Background to the Research: Aims and Objectives
The aim of the present study was to explore the social contexts, life experiences, vulnerabilities, and sexual risks experienced by men who sell sex in Southern and Eastern Africa, with a focus on five countries: Kenya, Namibia, South Africa, Uganda, and Zimbabwe. These issues were explored in the context of a participatory workshop and focused groups conducted with male sex workers (MSWs). Held in Johannesburg in December 2011, the workshop was underpinned by a definition of MSWs as “any man who accepts money or goods [favor, reward, value] in exchange for sex with another man” (Kellerman et al., 2009). The aim was to explore personal life stories as a way to achieve an understanding of the subjective circumstances and experiences of men who sell sex in these countries. We focused in particular on the experience of men who not only sold sex to other men but who, for the most part, self-identified with same-sex sexuality.
The work also sought to develop new and more effective means of representing MSWs through a respondent-driven approach, which included a seed/snowball method that involved follow-up work in Kenya and Namibia (Magnani et al., 2005). The MSWs who took part in the research represented different contexts on the African continent and a cross-section of personal experiences. They also were among those who might support and develop ongoing leadership for male sex workers in Africa. Against this background, our exploration included three distinct but overlapping areas:
Social contexts, including the geographic and political contexts of male sex work.
Sexual practices, including sexual activities, roles, identities, and internal and external responses to the labels designating both men who have sex with men and male sex workers, as applied popularly and in HIV prevention work.
Structural and personal risk factors, including a range of themes related to personal and social responses to male sex work within the context of marginalization and human rights violations, the absence of explicitly protective laws, HIV and AIDS, substance abuse, sociopolitical influences, family, culture and taboos, religion, stigma/prejudice, internalized phobias, and legislation.
FIGURE 12.1
African countries studied by the authors of this chapter.
Exploring these issues enabled us to develop a profile of key concerns related to understanding male sex work in the region. We specifically sought to add to the qualitative analyses of the social contexts and health-seeking practices, human rights scenarios, social and personal vulnerabilities, and HIV-related risks among men who sell sex in specific settings in the five countries. We sought specific information on male sex workers’ life stories, social vulnerabilities, and sociosexual practices and risks. It is important to note that this information represents the particular viewpoints of certain individuals and thus should not be considered an analysis or assessment of the countries represented per se but, rather, a presentation of personal views that are indicative of differences and similarities across countries in the region (Magnani et al., 2005). These viewpoints were explored in context as being relevant to the development of advocacy, representation, rights, HIV prevention, and health promotion for men who sell sex in Africa.1
Context: Sexualities, Sex Work, HIV, and Social Justice
In some African countries, sexual and gender minority peoples have, over the last few years, become more visible and vocal in claiming their legal and social rights, including rights to HIV prevention, treatment, and care. This has occurred against the background of complex and resurgent homo-prejudice and hate crimes in parts of Africa, wherein same-sex sexualities have been increasingly subject to pernicious legislation and prejudice (Okal et al., 2009). Within this broader context, the basic HIV prevention needs of the majority of men in Africa who have sex with men are typically underserved, most often because of prejudice and/or denial in many countries that such men exist, including within civil society and government bodies (Baral et al., 2009; Nguyen, 2005). Moreover, the risky sexual practices, social vulnerabilities, and prevalence of HIV among men who have sex with men remain significantly underresearched and consequently are poorly addressed in HIV prevention programming (Kellerman et al., 2009). A recent study conducted in Malawi, Namibia, and Botswana, for example, found that men who have sex with men who are over the age of 25 are more likely to be HIV positive and to practice unprotected sex than younger men in the study cohort. Moreover, they are more likely to engage in concurrent sexual relationships with men and women, significantly blurring any meaningful differentiation between what might be designated as homosexual and heterosexual life worlds and HIV epidemiologies (Baral et al., 2007; Baral et al., 2009; Fipaza, 2010; Mannava et al., 2013; van Griensven, 2007).
Research on male sex work in Africa has revealed an alarming paucity of adequate HIV knowledge and health care (Mannava, et al., 2013; Sanders, 2007). Much of the limited research to date has taken place in Kenya, where studies of male sex workers in Mombasa, for example, found that many young MSWs do not consider themselves at risk from HIV and sexually transmitted infections (STIs). Moreover, they are inclined to self-treat STIs because of prejudicial attitudes among health-care providers toward, for example, men presenting with anal STI symptoms. Police often are similarly prejudiced or hostile when men who sell sex attempt to report sexual abuse or violence. Overall, men selling sex in Mombasa were typically found to have significantly low self-esteem and to need improved counseling and psychosocial support.2 Moreover, recent research has reported an increase of sex tourism in Mombasa and of MSWs having unprotected sex with female clients.3
Research in Pretoria, South Africa, found that men who sell sex to other men are more likely to have anal sex with men than are men who have sex with other men but do not sell their sexual services (41 percent and 21 percent, respectively). Men who sell sex to other men also are far more likely to have female sex partners than other men who have sex with men (45 percent and 19 percent, respectively; Fipaza, 2010). However, the data on male sex work in Africa are among the sparsest worldwide in terms of research on HIV, sexuality, and health.
To date, much research on male sex work in Africa and elsewhere has focused on sex work as a means of survival and/or transactional sex, or as a behavior especially associated with sexual risk and HIV transmission. Such emphases have tended to diminish understanding of the nuanced motivations and life experiences of sex workers, especially the complex interrelationship between sex workers’ sexual subjectivities, their sex work practices, and their attitudes toward HIV. Focusing on these issues is particularly important in research on the experiences of men who sell sex to other men, as there often is a distinct and complex “interplay between self-realization, sexual desire, social interaction, and public health discourse” (Lorway et al., 2009) in the context of such work. For example, MSWs often may not experience a pronounced differentiation between commercial and noncommercial sexual activities if selling sex takes place, for instance, in social and sexual spaces where men who have sex with men socialize. A sense of oneself as a man who has sex with men or as a male sex worker may often overlap, as the social scenes where male-to-male sexual encounters occur may blur with the social and economic contexts of sex work. This is not to say that a similar blurring does not occur among female sex workers or in other contexts of sexual practice, but the issues described have a particular relevance for men who sell sex, especially in the African countries represented here, where social contexts for male-to-male sexual expression are often limited and prejudice toward men who have sex with men socially and men who sell sex to men is equally strong.
Subjectivities and Narratives
The social and subjective contexts of male sex work in Africa are far from straightforward, nor are they easy to characterize in any uniform or linear sense. Male sex work cannot be viewed within a narrow prism and instead must be considered first within the relevant culture and social contexts in which men who sell sex live as human beings, and second within the context of selling sex as means of earning a living, getting by, or surviving. Given this, the individual stories of male sex workers become especially important as a means to learn how such men live their lives and make sense of their experiences, risks, and vulnerabilities. We focused on the following concerns to determine how they might be relevant to improving and reconfiguring rights-oriented HIV prevention and sexual health promotion work with MSWs in Africa:
Stories of resilience and achievement. With a view toward countering associations between sex work and poverty, we sought to identify some of the positive aspects of sex work.
Subtexts and power. We sought a nuanced understanding of how the underlying difficulties sex workers face often relate to complex social contexts of power and prejudice, including masculinity, role identity, and heterosexist norms and morality that are enshrined in community and ancestral beliefs.
Sexual life worlds. We explored the subjective and social context of people’s sexual lives and the salience, or otherwise, of differentiating between sex work and sexual experiences, including identity, self-esteem, and the power of fantasy and fetish.
During the workshop discussions and activities, we also explored some of the words and labels associated with male-to-male sex, including culturally specific language and the values attached to particular words. For men who took part in the workshop, it was important to stress that, before being known in terms of any label that might designate same-sex desire or practice (men who have sex with men, sex workers, men who sell sex for financial reward, gay, moffie,4 etc.), the participants wanted to be respected as human beings outside potentially reductive associations with categories of sexuality. At the same time, participants recognized the political power that can come with being labeled a male sex worker or a man who has sex with men, which is important to most forms of organizing and collective actions in terms of rights and advocacy pertaining to the selling of sex and/or same-sex sexuality. Given this tension, during the workshop we explored participants’ attitudes toward ethical representation, and the words, terms, and language that were important to them as people involved, in one way or another, in rights-based work pertaining to sex work.
The study participants recognized the salience of different terminologies in different contexts. The term “MSM”—men who have sex with men—for example, is readily recognized as a terminology in HIV prevention work in Africa and internationally, but male sex worker, or “MSW,” is less well understood in the African context, where male sex work has been so poorly researched. “LGBTI” (and variants thereof) may be seen as generally inclusive, and it alludes to the allied politics that male sex workers often share with LGBTI individuals, which they may not share with female sex workers.5 Nevertheless, MSWs who took part in the study stressed that they often feel excluded or stigmatized by “LGBTI people” in the context of community-based organizations for sexual and gender minorities, where men who sell sex might not be welcome. As such, male sex workers often find themselves caught between differing discourses and contexts of activism, social support, and health intervention/HIV prevention; they are not always well represented in sex worker activism, although this is significantly improving in Africa; and they are not necessarily fully included in social action for sexual and gender minorities.
During the workshop, against the backdrop of these issues, we explored a number of men’s life stories, a few excerpts of which are given here. These stories might be read as revealing resilience, among other qualities, and offer some personal reflections on the experience of selling sex.
Story 1
My mother was a teacher and sent me to private schools. At the age of 12, I was invited to play netball, not knowing the game was being recorded. My father saw me on TV [and] when he arrived at home … [he] ignored me. My father told my mother that he did not have time for a “moffie dog.” While my father was out I packed my bags and ran away from home.
I started sex work (and drinking) at 13. I continued with school until I matriculated at 18. I joined the Rainbow Project to develop my leadership qualities and to work with the LGBT [community] in Namibia. I am currently busy with my law degree.
Story 2
I am from Zimbabwe. I have a son. I have a diploma in human resources by qualification but I got deeply involved in politics in my country. I had been assaulted as a political activist and had to run away. I left Zimbabwe for South Africa. I worked as a waiter, but the money was not enough to support myself and my son. A friend told me he was sleeping with men for money and it was easy cash. I struggled to imagine myself sleeping with another man.
He took me along to his clients; they bought him drinks and paid him well. He complained about me depending on him. One day I decided to try it for myself. I made sure I was drunk first and I slept with a man. He paid me well and I was so happy and excited I tried to plan what I was going to do with the money but it didn’t last. So I had to go back. I got myself drunk and had sex for money again. I didn’t think of myself as a sex worker at the time. I realized that it wasn’t too bad and earned money this way to take care of my girlfriend and son. I have joined [the Sex Worker Education and Advocacy Taskforce] as a counselor, the Desmond Tutu Foundation, and Health4Men.
Story 3
I was born in Kenya, on the slopes of Mount Kenya. I was born in a family of eight, five boys and three girls. I realized I was gay [a] long time ago. I was eight years old when I realized I like boys.
I remember years ago when I went to Mombasa. I was staying in a hotel and spoiling myself. One day I ran out of money. I went to the streets [and] met some gays and they introduced me to sex work. I also met a friend. She and I became very close. She found out she was HIV positive. When she was sick, she asked me to take care of her son. I began the legal adoption process, which took three years to successfully complete. Now I have a son I love very much. His mother passed away. I fell in love and started a life with my lover. He bought me a nice beautiful house that cost millions.
I moved to Nairobi and carried on with sex work there. I went to church; I got “saved.” Even though I was saved and highly involved in church as a choir leader, I carried on working discreetly with members of the church. I started having pastors as clients and now I only work with pastors and high-profile clients, like professors.
I dream of starting a home for children of HIV-positive parents. So far I have founded a clinic for sex workers, HOYMAS, to help young men with HIV/AIDS and STDs. I am a peer educator at Sex Workers Outreach Program.
Protestors affiliated with the Sex Worker Education and Advocacy Taskforce (SWEAT) march in a demonstration in South Africa, wearing t-shirts that read, “Stop harassing us and tackle real crime.”
Although some sex workers overcome a great deal and may become advocates for others, they may well live through a range of complex and painful experiences that have profound and lasting effects. The participants in the present work stressed the recursive relationship between sex work and their sexual and emotional lives. While men who took part in the work certainly had various strategies for delineating boundaries between commercial sex and their sexual and emotional lives more widely, many also had established enduring romantic and emotional relationships with clients that blurred the boundaries between their work, love, and emotional lives, and which disrupt any simplistic or reductive definition of male sex work.
Advocacy, Sex, and Work
The MSWs who participated in the present study compared their work with other professions, such as nursing, noting some similarities in the context of work. They identified intimacy, touch, and healing as the binding theme and often referred to sex work as a form of “therapy” for clients, who might have relationship concerns, “intimacy deficits,” and sexual preferences that could not be expressed elsewhere. They cited one key difference with many other professions—the lack of legislation, including labor and occupational health rights, around appropriate working practices for sex workers. Many of the men saw this as a good thing, as it could keep them free of surveillance and registration that might be used to control sex work. The men shared a strong desire to see sex work decriminalized, with health and human rights seen as symbiotically linked, and they shared the view that sex work is work.
Another consequence of putting restrictions on male sex work is that, if MSWs were to seek rights as sex workers, it could be difficult for activists to claim such rights if these men did not necessarily identify what they do as a profession or even conceptualize what they do as work. These issues may differ somewhat between male and female sex work, as unionization has been much weaker among male sex workers. However, in Kenya and South Africa, there is a move toward mobilizing male sex workers and their joining political movements.
The participants identified some of the strengths, weaknesses, opportunities, and threats involved in sex work and the potential for stronger advocacy among MSWs in Africa. Some characteristics of the work were understood to be both positive and negative. Fun and play, for example, were identified as a positive aspect of sex work but also a weakness and potential threat in that too much emphasis on fun or the immediate gratification of needs among some male sex workers stops them from taking sexual health and the threat of HIV seriously. Forming coalitions with other sex workers was another opportunity/potential threat in terms of competition from female sex workers, which could prejudice them toward one another and get in the way of common activism, organizing, and advocacy. This subtle view of sex work, including gender bias, highlights the need for further research on the topic and for a greater focus on HIV prevention and sex workers’ rights.
Discrimination toward male and transgendered sex workers and intercommunity hostility varies between countries, though all are influenced by sociopolitical factors, human rights movements, and other contradictory realities (Wojcicki et al., 2002). South Africa, for example, has passed laws that protect the rights of LGBTI people but are only partially effective in reducing prejudice, and they do little to protect or change attitudes toward male sex workers (Dunkle et al., 2007). Male sex workers from other countries reported working in pernicious political and religious contexts. MSWs from Zimbabwe, for example, reported some direct hostility from the Anglican Church, and men from Kenya also have experienced prejudice from religious groups, but more from people of the Islamic faith than from Christians. Some in each country have experienced xenophobia, especially migrant sex workers, including ostracism and exclusion from other sex workers.
Secrecy, Intimacy, and Power
One of the key attributes of sex workers (both male and female) is that they often keep clients’ secrets. Of course, the sex work transaction itself may be a secret, but clients also share secrets with sex workers about their lives that they do not share with others (“the unseen patron”; Sullivan & Simon, 1998), which can create a certain kind of intimacy beyond the intimacy (or otherwise) of sexual acts. This paradox holds the diverse expressions of intimacy, sexual needs, private fantasies, and especially power, as keeping secrets may give the sex worker a certain kind of power, although the client in many ways will determine the parameters of what is shared and concealed in the sex work relationship.
Male sex workers’ experiences cannot easily be classified or characterized through associations with poverty, survival sex, and HIV. The landscape of male sex work is more than a sexual transaction and is composed of powerful and intricate interactions and strategies that involve issues pertaining to masculinity, gender variances, relationships of care, and what might be thought of as unconventional liaisons. This is portrayed in the following stories:
I met one man who told me how he was not paid the night before by a client. The client also verbally abused him. He seemed traumatized and I offered to take him to a clinic for counseling. While at the clinic we took an HIV test and he found out he was HIV positive. We went to a government hospital. The nurses just stood in front of everyone and shouted out loud to the people waiting for assistance: “If you have HIV, go to room 9, TB room 12, and STD room 8.” Everyone left at that moment. (workshop participant from Nairobi)
I introduced Josh to sex work. Peter, a client I knew well, wanted a companion, and he and Josh established a serious relationship. Sometime thereafter my sister told me that Josh was sick. I decided to visit him at his house.
When I saw Josh, I could not believe what I saw. He had a gorgeous physique and it was all gone. He had found out that I was sick too and he would not talk about his health. He kept asking me if I was fine. He was so concerned about me when all I had was a cold and he was in a really bad state. Every time I asked him if he was fine he would dismiss it and claim he is fine.
Later, when I was at training, I received a message that Josh was taken to the hospital. To his last moment, he didn’t tell anyone that he was HIV positive. To go for testing he had to be accompanied by a supportive person, otherwise the clinics would not allow it. I found out that at one point Josh had sought help from my sister to go for testing, but it never happened.
I found out thereafter that Peter always refused to use a condom, so [he] intentionally infected Josh. The memories of leaving the HIV course, introducing Josh to Peter, Josh refusing to talk to me about it [is] still on my mind. (workshop participant from Windhoek)
The present study focused on understanding sex workers’ life experiences beyond cultural labels or stereotyping, or accounts of risk practices or vulnerabilities, and toward a more personal, psychosocial view of research participants as people engaged in their own worlds who address risk and vulnerability in their own lives and the lives of others in complex ways. Male sex workers (and sex workers in general) not only sell sex but also are involved in nuanced relationship trajectories of power, intimacy, and control with their clients and other stakeholders, such as health-care providers and police, which can result in exclusion, for example, from mainstream health services and orthodox routes to social justice. MSWs may be the bearers of secrets, which can empower them but also limit them; for example, if a sex worker reveals secrets about clients, he will likely lose them.
In-Country Work
After the initial workshop, we followed up with MSWs in two of the five countries, Kenya and Namibia. The purpose of this aspect of the research was to find out more about the lives of male and transgendered sex workers from their own points of view as the initial stage of a longer-term strategy to develop new research conducted for and by sex workers in Africa. It also was intended to inform and improve representation of male and transgendered sex workers in regional bodies, such as ASWA, and within national HIV prevention and rights-based action groups.
We spent time working with local MSW activists, socializing in bars, cruising areas where men work, and conducting interviews, informal discussions, and so on with men who sell sex. These activities took place within a six-month period and focused on seven questions, each one having an underlying hypothesis. Here we present some overarching themes that emerged from these enquiries, which explored some core questions.
How did you get into sex work?
The majority of the research participants in both Nairobi and Windhoek used the word “introduced” to describe how they got into sex work, the introductions having been made by an older person, in many instances a male or female sex worker, in the context of clubs, bars, and shebeens (township pubs). Some respondents had also introduced others to sex work:
I have introduced a few people to sex work. One of them was a 22-year-old boy, John. I recommended clients to him and told clients about him. John was bright, outspoken, and attractive. We became good friends and [had] a close relationship. He was one of my best friends. (respondent from Windhoek)
Some research participants described financial/transactional rewards as the motivation for doing sex work, and one transgendered sex worker in Namibia spoke of early teenage sexual experiences in which a form of barter took place—in this case, sex in exchange for the necessities of home. An overarching theme was that sex work is bound up with self-realization and familial rejection and/or community hostility due to same-sex sexuality. Most study participants revealed that they came to understand themselves as being attracted to men in their late teenage years and that this catalyzed a move away from the natal family, either because they were rejected or as a matter of choice, although this “choice” may have been made under constrained circumstances, given the lack of opportunity for sexual expression, familial pressure to marry, and so on. One respondent from Kenya mentioned his family chaos and explained that running away from home took him into the streets, where he quickly “learned the trade, specifically becoming apprenticed to mature and experienced female sex workers.” Many have completely severed family ties, but some maintain contact with their families, including visits home. Indeed, some maintain heterosexual marriages, although their wives and children typically live in other towns.
The participants commonly reported that they took up sex work as a means of survival in the absence of any other way to earn a living. In discussions with MSWs in Nairobi and Windhoek, the men reported that they had entered sex work primarily as a way to earn a living. However, most also said that it was a form of self-expression and a context within which self-understanding as someone who is attracted to their own sex can be explored and consolidated. Sex work thus offers these men a way to “be oneself” on a profound level; indeed, participants often described the selling of sex as inseparable from a sense of themselves as sexual in any terms. This is not to sanitize sex work as a positive construct of self-realization. In fact, most respondents reported that the work could be hard and in some ways alienating; for example, for some it exacerbates a sense of difference and disconnection from their families, partners, and peers. Nevertheless, for many participants, the selling of sex also engenders a sense of freedom and existential choice, even as it might also be bound up with a sense of abjection and low self-esteem. Such feelings were closely linked to the experience of same-sex attraction and the complexities pertaining to self-actualization in a hostile and “homo-prejudiced” society.
What has sex work brought into your life?
The study participants have mixed feelings and experiences related to sex work, given their complex reasons for entering sex work in the first place. Earning money was a significant and obvious reason, even if attenuated by other motives and factors, but the relationship to money earned doing sex work is far from straightforward. Some men reported that money earned in this way came and went quickly, in part because sex work costs money—to buy clothes, drinks in bars, etc.—in order for sex workers to look attractive and hang out in places where they might meet clients, as well as some private spaces. Lack of privacy and geographic spaces added to this burden, as several sex workers described the mobility of their work, which took them from one location to another. Moreover, sex workers do not always feel good about or take ownership of the money they earn this way, so spending it on clothes, having a good time, etc., acts a strong antidote or form of self-pleasuring to mitigate any sense of debasement, humiliation, shame, or pain they might experience.
Given the commercialization of “gay” and transgendered spaces—for example, particular bars in large cities—self-expression through consumption is an intimately interconnected facet of life as a sex worker and as a sexual and/or gender minority person. Research participants regarded sex work as both a positive and negative life attribute within this context, as something that might allow a certain kind of freedom but also could be a restraint. The majority reported that sex work keeps them “ticking over financially”—that is, they earn enough money to live on, pay rent, drink, use substances, and generally get by, but that is essentially it. Few had any savings, and most admitted to having periods of financial insecurity; for example, when clients were scarce and they couldn’t pay the rent. Sex work brings significant insecurity into the participants’ lives, and many were worried about the future. Immediate gratification and the constitutional illegitimacy of sex work created a sense of a foreshortened future.
Some participants were acutely conscious that sex work is an age-limited profession; for many, clients certainly became harder to find once they entered their late twenties and early thirties. This is especially so because the majority of male sex work in Kenya and Namibia, as perhaps elsewhere in Africa, is oriented around youthful, sexually attractive boys/men/transgendered people. Models of the macho older male sex worker exist, usually as a symbol of patriarchy and monetary power, but they are not as prevalent in terms of sex work among men. A key attribute of sex work, then, is anxiety about what happens after sex work—that is, what to do upon leaving the profession, often with no savings or socially recognized work skills or experience that corresponds to the labor needs of the given country, even if a person who sells sex actually has these skills.
Where do you feel most at home?
Despite their many stories of family rejection, some sex workers still live with their birth families. Whether they feel at home there is another matter. Many say it is difficult to achieve a sense of belonging or of “being at home” wherever they live, given the stigmas of both their sexuality and the sex work profession. The study participants say they feel at home with fellow male and transgendered sex workers, and sometimes with other LGBTI people, as a kinship of choice and commonality; however, LGBTI people sometimes reject them due to their sex work and social status. Being “at home” with other sex workers is manifested, for example, in the way they look out for one another when working on the street. This relationship of care often includes female sex workers, although in some contexts there is strong rivalry and mistrust among female, male, and transgendered sex workers.
Participants reported that maintaining a home could be complex. The majority typically rent small rooms in poorer neighborhoods, where neighbors gossip when they bring boyfriends or clients home; indeed, many avoid bringing clients to their homes for this reason. A number say they have moved frequently, often to escape escalating gossip and neighborhood hostility, or because they can’t pay the rent. Some do maintain good neighbor relations by being polite, congenial, etc. Home provides these men a haven, a safe place to return to after an evening of exposure and potential risk on the streets, in the bars, and in clients’ rooms or cars—even if home is just a rented room.
Sex workers’ feelings about home are especially salient, given the level of rejection, alienation, illegal work and sexuality, risk, and vulnerability in their lives. Eric Harper (2013) describes sex work as a means of obtaining a space within which to exist, a form of independence, as it were, employment, and for some sexual enjoyment and pleasure. He goes on to describe that sex workers, in a metaphorical sense, “use” sex work to overcome a sense of homelessness and that it intersects with urban space, art, ethics, consumption, sexuality, class, race, and a social construct of citizenship. MSWs’ social contexts include meeting friends, drinking and going to bars, in-house parties, clubs, and restaurants. They are always alert for business opportunities, and many say they have a sense of being homeless, of feeling like an outsider within the sociocultural context of their life space, of not belonging in the world other than as a marginal player. Some feel a strong allegiance to their ethnic identity but have little sense of family kinship, although some do have significant relationships with family members and are invited to parties and other social gatherings. Very few attend formal church services.
What are your views on the changing legal, social, and cultural contexts of homosexuality in Africa?
The study participants expressed a general sense of both hope and despair. Hope was particularly associated with changes in the South African constitution that outlawed discrimination based on sexual orientation and legalized same-sex marriage, which may influence other African countries. A national sex work program is now in place and is aligned with the South African National AIDS plan, and the male and transgendered female sex work movement is growing. Kenya, too, is witnessing a nascent, even pronounced social transformation with respect to sexuality, such changes being bound up with neoliberal social-economic transformations. However, trafficking, homelessness, and xenophobia seem to be on the increase in Africa, with constant threats of deportation; the study participants also expressed concern about male (and female) sex workers who have fled certain countries because of human rights abuses. They believe it will take a long time for the African continent to accept male-to-male sexuality and sex work.
In Kenya’s cities, particularly Nairobi and Mombasa, social spaces for gay and other men who have sex with men are increasingly apparent. For example, a number of bars tolerate and to some extent accept LGBTI clientele. These changes reflect the wider momentum for change in Kenya, where recent government policies aimed at promoting economic growth and liberalization are contributing to changes in social attitudes and a new culture of individualism, as a younger generation seeks increased social mobility and personal choice in working and self-expression in consumption. This has tended to promote a new global outlook. An emerging, if uneven, tolerance of LGBTI communities and rights is a facet of this social change in some urban areas. It is notable, for example, that the prime minister of Kenya recently called for the arrest of gay couples in the country but later was compelled to retract his statement due to civil activism, including from the LGBTI community. This reflects the sociocultural context of LGBTI issues in Kenya, where political and social attitudes reveal strong homophobic prejudice at the same time new and emerging social attitudes are acquiring some legitimacy.
Nevertheless, Kenya has an enduring culture of homosexual and sex work prejudice. Same-sex sexuality is heavily stigmatized and LGBTI people are often subject to abuse and harassment. Police officers are among the perpetrators of such violence and often are reluctant to support and protect victims of homophobic crimes. In health-care settings, people of same-sex sexuality often face similar discrimination. For example, gay men and other men who have sex with men often encounter hostility and discrimination if reporting anal STD symptoms, despite new health ministry guidelines on male-to-male sexuality, sex work, health, and HIV. This occurs in the context of an especially high rate of new HIV infections among men who have sex with men in Kenya—reportedly 15 percent of all new HIV infections in 2010. This is confirmed in a study of at-risk populations (also referred to as key populations; Desmond Tutu Foundation, 2011) that includes MSM and sex workers. A Kenyan and South African study reported that MSM had the highest rates of HIV (6.8 cases per 100 people; Price et al., 2012)
In Namibia, despite the fact that no legislation exists concerning same-sex sexuality (although there are laws against sodomy), the study participants believe the oppression and abuse directed toward them is driven by institutions (policymakers, politicians, and police) rather than by civil society. They now have easier access to public spaces and more tolerance from at least some quarters of civil society, and there is increasing visibility of gay doctors, nurses, and teachers who do not mask their identity. Health facilities, however, are still discriminatory and not gender sensitive.
The moral climate elsewhere in Africa is volatile and violent, as evidenced by the murder of same-sex rights activist David Kato in Uganda and the Ugandan parliament’s efforts to pass an “antihomosexuality bill.” The murder of gay men and sex workers in South Africa, police harassment and violence, and the “corrective rape” of lesbians in townships attest to this currency. The sociomoral position of homosexuality in Africa contributes to a sense of social anxiety and danger among male sex workers, although most say they feel relatively free in much of day-to-day life, having found some degree of freedom in sex work, although this must be interpreted with respect to people’s abjection and lack of choice with regard to selling sex.
What makes you vulnerable and what makes you safe—thoughts, places, people, and behavior?
The study participants’ safe spaces correspond to their collective identity or “family of choice”—that is, the subculture of sex work, which includes bars, clubs, and other indoor/outdoor venues where they feel safe and have a sense of agency. Many also said that sex work makes them feel both safe and vulnerable, as selling sex is a way to purchase some freedom and autonomy and yet is risky and dangerous. Power relationships are often based on the youth and sexual prowess of the sex worker, on the one hand, and the fiscal prowess of the client on the other. Clients can be violent and aggressive, and many of the sex workers said they have unsafe sex, either by choice, at the client’s insistence, by force, or because of a lack of self-control brought on by excessive alcohol or drug consumption (Richter et al., 2013). The advent of HIV treatment as prevention has also created a false belief that condoms might not be necessary.
Using mood- and mind-altering substances to excess is part of the scene in which some men work and socialize, and many said that it makes sex work tolerable. Other risks include significant police harassment and violence, which is often sexualized, such as rape/forced sex. These risks had become commonplace for some and they were somewhat inured to their effects, whereas others felt the risks keenly and constantly, hence the use of drink and drugs.
Other risks cited by the study participants included health-HIV, domestic violence, being arrested (for sodomy and/or sex work), and homelessness. Nevertheless, this “risky world of sex work” also provides a haven, a place to belong, to find connection, and, conversely, to feel safe. The participants typically said that sex work was a “way of being” and of finding a sense of meaning in life. Important within this were social connections and support with other sex workers, and sex work as a space where men were able to realize and explore their sexuality in a context where same-sex sexuality was most often abject. As such, the social milieu of sex work offers a symbiotic sense of social cohesion and self-realization in otherwise complex and often negative circumstances, which was manifest in research participants’ complex attitudes and experiences of risk and safety, vulnerability and protection, which are constant and close companions when selling sex.
It is imperative that the hitherto silenced voices of MSWs are given a platform on which to articulate their experiences and to advocate for nonprejudicial access to health and social services, civil and legal rights, sexual and health education, and HIV prevention programs that are specifically designed for male sex workers and other men who have sex with men.
Men who have sex with men in Africa (those who sell sex and those who do not) and who do not necessarily subscribe to hetero-normative injunctions often have been excluded from policy and program planning and research regarding HIV/AIDS, STIs, hepatitis screening, and sexual health, chiefly because of prejudice and denial. Men who sell sex may be doubly stigmatized, due to their assumed sexual orientation and as sex workers, and are therefore subject to abuse and harassment. Police officers are among the perpetrators of violence against MSWs, or they join the justice and health-care systems in being dismissive of or reluctant to deal with, support, and protect male sex workers who are victims of violence. In health-care settings, MSWs face discrimination, are denied access to basic treatment and care, and encounter hostility when reporting symptoms of a sexual nature, including HIV. Such factors inevitably drive and compound MSWs’ vulnerability to HIV.
Against this background, this chapter has aimed to present a nuanced account of the lives and life worlds of male sex workers in southern and eastern Africa, as explored in some specific workshop and research activities conducted with ASWA. The research consciously avoided approaches to the study of sex work that classify “types” of sex workers or quantify the risks of such work, focusing instead on the day-to-day practices, perceptions, and experiences of these men. In basing the study on firsthand accounts of sex workers’ lives, we sought to ground the research in an experiential epistemology that was personally and emotionally sensitive. We argue that such an approach can offer important insights into sex workers’ life experiences in a manner that provides new and significant pathways for addressing their social vulnerability, rights, risks, HIV issues, and health.
Baral, S., et al. (2007). Elevated risk for HIV infection among men who have sex with men in low- and middle-income countries, 2000-2006: A systemic review. PLOS Medicine, 4(12), e339.
Baral S., et al. (2009). HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLOS ONE, 4(3), e4997.
Desmond Tutu HIV Foundation. (2011) Key populations, key responses. Cape Town, South Africa: Desmond Tutu HIV Foundation and University of Cape Town Faculty of Health Sciences.
Dunkle, K. L., et al. (2007). Transactional sex and economic exchange with partners among young South African men in the rural Eastern Cape: Prevalence, predictors and association with gender based violence. Social Science and Medicine, 65, 1235-1248.
Fipaza, Z. (2010). Population-based estimates of MSM male sex workers in South Africa. Paper presented at South African Medical Research Council seminar, Prostitution in South Africa: Developing a Research Agenda, Pretoria, South Africa.
Harper, E. (2013). Homelessness and violence: Freud, Fanon and Foucault and the shadow of the Afrikan sex worker. Unpublished doctoral thesis, University of the Western Cape, Cape Town, South Africa.
Lorway, R., Reza-Paul, S., & Pasha, A. (2009). On becoming a male sex worker in Mysore: Sexual subjectivity, “empowerment,” and community-based HIV prevention research. Medical Anthropology Quarterly, 23, 142-160.
Magnani, R., et al., (2005). Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS, 19(Suppl. 2), S67-S72.
Mannava, P., et al. (2013). Male sex workers who sell sex to men and have anal intercourse with women: Evidence from Mombasa, Kenya. PLOS ONE, 8, 1-7.
Nguyen, V.-K. (2005). Uses and pleasures: Sexual modernity, HIV/AIDS, and confessional technologies in a West African metropolis. In V. Adams & S. L. Pigg (Eds.), Sex in development: Science, sexuality, and morality in global perspective. Durham, NC: Duke University Press.
Okal, J., et al. (2009). Social context, sexual risk perceptions and stigma: HIV vulnerability among male sex workers in Mombasa, Kenya. Culture, Health & Sexuality, 11, 811-826.
Price, M., et al. (2012). Identifying at-risk populations in Kenya and South Africa: HIV incidence in cohorts of men who report sex with men, sex workers, and youth. Journal of Acquired Immune Deficiency Syndrome, 59, 185-193.
Richter, M., et al. (2013). Characteristics, sexual behavior and risk factors of female, male and transgender sex workers in South Africa. South African Medical Journal, 103, 246-251.
Sanders, E. (2007). HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS, 21, 2513-2520.
Sullivan, E., & Simon, W. (1998). A social, psychological and behavioural look at the unseen patron of prostitution. In E. James et al. (Eds.), Prostitution: On whores, hustlers, and johns. New York: Prometheus Books.
Wojcicki, J. M., et al. (2002). Commercial sex worker or Ukuphanda? Sex-for-money exchange in Soweto and Hammanskraal area, South Africa. Culture, Medicine and Psychiatry, 26, 339-370.
Acknowledgments
The work for this paper was conducted with the African Sex Worker’s Alliance (ASWA) in partnership with the Sex Worker Education Advocacy and Taskforce, and was supported by the United Nations Development Program Regional Service Center for Eastern and Southern Africa.
Thanks are due to Kyomya Macklean and Beyoncé from the Women’s Organization Network for Human Rights Advocacy; Eric Harper from SWEAT; Anthony Kanengoni, Loyiso Dube, Pepsi Livi, Cym and Netta (Sisonke); Nelson Massilela (Mozambique); Gregory Kata and Mojalife Ndlovu (Sexual Rights Centre); Nelson Goagoseb and Abel Shinana (Red Umbrella); John Maina (Bar Hostess); Daughtie Ogutu (Fahamu); Clifford Duncan and Maureen (Kenya); Benecia (South Africa); Robert Hamblin and Hejin Kim (Gender Dynamix); and Marcos Benedetti (Pathfinder), whose assistance with the data collection made this report possible.
Lastly, but most importantly, we acknowledge the participants in Kenya, Namibia, South Africa, Uganda, and Zimbabwe, who engaged in the research workshop and participated in the follow-up research.
