Free download from www.hsrcpress.ac.za Free download from www.hsrcpress.ac.za For everyone who has died of HIV and AIDS. For everyone who lives with HIV and AIDS. For everyone who works to make a difference for those living with HIV and AIDS. From Vasu, for the late Ronald Louw, my mentor, my friend and my comrade From Theo, for all women and men who relentlessly put same-sex sexuality on the African map of HIV/AIDS From Laetitia, for all the courageous researchers who dare to push the boundaries of public health and social science research Free download from www.hsrcpress.ac.za Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za First published 2009 ISBN (soft cover) 978-0-7969-2276-2 ISBN (pdf) 978-0-7969-2277-9 ISBN (epub) 978-0-7969-2295-3 © 2009 Human Sciences Research Council The views expressed in this publication are those of the authors. They do not necessarily reflect the views or policies of the Human Sciences Research Council (‘the Council’) or indicate that the Council endorses the views of the authors. In quoting from this publication, readers are advised to attribute the source of the information to the individual author concerned and not to the Council. Copyedited by Barbara Hutton Typeset by Baseline Publishing Services Cover design by Karin Miller and FUEL Design Printed by Logo Print, Cape Town, South Africa Distributed in Africa by Blue Weaver Tel: +27 (0) 21 701 4477; Fax: +27 (0) 21 701 7302 www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) Tel: +44 (0) 20 7240 0856; Fax: +44 (0) 20 7379 0609 www.eurospanbookstore.com Distributed in North America by Independent Publishers Group (IPG) Call toll-free: (800) 888 4741; Fax: +1 (312) 337 5985 www.ipgbook.com Free download from www.hsrcpress.ac.za Contents Foreword vii Messages of support viii Acknowledgements ix Introduction xi Vasu Reddy, Theo Sandfort and Laetitia Rispel Theory, methodology, context 1 Researching same-sex sexuality and HIV prevention 2 Peter Aggleton 2 Sexuality research in South Africa: The policy context 14 Robert Sember 3 Same-sex sexuality and health: Psychosocial scientific research in South Africa 32 Juan Nel 4 Homosexual and bisexual labels: The need for clear conceptualisations, operationalisations and appropriate methodological designs 51 Theo Sandfort and Brian Dodge 5 Gender, same-sex sexuality and HIV/AIDS in South Africa: Practical research challenges and solutions 58 Pierre Brouard 6 From social silence to social science: HIV research among township men who have sex with men in South Africa 66 Tim Lane History, memory, archive 7 Gay AIDS activism in South Africa prior to 1994 80 Mandisa Mbali 8 Sexing women: Young black lesbians’ reflections on sex and responses to safe(r) sex 100 Zethu Matebeni 9 Creating memory: Documenting and disseminating life stories of LGBTI people living with HIV 117 Ruth Morgan, Busi Kheswa and John Meletse Free download from www.hsrcpress.ac.za Perspectives from sub-Saharan and southern Africa 10 What we know about same-sex practising people and HIV in Africa 126 Cary Alan Johnson 11 Same-sex sexuality and HIV/AIDS: A perspective from Malawi 137 Daveson Nyadani 12 A bird’s-eye view of HIV and gay and lesbian issues in Zimbabwe 143 Samuel Matsikure 13 Epidemiological disjunctures: A review of same-sex sexuality and HIV research in sub-Saharan Africa 147 Kirk Fiereck Needs, programming, policy and direction for future research 14 Mobilising gay and lesbian organisations to respond to the political challenges of the South African HIV epidemic 168 Nathan Geffen, Zethu Cakata, Renay Pillay and Paymon Ebrahimzadeh 15 Are South African HIV policies and programmes meeting the needs of same-sex practising individuals? 176 Laetitia Rispel and Carol Metcalf 16 Lessons learned from current South African HIV/AIDS research among lesbian, gay and bisexual populations 190 Dawie Nel 17 Observations on HIV and AIDS in Cape Town’s LGBT population 198 Glenn de Swardt 18 Some personal and political perspectives on HIV/AIDS in Ethekwini 207 Nonhlanhla ‘MC’ Mkhize 19 Health for all? Health needs and issues for women who have sex with women 216 Vicci Tallis Conclusions 20 Taking research and prevention forward 228 Theo Sandfort, Vasu Reddy and Laetitia Rispel Contributors 242 Index 246 Free download from www.hsrcpress.ac.za vii Foreword To be same-sex oriented and South African, to live in the age of AIDS, and in a time of struggle for democracy, freedom and social justice is exciting, challenging, painful and often bewildering. These are some of the energies behind this book. Our Constitution proudly safeguards gay and lesbian equality, and renounces discrimination on the ground of disability. But its vaunting promises fall far short of reality in too many lives in our country. Despite constitutional protection on the ground of sexual orientation, hatred, phobia and discrimination are still rife. From the mid-1980s, as the fearsome African demography of the disease became apparent, AIDS was neither seen nor labelled as a ‘gay disease’. As a proudly and openly gay man, one who not long after my sexual coming-out had to come to terms with being infected myself, I felt some obscure relief to think that I was one in a mass heterosexual epidemic. The ‘non-gay’ shape of the epidemic would protect me, and other gay men, from the worst homophobic reactions to AIDS. And in many ways it did. But too often heterosexual predominance meant that same- sex sexuality and gender were eclipsed. In our national response, both governmental and organisational, gay people have been under-served, under-informed, and under-treated. The harm-sowing myth that homosexuality is ‘unAfrican’ has played its part in obscuring and stifling responses to the epidemic amongst gay people in Africa. The result has been a partially ‘hidden epidemic’. From Social Silence to Social Science offers important new thought and understanding. The volume raises visibility about vulnerable and marginal groups. Its varied chapters – by scholars, programme workers and activists – light the obscure corners of the epidemic, and suggest practical action. A striking feature of the volume is that its contributions address both local and continental research and programming. It is my hope that the authors’ expertise and insights, and their collation in this volume, will foster real thought and real action. The diversity of contributions is impressive, and many authors proffer important ideas. So the text is timely. We have yet a long journey ahead with same-sex equality in Africa, and perhaps an even longer journey with AIDS. This volume will, I hope, help light our way with both. Edwin Cameron Justice of the Constitutional Court of South Africa Free download from www.hsrcpress.ac.za viii Messages of support In May 2007, a varied group of sociologists, epidemiologists, social workers and HIV/AIDS activists gathered in Pretoria for a ground-breaking conference entitled Gender, Same-sex Sexuality and HIV/AIDS. The conference was jointly convened and funded by the Human Sciences Research Council (HSRC) and the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University. In an address to conference delegates, Dr Olive Shisana, president and CEO of the HSRC, emphasised that, ‘while we know the epidemic is pronounced among our heterosexual population, we also know that our lesbian and gay communities are not immune to HIV/AIDS. Over and above people who self-identify as lesbian, gay or bisexual, HIV and AIDS also impacts on men who have sex with men [MSM] and women [WSW] who have sex with women – categories of sexual practice that are often erased from studies and interventions. ‘We also know that we live in a society where prejudice runs deep about homosexuality, fuelled in part by perceived ideas about gender, belief systems, stigmatisation and socialisation. Despite the commendable Constitution of South Africa, sadly attitudes and stereotypes prevail about homosexuality and same-sex sexuality’. She concluded that ‘work on MSM and WSW in relation to HIV/AIDS is long overdue in South Africa…This conference will stimulate all of us to explore challenges and find potential solutions for research on same-sex sexual practices and HIV/AIDS’. Dr Anke Erhardt, director of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University also addressed delegates, noting that ‘while the AIDS epidemic started in South Africa as a gay epidemic, gay men disappeared from view as soon as it became clear how devastating the epidemic was going to be in the heterosexual population. These developments are understandable, but not acceptable. This event will help to increase the political attention for same-sex sexuality and HIV/AIDS’. Dr Erhardt went on to note: ‘I am pleased that the conference does not only deal with men. It is my understanding that, contrary to what usually is thought, HIV/ AIDS is a major concern for lesbian women as well. It deserves balanced attention… [This event will form] the basis for future collaborative projects, in the field of research, prevention, advocacy and policy, and ultimately contribute to the end of the HIV/AIDS epidemic and the stigma and injustice that is furthered by this gruesome epidemic…I am pleased that, with the Center’s expertise in these areas, we were able to contribute to the organisation of this conference. I would like to congratulate the organisers on the stimulating programme they were able to put together…I want you to know that the HIV Center is committed to working with you after the conference is over.’ Free download from www.hsrcpress.ac.za ix Acknowledgements Expressing thanks and appreciation should not be just an empty ritual, and because we feel it sincerely, it is not possible to make too much of it. First, we acknowledge the individual contributions of our authors who helped move From Social Silence to Social Science from the spoken text at a conference to the published version now before us. Many of the authors originally presented their papers at the conference – Gender, Same-sex Sexuality and HIV/AIDS in South Africa: An International Conference of Researchers, Community Leaders and Activists – which was held in Pretoria from 9 to 11 May 2007. As co-editors, we relied heavily on each other to carefully peer-review each contribution. We very much appreciate the patience and willingness of our contributors to revise and sometimes rewrite sections. Tim Lane in particular must be thanked for his wonderful collegiality in agreeing to us appropriating his invention as the title of this volume. We are confident that what we have assembled here is highly relevant and contributes to improving our understanding of HIV/AIDS in South and southern Africa in its complex relationship to gender and same-sex sexuality. Second, our funders were crucial to our thinking about, and implementation of, the project. In no particular order, our special thanks to Aids Fonds Netherlands, HIVOS (Humanistisch Instituut voor Ontwikkelingssamenwerking) and the Royal Netherlands Embassy in Pretoria for resources that principally funded the conference. More directly, without the generous financial support of Atlantic Philanthropies, this book would not have been published. Third, we acknowledge and appreciate the partnerships we as editors have collectively developed and strengthened, which emerged first with the conference, then with this book and subsequently with other local and internationally-driven research projects. The Human Sciences Research Council (HSRC) of South Africa, together with the HIV Center for Clinical and Behavioral Studies, Columbia University, have firmly consolidated partnerships in research. Within the HSRC we thank Dr Olive Shisana (president and CEO) for her support for the work we have embarked on through this conference, and at the HIV Center we express to the director, Dr Anke Erhardt, our appreciation for her ongoing wisdom and collegiality in strengthening our work in the field. These partnerships are also significantly consolidated through our collaboration with community partners, including OUT LGBT Well-being (Pretoria) and the Durban Lesbian and Gay Community and Health Centre. And here we thank Dawie Nel (OUT) and Nonhlanhla Mkhize for their continued support, enthusiasm and willingness to collaborate with us. Vasu would like to acknowledge the work and example of his co-editors for their personal support, friendship, patience and intellectual advice. He maintains that while the theoretical perspectives and disciplinary backgrounds of his co-editors (and the many authors in the book) may be diverse and multifaceted, the final Free download from www.hsrcpress.ac.za FROM SOCIAL SILENCE TO SOCIAL SCIENCE x manuscript demonstrates how difference can strengthen the cohesiveness of the final product. He also thanks colleagues within the HSRC (particularly staff within the Gender & Development Unit, Annette Gerber and Ella Mathobela for administrative support in the lead-up to the conference) and especially our editor at the HSRC Press for her patience and perspicacity in the editing process. Without loved ones, writing would certainly be lonely. Vasu would like to thank Sudeshan who, as always, continues to nourish with companionship, affection and support, and to inspire by example. Through all stages of this project, my father especially, and my mum, sisters and niece, and a small circle of friends provided comfort, love and advice. Theo would like to express his thanks to all people who made the conference and this book a success. It is amazing what people are able to accomplish together, when they decide that change is needed. While same-sex sexuality was virtually off the map, the conference seemed to have induced an enthusiasm about much-needed research activities. In the meantime, new contacts are made and friendship circles are built. He thanks his colleague Vasu for the deep friendship which has developed through the process. Special thanks also go to Laetitia, as co-editor, and to his colleague Robert Sember, with whom he started this journey and whose valuable insights and critical skills have helped sharpen his focus. Finally, Theo especially thanks his sometimes worrying but always supportive and proud partner Jeff. Laetitia would like to acknowledge Vasu and Theo for their comradeship, and for giving her an opportunity to climb an exciting and steep learning curve and to explore largely unchartered terrain. Thanks to Nico Jacobs for administrative support. Edward Hank is thanked for his support, wisdom and encouragement, and her children Andrew and Nadine are thanked for their understanding and the many cups of tea. Free download from www.hsrcpress.ac.za [...]... homosexual transmission to the South African epidemic? The answers to these questions lie beyond the scope of this book However, they are developed from the conference consensus that to administer any meaningful HIV intervention for same- xix FROM SOCIAL SILENCE TO SOCIAL SCIENCE sex practising populations, it is crucial to determine HIV prevalence, behavioural correlates, psychosocial contexts, sexual... we want to stress that the focus should be on vulnerable populations and the themes they represent in relation to HIV/AIDS, in order to address the absence in the South African literature and to encourage broader critical analysis of same-sex sexual practices in the context of HIV/AIDS in South Africa This brings us to the organisation of the book An overview of From Social Silence to Social Science. .. expertise of research psychologists, historians, epidemiologists, sociologists, literary scholars and so forth Our vision was to xxi FROM SOCIAL SILENCE TO SOCIAL SCIENCE reflect the perspectives of a broad range of stakeholders and to provide authors (irrespective of their background and location) a space in which to think critically about key issues pertinent to developing our understanding of the... ‘voice’ xxv FROM SOCIAL SILENCE TO SOCIAL SCIENCE Chapter 7 by Mandisa Mbali provides a detailed and cogent socio-historical analysis of how HIV/AIDS entered into a complex same-sex social and organisational world in the early 1980s in South Africa She outlines how the freer political climate in South Africa’s transition era provided spaces for advocating for non-discriminatory approaches to sexual orientation... represents an exploratory effort to examine what we know about homosexual transmission in the context of HIV/AIDS, the chapters do not provide a detailed account of everything relevant to gender, same-sex sexuality and HIV/AIDS (understandably a rather tenuous and broad relationship exists in xxiii FROM SOCIAL SILENCE TO SOCIAL SCIENCE same-sex sexuality) Rather, chapters are meant to offer both descriptive... collective history, demonstrating a process in which researchers, subjects, their histories, identities, contexts and experiences impact on the ‘new knowledge’ that emerges out of gaps identified when questions are posed This volume has such a history From Social Silence to Social xx INTRODUCTION Science: Perspectives on Same-Sex Sexuality, HIV/AIDS and Gender in South Africa is a project with its history in... rights to life, liberty and security, to health, education and work, to freedom of opinion and expression, and to freedom of thought, conscience and religion.1 Subsequent instruments, such as the International Covenant on Economic, Social and Cultural Rights, expanded the field to include reference to a wide range of economic and social rights.2 More recently, there have been growing struggles to delineate... Well-being (Pretoria) Overall, the conference had a threefold purpose: 1) to review the history of research strategies on homosexuality in South Africa and to evaluate available research pertaining to same-sex sexual practices in South Africa, in general and as it relates to HIV/AIDS; 2) to identify research needs and priorities related to same-sex sexual practices and HIV/AIDS; and 3) to explore challenges... there is a common denominator At face value, if social silence implies that homosexual transmission is absent from epidemiological studies, then the social science envisaged in this book offers a corrective to that erasure The title therefore signifies the recognition that there are shifts, movements and developments to the way knowledge is made and remade Many of our contributors persistently ask,... South xv FROM SOCIAL SILENCE TO SOCIAL SCIENCE Africa, it may be the case that there are more white men and women who have the luxury of access to private space in comparison to black men and women This does not rule out the reality that a slowly emerging black middle class has also facilitated privileged access for upwardly mobile black lesbians and gays Over and above these differences, access to resources . possible to make too much of it. First, we acknowledge the individual contributions of our authors who helped move From Social Silence to Social Science from. Pierre Brouard 6 From social silence to social science: HIV research among township men who have sex with men in South Africa 66 Tim Lane History, memory,