On the Ground with Brian Kanyemba: A snapshot of advocacy in Africa

It’s one thing to read about HIV advocacy and prevention and another to experience it first-hand, on the ground, day to day. That’s how Brian Kanyemba experiences it. He is the research assistant at the Desmond Tutu HIV Foundation, a Mapping Pathways partner organization. A core part of Brian’s job involves traveling through South Africa’s villages and cities, talking to people about issues surrounding men who have sex with men (MSM), and what the prevalence of HIV means within this group of people. Of late, his focus has been on putting forward the “meaningfulness of Pre-Exposure Prophylaxis (PrEP)” within the South African context, especially for the MSM community. This is no easy task.

Let’s talk about sex
“South Africa is a really interesting and dynamic place,” says Brian. “We might have gay rights and rights access of services across all sexual orientations, but when you start to talk about MSM, or about PrEP as an intervention among MSM, this is faced by a huge mental wall.” This wall extends to talking about rectal microbocides as well, mostly due to the taboo against anal sex. Currently in development, rectal microbocides, or “topical PrEP”, are ARV-based products that might reduce the risk of HIV infection when used topically in the rectum during anal intercourse. These are in phase II, with an expected phase III to be carried out in Africa and possibly Cape Town (to learn more about rectal microbocides and PrEP click here and here). “No one will come forward to talk about this openly,” says Brian, “because in Africa, anal sex is associated with homosexuality, and homosexuality in Africa is not okay.”

One way Brian goes around this taboo is by using a simple game about sexual pleasure called “Mapping the Body”. While talking to people, he introduces the discussion on rectal microbicides by drawing three images on the board: a simple figure of a man, a woman, and another man. “I say, ‘Guys let’s put stars on areas where one can be sexually stimulated’,” says Brian. “You get amazing ideas from the group. And some people will say to put a star on the anal area, and then from there it is easier to link to PrEP and to introduce rectal microbocides.” By conducting a matter-of-fact discussion focused on pleasure and the body, Brian finds the group is much better able to accept the idea of rectal microbocides as a form of protection.

“Heck no… I am not interested.”
Despite his innovative methods, Brian has run into some pretty big walls where the topic of MSM and PrEP is concerned, especially within the healthcare sector and even the government. At a meeting with a parliament member who represents HIV issues, Brian recalls that when he brought up the topic of MSM and PrEP, she said, “’Oh no, can you please stop there because that doesn’t exist in my frame of mind.’” Says Brian, “This was a woman in the parliament whose job was to discuss issues of HIV. So, I’m talking to her about MSM being a group of people who have a high prevalence of HIV infection and she just says, ‘Heck no, we’re not going to talk about that topic now. I am not interested.’”

Brian clearly remembers his most unexpected encounter with homonegativity – it was at a focus-group PrEP presentation that he conducted in Durban, the third-largest city in South Africa. Recalls Brian, “I put the word MSM on the board, and do you know what one woman participant said? She said, ‘By MSM do you mean men who have sex with men? Yes, they must die; and if not, they must be killed!’” The woman participant who said this was on the community advisory board for one of the major HIV trials in South Africa, which made the statement all the more startling for Brian. “I was so taken aback. I thought, ‘Oh my God, this is where the advocacy has to start from.’”

A personal quest and mission
For Brian, the advocacy began many years ago in Zimbabwe, when he was just 19 and right out of college. He says, “As I was growing up, it was just accepted that being gay is bad. That is one of the reasons I left Zimbabwe, because of the way gay people are treated, are not spoken about.” He vividly remembers the moment that he began on his path as an HIV advocate, “A very close friend of mine was diagnosed with HIV and he was gay and, at the end of the day, he committed suicide. He didn’t understand HIV, he didn’t understand that it’s not a death penalty, he didn’t know that you can access treatment, he didn’t know that ARV treatment and care is available… and so advocacy become a passion, it was so personal to me.”

Despite the intense societal taboo, Brian worked in Zimbabwe on HIV and gay rights issues for almost a decade. His first job was with the National Army, working at the provisional hospitals on HIV and AIDS issues, ARV rollout, and providing counseling services for homosexuals. Says Brian, “I was working in the psychiatric department of the hospital… they realized I was gay, so they sent me to the lunatic asylum!”

Brian’s journey hasn’t been easy, and yet he continues with dedication, enthusiasm and hope. Why? Why not choose an easier job, an easier path? Brian’s response is prompt, “They say in my culture that when a funeral happens next door, you say ‘Ah ok, there is a funeral.’ But when a funeral happens in your house, it becomes a personal issue. When my friend passed away, I thought, ‘Ok, I need to put on my armour and start fighting this war now. I am going to stop this. I am going to stop thinking like a young person, and I am going to fight and go forward fighting for all my friends and for my community.’ It was very early in my life that I decided this, and I am not going to stop.”

Brian is a research assistant with the Desmond Tutu HIV Foundation, a Mapping Pathways partner organization. He is also an advocate fellow with the AIDS Vaccine Advocacy Coalition (AVAC), and is an active member of the International Rectal Microbicide Advocates (IRMA). He has been very involved with IRMA's Project ARM - Africa for Rectal Microbicides, and is an integral member of the Project ARM video working group, which is producing an African-focused video on anal sex and rectal microbicides.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]