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The country now invests more than billion annually to run its HIV and AIDS programmes.2 However, HIV prevalence remains high (19.1%) among the general population, although it varies markedly between regions.3 For example, HIV prevalence is almost 40% Kwazulu Natal compared with 18% in Northern Cape and Western Cape.4 South Africa's National Strategic Plan 2012-2016 identifies a number of key affected populations that are at risk of HIV transmission.5 HIV prevalence among men who have sex with men (MSM) in South Africa is an estimated 9.9% with roughly 9.2% of all new HIV infections among this group. For example, one study reported an HIV prevalence of 43.6% among MSM in Johannesburg and Durban.6 By contrast, 10% of self-identified MSM from urban areas in Western Cape are reportedly living with HIV.7 Many MSM still face high levels of social stigma and homophobic violence due to traditional and conservative attitudes.
A 2013 study found that only 32% of South Africans said that homosexuality should be accepted by society.8 As a result, MSM find it difficult to disclose their sexuality to healthcare workers, limiting their access to HIV services.9 However, South Africa is the only country in sub-Saharan Africa where gay rights are formally recognised.10 Moreover, national policies strongly emphasise equity, social justice and forbid discrimination based on sexual orientation.
Moreover, many sex workers also inject drugs, exacerbating their vulnerability to HIV infection.19 Educational organisations have reported difficulties in delivering HIV prevention services to sex workers due to ongoing police harassment.
One study found that up to 70% of women who sold sex had experienced abuse by the authorities:20 "He put me on the floor.
The police officer raped me, then the second one, after that the third one did it again.
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