Voluntary HIV Counseling and Testing

Introduction

Since HIV was discovered in the 1980s, nations have been trying to come up with measures to prevent its spread and reduce the cases of new infections to zero. One of the ways that have been used by many governments globally is the use of voluntary HIV counseling and testing centers. A visit to the VCT’s helps one know their HIV status and therefore, one is able to plan their life accordingly.

Voluntary HIV counseling and testing can be defined as a process that involves a session of being counseled concerning HIV (Clark et al, 2008). This enables a person to be in a position to make a choice whether they would like to be tested after receiving all the needed information through counseling. According to Herbst et al (2007), the process of counseling and testing can be done to an individual or a couple. The decision on whether one wants to undergo the counseling and testing services offered at the VCT’s is entirely a personal choice. This means that one has to give their consent to undergo this process without being coerced or forced to do so. Moreover, the results of the testing process are supposed to be kept confidential and the person or people undergoing this process should be assured that the information about their HIV status will not be disclosed to anyone else.

All countries globally have diversity in terms of the people living there. One of the groups of people present in all countries is men who have sex with men. Elam et al (2008) observe that some of these men describe themselves as gay, while others simply describe themselves as heterosexual but who also have sex with other men. There are various reasons that men may choose to have sex with their fellow men. Some of the common reasons include curiosity, for mere pleasure or for financial gains, among others (Lohse et al, 2007). The environment where one is confined might also influence one to have sex with other men. Palella et al (1993) and Doll et al (1996) give the example of people in prison, who have no contact with other people in society.

In this era when AIDS is an epidemic globally, men who have sex with other men cannot just be ignored and left out in the plans to prevent the further spread of HIV. Men who have sex with other men are very significant in the fight against HIV/AIDS because they engage in anal sex, an activity that increases their chances of contracting HIV, particularly when no protection is used (De Cock et al, 2009). According to Bourne et al (2009), the risk of being infected with HIV after having unprotected anal sex is higher than that of having unprotected virginal sex. It is believed that the first case of HIV infection was identified among men who have sex with men. Throughout the years and with the rising levels of HIV infection, HIV infection rates have also been high among men who have sex with men.

This paper shall address the factors that affect men who have sex with men (MSM) to seek HIV testing. Moreover, how demographic characteristics, HIV knowledge, HIV testing attitude and risk for exposure to HIV/AIDS stigma have affected MSM to go for voluntary HIV counseling and testing shall also be addressed. Finally, the relationship between the identified factors which influence the utilization of VCT among the MSM and the number of testing histories among this group shall be discussed.

Factors influencing utilization of voluntary counseling and testing centers among men who have sex with men (MSM)

Provision of helpful HIV/AIDS-related services

Krentz et al (2005) observes that there is more to the process of voluntary HIV counseling and testing than just the counseling and the testing done to determine one’s HIV status. This is one of the vital services that help in the provision of other helpful HIV/AIDS-related services. It provides an entry point to any other services that may be required after one discovers their HIV status. This is because, services such as prevention of mother to child transmission, issuing of drugs that help to mitigate the effects of HIV to keep any opportunistic infections at bay as well as advice on the best diet among other vital services can only be offered after one has visited a VCT and is aware of their status (Lima et al, 2008).

The holistic approach is used in VCTs

According to Lee et al (1997), a visit to voluntary HIV counseling and testing centers contributes a lot to behavior change. This is because the view that VCT takes is a holistic one. Higgins et al (1991) point out that this helps in addressing all factors that may put one at the risk of contracting HIV. Since one is educated on such factors, one is able to be more careful in the dealings to avoid contracting this virus. Factors such as poverty and risky cultural practices, which are closely related to high prevalence rates of HIV are addressed. One is therefore able to take control of their lives and avoid such practices.

Use of targeted approach

In order for VCT services to be more effective in addressing the needs of the divergent groups in the society, it has been suggested that it is important for them to adopt a targeted approach in addition to the general approach that it has taken over the years (Mocroft et al, 2003). This means that they may have to change to target certain groups, depending on factors such as the HIV prevalence rate and the health-seeking behavior, among other factors in such groups (Detels et al, 2001).

Some of the groups that have lately been targeted for voluntary HIV counseling and testing include the most vulnerable young people such as those involved in drugs (especially those who inject drugs into their bodies) and the young men who have sex with men (Health Protection Agency, 2009). Prost et al (2007) point out that these have been targeted for voluntary HIV counseling and testing because their risk of contracting HIV is higher than other groups in the society. VCT services are currently being set up for these young people, whose vulnerability to HIV/AIDS infection is high due to the risk of practices they engage in as well as exposure.

In most developing countries, sex between men and other men is illegal for those under the age of eighteen. However, many men are still engaging in sexual activity with other men, something which makes them very vulnerable to HIV/AIDS infection (Eadie et al, 1999). According to Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO) (2009), young men who have sex with other men or those who are involved in sex work are particularly vulnerable to HIV infection because they may not be very comfortable to seek medical intervention in matters relating to their sexuality. Moreover, they may hesitate to seek any preventative services to help them not to be infected with the HIV virus.

The offering of confidential and anonymous services

Gallagher, Sullivan, Lansky, et al (2007) observe that one of the factors that have influenced the use of VCTs among the young men who have sex with men is the confidentiality and the anonymous services offered at these testing centers. Mahajan et al (2008) point out that due to the fear of being stigmatized, the young men who have sex with men prefer to have such services at a place where their names will not be recorded and where they are guaranteed confidentiality after being tested. This is because, one may be required to disclose some very confidential information about themselves, such as their sexuality, which they may not be comfortable disclosing to other people in the society (Ekstrand et al, 1994). In all VCTs, those offering voluntary HIV counseling and testing do not demand the name of the person who has come for the services. Instead, they prefer to use a code for identification. This is important in case further services are needed after one discovers their status (Lima et al, 2007). This means that it is hard for someone else to know who visited the VCT and what their result was.

Increase in groups demanding MSM rights

Over the years, organizations representing men who have sex with men have mushroomed everywhere and they have been very vocal on issues relating to HIV/AIDS in relation to the men who have sex with men. According to Metcalf et al (2005), this has led to increased awareness concerning HIV prevention and management among people who fall in this category. These organizations also offer services to help those who are already infected and to help in preventing further infection among those who are not yet infected but are at risk of being infected with the virus (Hamers and Phillips, 2008).

In most countries globally, men who have sex with other men live undercover. According to Fox et al (2009), such men usually suffer stigma and discrimination from the society where they reside. Sex between men in such countries is usually illegal and a crime punishable by law (Hall et al, 2008). This makes men who have sex with other men in such countries remain more vulnerable to HIV infection compared to other groups in society. Carrying HIV prevention campaigns among these groups in such countries becomes impossible, leading to higher HIV rates of infection, compared to countries where such men are not stigmatized (Granich et al, 2009). In areas where men who have sex with men are stigmatized, the HIV prevalence rate is higher than in other areas (Moore et al, 1999). This is because; men who have sex with other men have other heterosexual partners, who may not be aware of their sexual patterns. According to Do et al (2006), this means that the chances of these men contracting HIV and spreading it among their multiple sexual partners, who are both men and women are very high. Since the problem of HIV prevalence among men who have sex with men is very real, therefore, use of VCT services to help in mitigation of this problem is very essential (Van Loon et al, 2004).

The education and income level of the MSM

According to Dowsett et al (1990), the education level, as well as the income of the men who have sex with other men, is a factor that is likely to their decision to seek voluntary HIV counseling and testing. Those with low-income levels are more vulnerable to HIV infection compared to those with high income. MacKellar, Gallagher, Finlayson, et al (2007) note that low-income earners are more likely to be involved in behavior that exposes them to HIV infection easily than those with high income. Such risk behavior includes having multiple sexual partners, who may be both male and female, for financial gains (Weinhardt et al, 1999). On the other hand, those who have high income have more control over their sexual behavior because they are not motivated by any monetary gains. Those who are illiterate or semi-literate also stand a higher chance of infection by HIV than those who are very educated. Dworkin et al (2001) says that this is because of the disparity that exists in the level of education that the two groups have and their level of information concerning HIV.

Introduction of ‘safe spaces’

Introduction of places where men who have sex with other men can safely meet and discuss matters relating to their sexuality as well as how HIV has affected them has also contributed to these men seeking voluntary HIV counseling and testing (Sabin et al, 2001). These meeting places often referred to as ‘safe spaces’, have helped these men interact freely with one another and learn from one another without fear, prejudice and discrimination. It is possible for the men who have sex with other men to receive voluntary HIV counseling and testing services in these safe places (Fang et al, 2007). The awareness that they are able to receive VCT services from people who understand their needs without stigmatizing them has made the men who have sex with other men come out in large numbers to be tested for HIV. This is because, previously, when such services were unavailable, such men feared going to conventional health centers to seek any of these services.

Moreover, the knowledge that early diagnosis of HIV has a lot of benefits instead of one waiting until they are already in the AIDS stage has affected many men who have sex with men to seek voluntary HIV counseling and testing centers (Couzigou et al, 2007). Early diagnosis is very useful to the prevention of the further spread of this virus among members of this group. Men who have sex between themselves, who visit the VCT for voluntary HIV counseling and testing services exhibit lower risk behaviors compared to their counterparts who have never visited a VCT (Wolitski et al, 1997).

Online meetings among the MSM

The internet has also been a helpful tool in affecting the decision of men who have sex with other men to visit the VCT (Centers for Disease Control and Prevention (CDC), 1998). This is happening globally, hence, information about HIV-related matters among this group is being disseminated very fast and many people are able to access it. This means that the level of awareness is increasing, therefore, these men are able to make informed choices whether or not to visit the VCT (McNaghten et al, 1999). In some of the websites that are dedicated to answering any health-related issues among the men who have sex with men, there are chat services whereby a health advisor is on standby to answer any HIV-related questions among these men. This means that information regarding HIV and its prevalence among these men is no longer inaccessible (Rotily et al, 2001). Since the health advisor in the chat room is a stranger to these men, they are able to talk openly about HIV-related matters without fear of being stigmatized. When all they need to know about HIV has been clarified by the health advisor, these men are able to make informed choices about visiting the VCT. Most of them no longer fear going to be tested.

The age of MSM

The age of men who have sex with other men is also likely to influence their decision to go for voluntary HIV counseling and testing. The older men who have sex with men are more likely to visit the VCTs for HIV counseling and testing compared to the younger men. Philippe (2009) concludes that the younger men are more vulnerable to contracting HIV compared to the older men in the same group.

The race of MSM

According to Cain et al (2006), the race of men who have sex with men also influences their vulnerability to HIV infection and their choice to seek voluntary HIV counseling and testing.

Factors that Influence young adult men who have sex with men (MSM) to utilize VCT

There are a number of factors that will influence voluntary Counseling and Testing among young adult men who have sex with men (MSM). These include the following; demographic activities, HIV/ AIDS knowledge, HIV testing attitudes and risk to exposure to HIV and AIDS stigma.

Demographic characteristics

Demography is the study of the population distribution of an area in terms of gender and sexuality. Demographic distribution has a large impact on the spread of HIV among young men who have sex with men (Wealt, 2007). Gender can be defined as the socio-cultural expectations of men and women, which will largely influence the behaviors of individuals as well as the opportunities in society. Various societies will have different gender groupings, depending on their cultural practices. Sexuality, on the other hand, can be defined as the biological drive of an individual. Sexuality assumes two states, which are either male or female (Ramaiah, 2008).

Young men have been identified as the most vulnerable to the spread of HIV. The demographic distribution of an area will largely influence the spread of HIV among men who have sex with other men. Many studies show that in an area where we have many women as compared to their male counterparts, the spread of HIV among young men is quite low. This is attributed to the fact that most women do not engage in other activities, apart from sex that spread HIV. In this type of area, men would be contented with one sexual partner. This would reduce the spread of HIV to other partners (Poindexter, 2010).

In an area where the women are less than their sexual counterparts, the spread of HIV is increased. This is attributed to the fact that most young men will engage in other activities apart from sex that propagate the spread of HIV. For example, many young men will engage in unprotected anal sex with other men and they will also engage in drug injections into their veins using syringes (Nichols, 2002). The gay communities, in most cases, are seen as outcasts and most churches, governments and individuals will despise them. Young men are sexually active and in case they cannot have full sexual satisfaction from their female counterparts, they will turn to their male counterparts for anal sex.

In so doing, they are exposing themselves to the risk of contracting and spreading HIV and AIDS. Most of these gays are reported to have engaged in anal sex with at least more than two men on average. Also, some of these gay men are reported to be having female lovers. This means that on average, one gay man can spread HIV to at least three people. The gay act is an act that is despised by many, hence, the gays will involve in anal sex in secret where even the use of condoms is sometimes hard (Beckerman, 2005).

Also, these young men who have sex with other men will always engage in intravenous drug use and also sharing of drug equipment like syringes. Intravenous drug use is whereby an individual injects the drug into his bloodstream, normally through veins using a syringe (Corner & Fan, 2011). This equipment is later shared among young people and re-used over and over again. This activity increases the spread of HIV. When one member among the group has HIV, then the others will contract the virus as well and they will, later on, transmit the same to their sexual partners (Franklin et al, 2008).

Poverty also plays a great role in the spread of HIV. The demographic study is the study of the human population of an area. The demographic distribution of an area will have an impact on the economic status of a region and will in turn affect the spread of HIV (Glass & Stolley, 2009). Also, the economic status of a place is determined by the social-cultural factors of the residents. For example, a high population would mean a strain on the available human resources. As a result, the resources will not be enough to sustain the overgrowing population (Hay, 1988). The aftermath is that young people will engage in other ways of generating income in order to meet and sustain their daily demands.

According to some research, selling sex among most women is a demeaning act that undermines and lowers their dignity. Most women would not prefer to engage in selling sex as a means of income-generating. On the other hand, most young men would freely engage in selling sex as means to generate income. In most populated regions, many young men engage in anal sex with other men in order to generate income for themselves, hence increasing the spread of HIV (Hein & Fey, 1991).

In some countries, it is even a breach of law to have sex with a member of the same sex (Kuszelewicz & Lloyd, 1995). Eventually, these young men who have sex with men will contribute to the spread of HIV but in secret. There is a need to establish voluntary counseling and testing centers in areas where people are highly populated and at the same time living in abject poverty. Also, in areas where male sexuality supersedes female sexuality, more has to be done in terms of creating awareness and educating the young men on how they can still maintain their sexual satisfaction safely without engaging in sex with other men (Kalichman, 2009).

HIV/AIDS knowledge

Knowledge about HIV is of paramount importance in the efforts to combat the spread of the virus (Stockdill, 2003). Young men who engage in sex with other men do not have sufficient knowledge about how the virus is spread. Most of these young men believe that HIV can only be spread through sexual intercourse with the opposite partner (Grady, 1995). They do not have knowledge that HIV can be spread through anal sex. When someone engages in unprotected anal sex, HIV can be spread due to the tearing of the rectal mucous membrane, which is normally thin.

The reception of sperms in this area also contributes to the spread of the virus. Again, the presence of macrophages also contributes to the spread of the virus. The receptive and the insertive partners in this act are at risk of contracting the virus (Weeks & Alcamo, 2010).

Many young men who have sex with other men are also not aware that HIV can be spread through other activities like sharing of equipment such as needles and syringes. Most of these young men will always engage in drug abuse activities as the only way to utilize their time since most of them are rejected by their societies. The drug joints form an arena where these men meet (Conklin et al, 2007). When they involve in drug abuse, they use syringes to inject the drugs into their body systems.

Knowing ways through which the virus is spread is not sufficient enough to guarantee a reduction in the rate at which the virus spreads (Jayasuriya, 1988). An individual should be well equipped about ways through which the virus can be prevented. Most of these young men lack knowledge about how the virus spread can be prevented or minimized. According to the Service employees union (1986), most young men would prefer having unprotected sex with their partners rather than using a condom. They say that using a condom is a sign of infidelity and lack of trust for their partner (Singhai & Rogers, 2003).

Knowledge is power and the only way to mitigate the spread of the virus among men who have sex with fellow men is through empowering the young men with information and knowledge about the virus. This population is the population that is so influential in the spread of HIV because their effect is twofold. For example, according to project inform (1998), a man who has had sex with fellow men at one point due to pressure, may want to marry and have children. In such a case, if the young man had contracted the virus from the men he had sex with; the woman he has sex with, as well as their children, may eventually have the virus (Ruiz & Fernandez, 2006).

The lack of knowledge among these young men will largely affect the voluntary and counseling and testing activities among these young men. They need to be empowered with knowledge and information about how the virus is spread and how to prevent its spread (Pinsky & Harding, 1996).

HIV testing

If there is any dreadful thing to happen to an individual, it is the shock one gets when they have to come to terms with the fact that they are infected with HIV. Young men who have sex with other men are not an exception. According to the World Bank report (1994), most people will have fear of the unknown, the fear of whether tomorrow will ever find them alive. Men who have sex with other men knowing well the acts they have engaged themselves in will always be reluctant to seek testing services (Gagnon et al, 1997).

In their view, HIV testing is the ultimate indicator that determines whether an individual is going to live or die. To them, a positive result means death. Most of these men are not prepared to know their status and they lack adequate knowledge about the HIV testing concept (Carruth et al, 2010). They do not know that testing will enable them to know their status, which will enable them to live positively and responsibly.

According to (Baert, 1995), some of the young men who have sex with men are not willing to go for HIV testing simply because they will be discriminated and rejected by their families. They also fear losing their families and spouses (Kotin & Marklink, 2004). Some of the men, especially those who engage in sex with fellow men on a part-time basis, are unwilling to go for an HIV test. They feel that society will downgrade and look upon them as outcasts. They also feel that, once they undergo an HIV test and their spouse discovers that they are positive, their spouses would leave them (Turner, 1989).

There is, therefore, an urgent need to solidify and create HIV testing awareness among these men. They should be informed that HIV testing is not meant to victimize the person but it is a way of planning how an individual can live positively (Diclemente, 1992).

Risk for exposure to HIV and AIDS stigma

HIV and AIDS stigma refers to the discrimination, maltreatment or any attitudes directed towards people living with HIV and AIDS (Glass & Stolley, 2009). HIV and AIDS stigma to young men having sex with fellow men will basically refer to the discrimination and maltreatment directed towards men having sex with fellow men (Chrin, 2007). Men having sex with fellow men are at high risk of facing HIV stigma, considering the fact that the act of having sex with fellow men is highly considered bad and shameful.

According to (Hart & Aggleton, 1991), these young men face HIV stigma by being shunned by the family, friends and community at large. Also, they face discrimination at some service centers like hospitals and even in educational institutions. These will largely affect their psychological health (Rawlings et al, 2009).

The HIV and AIDS stigma affects these young men at a personal level and also has effects at the national level. At a personal level, the psychological depression experienced by these young men might make them avoid and be reluctant to go for voluntary counseling and testing services (Wright et al, 1998).

The relationship between the factors influencing utilization of VCT and the number of testing history among MSM

Various studies have been done to determine the prevalence of HIV infection among men who have sex with men. The Journal of the American Medical Association (2008) indicated that men who have sex with other men are at a higher risk of being infected with HIV. It also conducted a data collection exercise to establish the number of men who have sex with other men, who have undergone voluntary HIV counseling and testing and the factors that influenced them to go for the test.

One of the things that emerged from this report is that young men aged between 18 and 29 years, who were having sex with men, had a higher level of infection compared to the older men (Centers for Disease Control and Prevention (CDC), 2010). Again, most of these young men had no previous record of visiting a VCT to know their HIV status. Most of them were therefore not aware of their status. To some, it was a surprise that they were infected with the HIV virus because they were not aware. The young men who have sex with men were less likely to be aware of their HIV status because most of them do not visit the VCT for these services.

According to Futterman, Chabon and Hoffman (2000), men who have sex with men and are also drug users registered a higher number of people infected with this virus compared to the rest in this group. Peck, et al (2005) say that those who use drugs were more likely to engage in risky behavior which would lead to them contracting the virus as compared to the rest in this group who were sober all the time. Drug users were likely to engage in risky behavior such as sharing syringes for injection, in addition to the risk that they are exposed to whenever they engage in anal sex with other men (Crepaz et al, 2009). Again, since those who do not use drugs are sober all the time, they are able to actively seek helpful information about their HIV status and make informed decisions. This means that they are able to make the decision to visit the VCT for voluntary HIV counseling and testing as a result of being informed about the benefits of doing this. McCartney et al (2009) are of the opinion that knowledge of one’s status helps one to plan their life appropriately and in case one needs further medical care, they are able to access it at the right time. On the other hand, men who have sex with other men and use drugs as well may not be able to actively seek information regarding their HIV status, which includes visiting a VCT for voluntary HIV counseling and testing (Vittinghoff et al, 1999). Marks et al (2005) says that this explains why the HIV infection rate is higher among this group of people than among the rest in the same category of men having sex with men.

In terms of the social class that one belongs to, Braithwaite et al (2008) observe that high-income earners among the MSM report lower rates of infection compared to low-income earners. This trend is also replicated among the very educated and those who are not educated. Most of the low-income earners, the illiterate and semi-literate do not see the importance of going for voluntary HIV counseling and testing and continue being involved in risky behavior such as having multiple sexual partners or using drugs. One of the factors that motivate the high-income earners in this group to visit the VCT to know their HIV status is because they have health insurance.

Avert (2011) notes that HIV prevalence is higher among Blacks compared to those of other races. The majority of the blacks who are infected with this virus are under the age of 30 years. This shows that most of the black men who have sex with other men and who are under the age of 30 do not visit the VCT as often as their white counterparts in the same group do. This can partly be attributed to the fact that among most African people, men who have sex with men are usually stigmatized; therefore they choose to remain underground. They fear disclosing their sexuality because, in some countries, the act of having sex with another man is a criminal one. Due to fear, these men do not seek health services related to their sexuality from conventional health care providers. This means that even information related to HIV may not be readily available to them as it is to their counterparts, who have access to such information without being stigmatized. This probably explains why the black men having sex with fellow men may report higher levels of HIV infection compared to the whites (Louie et al, 2002). The race or ethnic background that one belongs to therefore influences the decision which men who have sex with men from these races or ethnic backgrounds make concerning whether or not to be tested for HIV.

Conclusion

Attia et al (2009) note that; men who have sex with men have the greatest risk of being infected with HIV. It is also the group that has been adversely affected by the HIV/AIDS pandemic globally. According to Marks, Crepaz and Janssen (2006), the rate of new HIV infections among the MSM is higher among the blacks aged between 13 and 18 years than among the rest of the same age in this group. The alarming rate at which the cases of new HIV infections are being reported among the MSM calls for urgent intervention in order to prevent further infections and mitigate the effects of the virus in the lives of those who have it. CDC Factsheet (2011) indicates that the number of MSM infected with HIV is almost half the total number of those living with this virus globally. Most of those who are newly infected with this virus also come from this group.

According to CDC Factsheet (2011), a great percentage of the MSM who are infected with the virus do not know their status. This conclusion was arrived at after they did a study to determine this. This was especially among the young black MSM, who were less likely to know their HIV status compared to the whites and the Hispanics. This shows the dire need for VCT services that are friendly to the MSM in order for them to willingly visit these centers to be counseled and tested.

Recommendations

• MSM in countries that criminalize sexual activity between two men is vulnerable to HIV infection than those who are in countries that recognize the rights of such men. This makes it hard or impossible for MSM to discuss with the health providers their risk in terms of engaging in sexual activity with other men. This is due to fear that legal actions may be taken against them if they disclose they disclose their status when they seek health services. Countries that do not recognize the rights of MSM should try and be tolerant to all groups within it including the MSM. Montoya et al (2005) note that this will ensure that there is a legal and social environment that promotes the enjoyment of human rights among MSM in these countries. When MSM is assured that they have state protection concerning their rights, they will be able to seek medical intervention in matters relating to their sexuality.
• To prevent further transmission of the virus, preventative measures should be encouraged. Such measures include consistent use of condoms whenever the MSM are having anal sex. According to Bhaskaran (2008), serosorting is also a useful technique that can be applied to prevent the further spread of the virus. Abel-Ollo et al (2009) define serosorting as an act of choosing sexual partners who have the same HIV status to avoid infecting one another.
• Blower et al (2000) suggest that voluntary HIV counseling and testing should be encouraged. To do this, VCTs that are friendly to the MSM should be set up. This will encourage the MSM to visit the VCTs without fear of being stigmatized.
• Adequate information concerning HIV should be disseminated to the MSM. This will help them make informed choices about their behavior and lifestyle in order to avoid being infected with the virus. In case one is infected, one is able to take the necessary measures to stay healthy. According to Adler Mounier-Jack & Coker (2009), the combined efforts between prevention and treatment that VCT services offer help in the prevention of the spread of the virus. Several methods can be used to disseminate information concerning HIV spread among the MSM. The use of the internet, especially social networking sites, should be encouraged.
• For the MSM who inject drugs into their bodies, safe injection methods should be encouraged (Smit et al, 2004). Anaya et al (2008) record that sharing of needles to inject these drugs should be discouraged. Moreover, campaigns concerning how these people can be rehabilitated to stop using drugs should be conducted. This will help to reduce the rate of infection among MSM who are drug users.
• Measures should also be taken to prevent the spread of Sexually Transmitted Infections among the MSM (The Antiretroviral Therapy Cohort Collaboration, 2008.). This is because the STIs put the MSM at a higher risk of contracting HIV.

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