One in 10 South African men have been forced into sex by another man, according to a 2009 Medical Research Council study conducted among men between the ages of 18 and 49 in the Eastern Cape and KwaZulu-Natal.
The study, which investigated the links between HIV and rape in South Africa, as well as why South African men are so violent, used data from the 2001 government census to select a random sample of households with men to interview.
"One of the surprising findings of the study was the high proportion of men who disclosed having been forced into sex by other men and also forcing other men to have sex. Nearly one in 10 men said they had been forced into sex by a man, and this was very much more common among men who rape [women]," the authors of the study report said.
One out of every 30 men who had been forced into sex was anally penetrated by his perpetrator.
Higher HIV risk
Male-male rape was associated with much higher rates of HIV infection, because it mostly involved anal intercourse without a condom.
"Unprotected anal intercourse poses a very high risk of transmission, approximately 18 times higher than unprotected vaginal intercourse," said Glenn de Swardt, from the HIV organisation Anova Health Institute in Johannesburg. "In rape, a lubricant is generally not used and, if we factor trauma to the fragile rectal lining into the equation, the risk of transmission increases exponentially," he said.
Post-exposure prophylaxis, medication that can prevent HIV from taking root, is freely available to rape survivors at government hospitals. But it must be taken within 72 hours of the rape to be effective.
"These findings point to the importance of raising awareness of male rape in communities so that men and boys who are raped come forward to rape services and receive post-exposure prophylaxis for HIV. They also highlight the importance of these services providing psychological support to male (and female) victims so that the well-recognised cycle of victimisation leading to a greater risk of perpetration can be broken," the authors said.
"Most South Africans don't even consider the reality of men being raped," said De Swardt, "except possibly in prisons." He said he believed male rape was under-reported. "The stigma and taboo surrounding male rape is very powerful, because it raises the issue of anal sex, which is in itself a taboo subject when practised consensually by heterosexual couples."
South Africa is falling behind
An American-based co-author of the study, Kristin Dunkle, from Emory University in Atlanta, said South Africa was in many respects still a conservative country. "What's interesting about South Africa is you're legally more progressive than the United States, which is fabulous, but on the ground, in many cases, it's a lot worse."
Dunkle said South Africa's biggest problem was a misguided sense of masculinity.
The study also revealed that men who have been raped by other men are more likely to perpetrate acts of sexual violence (mostly towards women) than men who have not been raped.
According to Mbuyiselo Botha, from the gender rights group Sonke Gender Justice Network, this could be explained as an attempt to regain lost power. "A man has been raped and, as a form of re-appropriating power, he rapes. Because I was ‘made a woman', by being penetrated, this is how I prove I am still a man," he said.
De Swardt said that the way masculinity was understood and played out in South Africa didn't only relate to how men related to women. "It raises questions about male-on-male violence as well." He said the rape of both women and men was "one symptom of a society that is severely damaged by issues related to dominance and power".
Dunkle said that many male rape survivors feared that they would be regarded as homosexuals if they spoke out. "Raping a man and making him gay is just as false as the belief that raping a lesbian will make her straight," she said.
Botha said the only way to tackle both male and female rape was for men to realise that the "patriarchal notion" of being a man was a "bitter prison".
"The elephant in the room is patriarchy and its ugly, toxic consequences," he said.
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