups of MSM in novel, pro-sex ways that will appeal to them.
"The paradigm is sex-positive - most messaging comes from a hetero-normative paradigm. A guy hears, ’You must abstain because your sex is bad.’ Patriarchy teaches us that men penetrate, don’t get penetrated, so there’s shame there. We say, ’Let’s celebrate [MSM sex], let’s talk about it, and let’s be responsible’," said De Swardt.
Health4Men has collected a database of phone numbers, and uses techniques like sending out a bulk text message on a Friday night, reminding guys who are "playing" to bring condoms and lubricant. Later in the evening another text message might be sent, informing recipients that if they have had unsafe sex, they have 48 hours to begin post-exposure prophylaxis (PEP), and giving a number they can contact to receive treatment.
Health4Men has an office in Cape Town’s "gay village" of De Waterkant, holds seminars at gay venues, posts articles in the gay newspaper, Pink Tongue, and distributes messages in the lockers at a steam bath frequented by MSM.
A clinic for men
According to De Swardt, the average gay man in South Africa doesn’t know his HIV status. Numerous MSM say that part of the reason MSM do not go to be tested is because they are embarrassed to go to "normal" clinics.
"For the gay community, people feel embarrassed to go to the local government clinic where they are known. To have sores in your mouth or down there ... if you can go to a special clinic where you’re comfortable and won’t be discriminated against, that’s good," said Prosper Mandy at the Play Nice launch party.
Health4Men will be opening a facility at the Ivan Toms Centre for Men’s Health in the Cape Town suburb of Woodstock in the coming months. De Swardt describes it as a "male friendly" space.
"Personnel are all male, though not necessarily all gay," he said. All services will be free, and will include HIV tests, CD4 counts to measure immune system strength, viral load testing to check the quantity of HI-virus in the body, screening for sexually transmitted infections, counselling, and antiretroviral and other treatments.
Dr Kevin Rebe, an infectious disease specialist and HIV physician who will be the primary medical officer, said the clinic would adhere to all Department of Health guidelines, but would be "more holistic".
"We’re assessing sexual risk in greater detail; we are extra tailored to higher-risk populations." In addition to physical care, "we deal with psychosexual issues that really affect sexual activity, like impulsivity, sexual addiction, and the use of drugs and alcohol." Health4Men distributes free lubricants along with condoms, a vital component of safe anal sex.
De Swardt also runs support groups for HIV-positive men. "In the next three months I want to have three support groups running: one for people who have just found out their status, one for those with difficulty adjusting to it, and a third for those going into treatment."
Coming out, "out there"
Referring to the black and coloured townships around Cape Town, Prosper Mandy said: "The problem is getting the message out there to the communities. As you can see, most people here [at the fetish party] are middle- and upper-class, so the question is how to get the services out there, and how to get them to come here."
De Swardt commented: "This campaign has been designed specifically for urban ... gay men. This campaign - the way it exists now - cannot be replicated in the Cape Flats [an area of large coloured townships] or the black townships. You can’t just take a campaign from one community and drop it in another."
The current Play Nice campaign is a trial run for larger campaigns to be rolled out during the year. Health4Men has set up the process for research among the various socioeconomic groups in the black and coloured communities around Cape Town. "Based on that research, we’ll design similar campaigns, but we don’t know what they look like yet," De Swardt said.
Adiel Peters, the administrator of the Woodstock Clinic and an MSM from the Cape Flats who runs support groups for MSM in Manenberg and Bonteheuwel townships, believes that direct support to MSM in the townships is desperately needed.
"At the moment there are no services specifically around MSM in those communities. Discrimination also affects service delivery - people won’t always give you the same level of service if they have preconceived thoughts about you being gay. Sometimes MSM are not taken seriously, or are chased away," Peters said.
"MSM in my community mostly engage in spontaneous sex – it’s about meeting a guy in the street at night and deciding to have sex for a number of reasons: enjoyment, financial gains ... most are reliant on substances, so it could be an exchange for drugs or alcohol. And because it’s spontaneous they don’t have condoms and engage in barebacking," he said.
"They’re usually intoxicated, can’t even remember what they did the night before; they wake up the next morning on the side of the street or in someone’s home they don’t know, and have had sex with people they don’t know or can’t remember."
Hoping to reach those communities, De Swardt has suggested that the new campaigns attempt to avoid the stigma of being MSM by providing testing and messaging in places like pharmacies, or even hairdressing salons.
"We have more resources for the new campaigns than we’ve had for the current one - we’re investing quite heavily in this preventative thing," said De Swardt.
"It’s the first time this kind of thing - MSM, multimedia, sex-positive kind of messaging - has been done in South Africa, and a lot more money will go into the next non-Eurocentric campaigns."