2. “ Challenges of condom compatible lubricant usage among men who have sex with men in Botswana, South Africa, Zambia and Zimbabwe: A qualitative study Presenter: Dr Olusegun Odumosu (Programme Manager: Dignity, Diversity and Rights Programme COC Netherlands) Co-authors: Bram Langen, Marie Ricardo, Munya Katumba

3. Overview of presentation Introduction Context Rationale for study Research question Methods Results Limitations Conclusions/Reccomendations Acknowledgements

4. Introduction: The lube as prime focus!!

5. Introduction: Context Epidemiological High HIV prevalence rate among MSM compared to national average e.g Marang’s Men Project. Structural Stifling legal and policy environment Community level Extreme stigma and discrimination/violence Anal taboo linked to cultural and religious norms Individual level Personal efficacy/agency; knowledge But we know, condoms with water based lubricant safest sex aid to prevent HIV during anal sex.

7. Introduction: Rationale for study Demand from Community Information gaps on water based lubricants Oil based lubricants myths: Mombasa study (Geibel et al, 2008) Existing research based on frequency of usage Paucity of research on actual experiences of lubricant usage in African settings

8. Introduction: Research question What are the actual challenges of condom compatible water based lubricant usage among MSM and other gay men in Botswana, South Africa, Zambia and Zimbabwe?

9. Method Study design: qualitative Sampling: Purposive sampling at safe spaces, meetings, peer networks Data collection: open ended semi-structured Interviews administered through focus group discussions 4 countries, 6 cities (Gaborone, East London, Pretoria, Lusaka, Harare and Bulawayo) 12 focus group discussions; 2 per city 58 respondents Age range 18-60, Average age, 29

10. Method Focus group discussion administered by COC partner organisations in 6 cities: Gaborone – Lesbians, Gays and Bisexuals of Botswana (LeGaBiBo) Pretoria - OUT LGBT Well Being East London – Social Health and Empowernment Lusaka - Friends of Rainka Harare - Gays and Lesbian of Zimbabwe (GALZ) Bulawayo - Sexual Rights Centre (SRC)

11. Method Eligibility criteria Age over 18 MSM or gay identified Linkages to LGBTI organisations Sexually active

12. Method Data analysis Focus group discussions taken down by note takers of the organisations Discussions transcribed verbatim Data organised using interview guide as template Data coded and categorised according to emerging themes/ideas

13. Results: Emerging themes Availability and accessibility of lubricants Lubricant use and practices HIV risk misconceptions of respondents

14. Results: Availability and accessibility of lubricants A majority of the respondents in Pretoria, Gaborone and East London cited being in contact with local LGBTI organisation as reason for easy access to lubricants. Some cited being close to peer networks as a reason for easy access to lubricants. Lube not accessible in mainstream health clinics, except in Pretoria and East London. Too expensive A few of the respondents from Lusaka and Harare cited stigma associated with identifying with their local LGBTI organisation as reason for poor accessibility. Some cited geographical distance from local LGBTI organisation as reason for poor accessibility.

15. Results: Lubricant use and practices Packaging of lubricants: A majority of respondents from Lusaka, Gaborone, Bulawayo, East London and Pretoria complained about quantity (10ml) and storage of left-over as hinderance to proper usage. Density of lubricants: A 60 year old respondent from GALZ noted: “this is the ideal lube which has no unpleasant smells”. Type of sexual activity: “Would use saliva or body cream for mutual masturbation”.

16. Results: Lubricant use and practices Water based lubricant associated with anal sex rather than sexual activities other than anal sex Fear of losing partners Preference for oil based lubricants Independence

17. Results: HIV risk misconceptions of respondents A few respondents from Harare, Bulawayo,Lusaka and East London had the following misconceptions: Lubricants without condoms is protective. Using water based lubricants in conjunction with oil based lubricants does not pose a greater HIV risk. Anal (as opposed to vaginal) sex is protective (with or without lubricants).

18. Limitations Anal sex by bisexual men was not fully probed. Sexual role (insertive/ receptive) as factor in use of lubricants not investigated. MSM not linked to organisations MSM in rural areas

19. Conclusion: Availability and accessibilty Water based lubricants are not widely available. MSM communities react positively to availability of lubricants. Lube as gateway: The lube project has helped open a broader demographic of gay men to access services at partner sites. On the whole, easier access to lube enhanced safe-sex practices.

20. Conclusion: Lubricant use and practices Variety in practice and use; Eg packaging: 50 ml may seem ideal, but only optimal if privacy is guaranteed.

21. Conclusion: HIV risk misconceptions Level of awareness and understanding of water based lubricants still inadequate. Lack of appreciation of difference in risk between water- based lubricants and oil based lubricants.

22. Reccomendations There is a need for better provision of water based lubricants in 4 study countries. Governments should be lobbied to include water based lubricants in their intervention programmes for MSM. A one-size-fits-all approach should not be followed, as factors inhibiting use of lubricants are dependent on specific individual. Condom-compatible lubricant use should be promoted among all MSM irrespective of sexual roles in anal sex. Need to start looking at universal access to lube and not confining it to gay toy status Health promotion efforts must not only push usage of lubricants with condoms but also provide lubricants along with condoms

23. Acknowledgements

24. Contact: oodumosu@coc.nl oodumosu@coc.nl THANK YOU!!!