New research shows link between criminalising homosexuality and HIV

What is the research about? 

Researchers looked at survey answers and HIV test results from around 8,000 gay men and other men who have sex with men. The research was done in Burkina Faso, Cameroon, Côte d'Ivoire, The Gambia, Guinea-Bissau, Nigeria, Senegal, Eswatini, Rwanda and Togo.  

Why is this research important? 

Globally, gay men and other men who have sex with men are 28 times more likely to have HIV than other men.  

This is due to many things, including criminalisation, stigma and discrimination. But most research in this area focuses on the link between HIV and stigma and/or discrimination at an individual or community level. There is less research on the impact of discriminatory laws and policies, especially in sub-Saharan Africa. 

What did they find out? 

HIV prevalence among men who have sex with men was significantly higher in countries that criminalise same-sex sexual activity. Countries with recent prosecutions and legal barriers to civil society organisations (CSOs) also had higher prevalence. 

Overall the study found that: 

• 61% of participants lived in countries that criminalise same-sex sexual acts 

• 48% lived in countries where men who have sex with men recently faced prosecution  

• 59% lived in countries that stop CSOs from registering or operating if they support men who have sex with men.  

HIV prevalence among men who have sex with men was: 

• 27.2% in countries that criminalise same-sex sexual activity, compared to 8.5% in countries that don’t 

• 31·1% in countries with recent prosecutions, compared to 9.3% in other countries 

• 26.3% in countries where CSOs face legal barriers, compared to 10·4% in countries without these barriers. 

The difference in HIV prevalence between men who have sex with men and other men was greatest in countries with homophobic laws and policies. 

Around 73% of participants had tested for HIV at least once in their lives. But only 40% of participants who tested HIV-positive through the study already knew they had HIV. This suggests regular HIV testing is low. 

The study found that HIV testing and HIV-status awareness were not linked with whether homophobic laws, prosecutions or legal barriers to CSOs existed. But the likelihood of being unaware of your HIV status was linked to legal barriers for CSOs. This suggests CSOs can play an important role in enabling men who have sex with men to take regular HIV tests. 

The study also looked at the link between stigma and HIV prevalence. Around one in three (30%) of participants experienced stigma from family or friends. Around one-quarter (26%) experienced healthcare stigma, and more than half (57%) reported general social stigma. All these forms of stigma were linked with increased HIV prevalence among men who have sex with men.  

The relationship between healthcare stigma and increased HIV prevalence was greater in countries that recently prosecuted men who have sex with men. But the relationship between general social stigma and increased HIV prevalence was not dependent on criminalisation. This suggests that stigma against men who have sex with men is likely to exist and be linked to increased HIV prevalence, whether a country decriminalises homosexuality or not. 

What does this mean for HIV services? 

This shows that decriminalising same-sex acts – or at least not enforcing homophobic laws – will make a country’s HIV response more effective. It is useful evidence for anyone doing advocacy aiming to challenge criminalisation and homophobic laws. 

But the finding that general stigma is not tied to the legal environment also shows how important it is to change mindsets about men who have sex with men and same-sex relationships, as well as pushing for legal reforms. 

The need to provide men who have sex with men with access to regular HIV testing, plus prevention and treatment services, is also essential.