• Africa
• HIV
• homosexual
• men
• risk behaviours

Men who have sex with men (MSM) in Africa, largely ignored in HIV prevention and treatment efforts until recently, are the focus of a new wave of research and advocacy. Henry et al1 in this journal edition (see page 136), provide the first report of MSM and HIV transmission risk in Cameroon. This work adds to recently published reports from a number of African settings, which together show a consistent pattern, and confirm that the transmission of HIV in African MSM is a significant problem.

The overwhelming scale of the heterosexual HIV epidemic in Africa, coupled with the political, social and cultural barriers against homosexuality, have meant that an MSM-focused response to HIV has been absent across the continent. New reports have shown prevalence rates in MSM higher than those in the general adult male population, with rates above 30% reported in a number of studies, including work from Zambia, Kenya and South Africa.2–4 Most of these data have come from snowball referrals, respondent-driven sampling or venue-based recruitment, as a result of the challenges of reaching the hidden broader and diverse population of MSM.

It is not surprising that population-level data on MSM are so rare—same-sex relations are criminalised in 37 out of 54 African countries and are punishable by death in four …