The findings presented at the annual Sexual Violence Research Initiative in Cape Town by Kristin Dunkle, assistant professor at the Rollins School of Public Health at Emory University in the US, are based on a household survey conducted among about 1,740 men in two of South Africa's nine provinces - KwaZulu-Natal and the Eastern Cape - by the Medical Research Council (MRC).
Published in 2009, the research became commonly known as the "MRC rape study" and showed that more than one in three South African men admitted to having raped a woman - but little attention was paid to sexual violence experienced by men.
Men abusing men
Many male survivors had reportedly been forced to engage in typically low HIV risk acts such as thigh sex, in which a man placed his penis in between their thighs, or masturbation. However, about 30% reported being anally or orally raped.
Men who have sex with men (MSM), or men who choose to have sex with men but do not necessarily identify themselves as gay, were more than nine times as likely to report having been raped than other men. About 3% of men reported sexually assaulting another man, about half of those who reported having raped a man.
Mirroring previous South African studies that showed an elevated HIV risk among men who commit intimate partner violence and the women they assault, Dunkle's work found that the perpetrators as well as the survivors of male-on-male sexual violence were generally more likely to be HIV positive.
There was one exception: rape survivors who did not identify as MSM. HIV prevalence among this group was not significantly different from men who have never been sexually assualed.
While the apparent lack of HIV-risk among male rape-survivors who are not MSM may seem puzzling, Mary Ellsberg, vice president of research and programmes at the International Centre for Research on Women, said the difference is almost certainly indicative of partner violence among MSM in relationships, and likened it to the rising HIV risk that accompanies women in abusive, long-term relationships.
"From previous MRC studies we see that [high HIV prevalence] results from a combination of factors for women who are beaten and raped by their husbands - they are having consistent sexual encounters with these men," Ellsberg told IRIN/PlusNews.
"But we also know that women who are raped only once by a stranger - while they can contract HIV from the rape - don't have a higher HIV prevalence than other women overall. The rape of men who aren't MSM also seems unlikely to be ongoing, so it's an infrequent exposure and it makes sense that their risk is similar to the general population."
The situation is different men in relationships with other men, who could be in long-term relationships with high risk, abusive men with whom they would have sex, either consensually or not, over time.
A quarter of MSM who had been raped were HIV-positive. Intimate partner violence between men could also explain why four times as many MSM reported having committed sexual violence against another man.
It's not just about the men
With two-thirds of MSM reporting that they were currently involved with a female partner, the findings have implications for men and women alike.
The overwhelming majority of perpetrators also reported being violent towards their female partners, an HIV risk factor for women in South Africa.
"Overwhelmingly, the men who are perpetrating violence against men are also perpetrating violence against women - there's more than a 80% overlap when you look at physical abuse of female partners.
We need to really think about the implication of this in terms of the risk for women, and interrupting the cycles of sex, violence, and HIV transmission," Dunkle told IRIN/PlusNews.
"When we're talking about violence linked to masculinity, we need to be thinking about it more broadly and be sure that we also look at men's violence towards other men."
About half of the male sexual violence survivors said they had raped a woman, and 25% had done so in the last year.
While Dunkle cautioned that more data on male-on-male sexual violence and rates of female-male partner concurrency were needed before policies and guidelines could be changed, she urged health service providers never to assume a man's sexual history or rule out the possibility of male sexual assault.
- (PlusNews, October 2011)