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The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. In episode 8 of the Steam Room, we talk about a habit that you might have first-hand knowledge of: smoking. All smokers know that smoking isn’t conducive to good health, but knows just as well that this habit is difficult to quit. What are the health implications of being a smoker? The impact smoking has on one’s health goes far beyond the warnings that are printed on cigarette packs. Dr Ezio Baraldi, a Pretoria-based family physician, says that one obvious risk is lung damage, due to the deposition of tar in the lungs. In addition, the highly addictive nicotine found in cigarettes can lead to the narrowing of blood vessels and long-term damage to the inner lining of the arteries, which can lead to high blood pressure, cardiac issues and strokes. Wendy Gidlow is affiliated with Smokenders, a six-week programme that helps smokers to quit. Gidlow echoes Dr Baraldi’s sentiments, adding that smoking also affects brain function, oxygen levels, memory, eyesight and skin elasticity, not to mention the psychological effects associated with nicotine addiction. “Smokers use cigarettes to reward themselves, to motivate themselves. They use cigarettes when they’re angry, to suppress emotions, they use cigarettes as company… there’s a very, very strong emotional attachment to cigarettes,” says Gidlow. Does smoking have an influence on the sexual health of men? Dr Baraldi explains that the damage that smoking causes to blood vessels start with smaller blood vessels first. As the blood vessel leading to the penis is a third of the size of the one leading to the heart, the blockage of arteries leading to the penis may lead to erectile dysfunction, also signalling possible heart problems in the future. Wendy Gidlow also warns of the damage that nicotine may cause in terms of hormone levels, and especially testosterone levels. Can hypnosis help you to quit smoking? Arno Stadler is a qualified member of the South African Institute of Hypnotism and has a practice in Nigel in Gauteng. According to Stadler, the British Medical Association has recognised hypnosis as the best way to stop smoking. With a 92% success rate, non-medical hypnosis aims to align the conscious and unconscious minds. While the conscious mind is able to handle 5 to 9 tasks a minute, the unconscious mind has the ability to do thousands of things every second, explains Stadler. The conscious mind might recognise the dangers associated with smoking and want to kick the habit, while the unconscious mind holds onto the habit, due to the emotional connection people have with smoking. Through hypnosis, conscious/unconscious alignment can help the unconscious mind to come to terms with letting go of the habit. Stadler says that because hypnosis and smoking are both trigger-based activities, smokers are very good candidates for treatment. However, before commencing any type of hypnosis-based treatment, Stadler first establishes whether a person is truly committed to stop smoking. People might feel that they want to quit because of societal pressures, but unless they have made a personal, conscious decision to stop, hypnosis might not prove as effective. This is because hypnosis cannot suggest a decision or course of action – it can only strengthen a decision that a person has already been made. Using non-medical hypnosis to help a person quit smoking entails a number of sessions, during which a smoker is empowered with tools to help them quit the habit permanently. Once a person realises that they are being controlled by a substance that they do not find the same enjoyment in and which doesn’t give them the same feeling of confidence as they had when they started, they can start letting go of it. In addition to helping people to quit smoking, hypnosis can also be used to treat stress, anxiety and anger, and can help to cultivate motivation to help with procrastination, and with confidence and sports performance. Overall, it can be a great tool to experience more joy and greater fulfilment. Where to look for help If you’ve come to the realisation that you want to stop smoking, there are a few avenues that can help you to quit the habit permanently. • Wendy Gidlow of Smokenders can be contacted on 072 896 5166, or send her an email at wendy@smokenders.co.za. • Dr Ezio Baraldi can assist people who want to quit smoking with various medical treatments. Contact him by calling 012 342 5704, or by sending an email to doc@edmc.qu.co.za. Remember to visit men2men for information relating to other issues faced by men who have sex with men. • To find a qualified hypnotherapist to help you quit smoking, visit www.hypnotherapy.co.za, or contact Arno Stadler directly by calling 011 814 2910 or by sending an email to jhb@hypnotherapy.co.za. Click on the player below to listen to our full discussion about smoking on Episode 8 of the Steam Room, brought to you by the National Department of Health’s Phila programme.  

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. Darkrooms, glory holes, pleasure pens… in episode 7 of The Steam Room, we get frank about sex clubs. What are sex clubs? We spoke to Danie Hamman, who has been the owner of Camp David in Pretoria since it first opened its doors in 2003. Hamman calls Camp David “heaven for gays”. Historically, spaces where men could safely engage in sex with other men were rare, and restricted to spaces like public bathrooms due to the criminal nature of homosexuality and homosexual acts. Hamman felt that the trouble MSMs had with the authorities, along with several instances of gay bashing, necessitated the opening of a space where men could engage in sexual activities with other men safely, securely, and without the treat of attacks for whatever reason. Hamman makes it clear, however, that Camp David is not a brothel, and paid sex as well as drug use is strictly forbidden, and no under-18s are allowed. Jean Nel agrees with Hamman, adding that these spaces are organised to cater for specific needs within the community of men who have sex with other men. According to Bruce Little, content creator at the Anova Health Institute, sex clubs were created to provide a service to men who make the lifestyle choice to engage in thrilling and group sex activities. “A sex club is a convenient way to make sure that a certain group of men meet at a certain place at a certain time so that they can engage in group sex,” says Little. Who goes to sex clubs? Danie Hamman says that the clientele at Camp David range from gay men, to bisexual men and other men who have sex with men. Quite often, these men have specific sexual preferences and fetishes, including S&M and kinky sex. Fisting, rimming, and the chance to live out your most intimate fantasies are all on the menu at Camp David. Jean Nel agrees, and says that there is not just one type of man that frequents sex clubs like Camp David, but that all the men who do, are sexually liberated and looking to satisfy their specific sexual needs. Bruce Little says that every sort of man can be a patron at sex clubs, and professionals, creatives and every other type of man can be seen. He emphasises that people should be careful of judgment and stigma, and be open-minded about the different ways in which men express their sexuality. Tips for men who are visiting a sex club for the first time Danie Hamman says that men are often shy, embarrassed and scared when they visit a sex club for the first time. However, the obligatory nudity at Camp David makes everyone equal. Upon arriving at Camp David, patrons are instructed to remove their clothes where they will be placed in safe keeping until they leave. First-timers can get a drink at the bar, where the barmen will inform them of all the different spaces within the club, including the dark rooms. Dos: • Do be prepared to be touched. • Do make sure that you are clean. Shower facilities and douches are available. • Do make use of the condoms and lubricants that are available. Hamman assures listeners that Camp David is a hygienic space that is cleaned throughout the evening, without intruding on patrons while they are busy, and then cleaned, disinfected and sterilised again thoroughly the morning after. What risks do men who go to sex clubs face? Bruce Little makes it clear that having more than one sexual partner at a time leads to greater risk of contracting HIV and other STIs. In this regard, it is important to make use of the condoms and water-based lubricants that are available at sex clubs. Men who are HIV-negative should also consider taking PrEP as a preventative measure against HIV infection. However, men should keep in mind that PrEP does not provide protection against other sexually transmitted diseases. Some STIs, like a particular strain of gonorrhoea that is doing the rounds, are drug-resistant, and require last-resort treatment with a specific type of very strong antibiotic. Especially in this case, prevention is better than cure. Jean Nel believes that collaborative efforts between the managers of sex clubs and health institutions can help to prevent the spread of STIs in sex clubs. In this regard, Camp David has been involved in a number of programmes and campaigns. Most recently, Camp David has started encouraging the use of PrEP, and for men to go for regular tests to ascertain the state of their sexual health. As an extra incentive to get tested, proving that you have recently been tested, guarantees free entrance at Camp David. Jay van der Merwe is a registered nurse with extensive experience in HIV treatment and counselling, and advices that men who have any itchiness in their genital area, or who experience a burning sensation when urinating, lower back pain or an unusual discharge should visit a healthcare professional to get tested for STIs. Does going to sex clubs negatively impact the mental health of men? Jean Nel says that sex clubs may negatively impact the mental health of some men, but that the atmosphere and an emphasis on promoting good mental health by getting rid of the stigma some men have with their sexuality can be an important factor. “A sex club has all of the possibilities to emphasise health and wellbeing, and that includes mental health,” says Nel. Bruce Little affirms this notion, and says that men who go to sex clubs should evaluate what they feel like while they are there, and after their visit. Should you feel comfortable having sexual encounters with a number of different men in a way that reinforces your sense of self – even after visiting – and provides connection in an intimate and meaningful way, frequenting sex clubs should not impact your mental health negatively. On the other hand, if you feel empty, sad and isolated after engaging in group sex activities, this may not be the best way for you to express yourself sexually. Has your interest been piqued? Listen to the full episode about sex clubs by clicking on the player below.

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. In episode 6 of the Steam Room, we delve a bit deeper – so to speak – and speak about the mental and sexual health issues relating to men who have sex with men. Is there a link between mental health and sexual health? Tom Budge, a Gauteng-based hypnotherapist, believes that mental health and sexual health are inextricably intertwined. “We’re like a three-legged stool, really. We stand on a floor of spirituality. The three legs that form the pillars of who we are as human beings are intellect, our emotions and our sexuality. Those three need to be in balance if that stool is going to be at all useful. If one leg is broken or missing, or one leg is too long or too short, that’s just not going to work. ” Budge says that one needs to make sure that there is balance in terms of sexuality, intellectuality and one’s emotional life. Pierre Brouard, Deputy Director at the University of Pretoria’s Centre for Sexualities, AIDS and Gender, agrees and says that for many people who form a part of the LGBTQI+ community, long-standing self-esteem issues may be the result of discrimination throughout a person’s life, and may lead to mental health issues later on. Feelings of isolation, alienation, depression and anxiety may all contribute to problems in a person’s sexual life. Contrarily, an affirming and mutually satisfying sex life contributes to mental wellbeing, which suggests a very powerful link between mental and sexual health. Bruce Little, Content Creator at the Anova Health Institute, confirms that feelings of isolation and depression could also lead to substance abuse, risky sexual behaviour, or a combination of both. How do mental health issues manifest in sexual health issues? Many factors are involved when mental and sexual health issues crop up, says Budge. There may be issues of struggling with affirmation, and basic brain chemistry, like the amount of dopamine in our systems also play a role. If sexual engagement provides the only way one feels good about oneself, it may lead to obsessive sexual behaviour to chase an short-lived emotional high. How should mental and sexual health issues be addressed? Bruce Little says that the first step to treating mental health issues is an acknowledgement of the issues, followed by taking responsibility for them and reaching out to get treatment. Little advises that individuals who experience mental health issues seek long-term solutions for underlying mental health issues like loneliness, instead of getting short-term sexual gratification by hooking up. Intimacy and sexual encounters should also reaffirm a positive sense of self-worth. Budge believes that balance is of key importance as it pertains to mental and sexual health issues. “If one is sexually continent, then you’re using your sexuality as a part of who you are. It is neither obsessive, nor is there any guilt about it,” says Budge. Pierre Brouard says that undoing years of negative conditioning does not come easy, but that individual psychotherapy may be a good start. Support groups, medications and seeing a mental health professional can be helpful. At the grassroots level, positive and affirming relationships with friends, family and partners, a sense of connection, and an accepting community could also be a form of treatment. In the age of social media and dating apps, judgment is often at the order of the day, and Brouard recommends that people who find that these spaces negatively impact their mental health should look elsewhere for affirmation and community. Brouard says that while searching for balance is important, resilience in the face of adversity and seeking support from those that you are close with helps on the continuing journey of seeking balance in your life. Where should you seek help with mental and sexual health issues? A wide range of experts and different therapies is available to those who seek help with mental health issues. Hypnosis, which Tom Budge has used with great success, can allow a person to find their character and nature and the safety zone in which one is allowed to be a human being. Alternative mental health therapies are another treatment option. Peter Furstenberg is a trained facilitator of LEGO® SERIOUS PLAY®. The Playful Men workshop, which uses Lego as a method of therapy, taps into childhood methods of play and highlights the common issues that men experience. Because men are more likely to remain silent about issues and problems, the workshop provides an avenue for men to open up about the things that bother them. While unconventional, this method of therapy taps into people’s inherent playful nature. Harnessing a method that is fun turns it into purposeful play that brings abstract issues and concepts into a three-dimensional sphere where they can be discussed. What is the link between age and mental and sexual health in the LGBTQI+ community? Budge describes a bell curve in terms of age and mental and sexual health. Before a young person comes out of the closet, there is often a lot of anxiety about the topic, which disappears once a person has come out and made their peace. The flip side of this, according to Budge, is that aging is a difficult process in the gay community. Very often, accomplishment, wealth and material acquisition are played off against youthfulness, beauty and physical attributes. Older men may feel a sense of desperation for emotional connection, while their physical prowess can’t compete with that of younger men. This may lead to older men being shunned from the gay community, leading to issues with loneliness. With that being said, older men possess something that they have acquired with age: grace. This is a magnetic characteristic that often inspires the younger gay community. Counter-intuitively, older men may have to go back into the closet in old age, as assisted living facilities are often not geared, may not understand or may be judgmental of homosexuality. Who to contact If you find yourself struggling with issues relating to mental and sexual health, please check out the following organisations: • The South African Depression and Anxiety Group • The Mankind Project • The Centre for Sexualities, AIDS and Gender Mental health is a topic that isn’t discussed nearly as much as it should be. Reaching out to organisations and individuals that accept you, support you and can assist you is an indispensable part of your sexual and general wellbeing.

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. In episode 5 of The Steam Room we talk about a controversial topic in the community of men who have sex with men: chemsex. What is chemsex? Chemsex is sex that happens between men while under the influence of illegal substances. These substances may include things like marijuana, Methylenedioxymethamphetamine (MDMA, commonly known as ecstacy), crystal methamphetamine (crystal meth), gamma hydroxybutyrate (GHB, also referred to as “G”) and methcathinone (commonly known as CAT), among others. Another legal substance that may be used is a class of alkyl nitrites that is inhaled, commonly referred to as poppers. In the gay subculture, chemsex sometimes forms a part of a hook-up where the purpose is to take drugs with the intention of having sex. On dating apps like Grindr, men who want to engage in chemsex refer to it as “chemfun” or “party and play”. Bruce Little, Content Creator at the Anova Health Institute, says that there are numerous reasons why men may want to engage in chemsex, including low self-esteem or other insecurities. Taking substances makes them feel more confident and takes away their inhibitions. Other men may feel that it enhances their sexual experience or allows them to engage in sexual activity for longer. Juan Nel says that chemsex has become a part of the gay subculture, as a result of the underground gay culture of the past. Substances are often used by men who have sex with men to disinhibit themselves or to maximise the experience of sex. This can become a problem when the substance does not provide the same high as it used to, and a user needs a larger amount to enjoy the same experience as before. Poppers are often the first substance that men who have sex with men encounter. Even when using poppers, users should be aware that the long-term effects are inconclusive, and take care when using poppers on the long-term. What are the health implications of chemsex? The disinhibition people experience when engaging in chemsex means that they often don’t take as much care to protect themselves during sex. In addition, there may be risks involving the mental after-effects of chemsex. “People potentially do things that they later regret,” says Nel. Little says that there are indications that men who engage in chemsex are much more likely to have unprotected sex and to have more than one sexual partner at a time, which automatically puts them at a much higher risk of infection with sexually transmitted infections and HIV. Some drugs impact different organs adversely, and mixing different substances also carries significant risk. “Any drug that you take has an effect on the brain, and have very powerful neurological effects. That’s why we feel this intense high or this amazing sense of euphoria. The problem is that our bodies are not designed for such intense highs, particularly over a period of time, and then it will lead to some kind of damage. That’s why there are so many people who, having used drugs for an extended period of time find that they don’t have the same cognitive abilities that they had before.” Needing a higher dose to get your fix may potentially also lead to addiction. Because of the association that the substances that are used with sex, sex addiction and substance addiction could go hand-in-hand. Should people not be able to have sex without taking a substance as well, this could lead to significant issues relating to their sexual health. How to protect yourself If you do engage in chemsex, learn to use chems responsibly. Even though there are high risk factors, Bruce Little advises that people who partake in chemsex do so responsibly. OUT LGBT Well-being’s Harmless Project offers a needle exchange programme, which allows drug users to exchange old needles for new ones to prevent the spread of diseases that are carried in the blood. OUT advises that you always use clean needles and never share needles when injecting substances. The use of condoms and water-based lube cannot be overstated. Test yourself for STIs and HIV regularly, and if you suspect that you might have been exposed to an STI or HIV, go to your nearest men’s health clinic and find out if you can go onto PrEP. “The number one thing that you should do is to educate yourself. If there is a certain drug that you prefer to take and are taking regularly, find out everything you can about it,” says Little. “When people are able to manage the substances that they use, rather than be managed by the substances, that’s one scenario, but when you become a slave to whatever the substance may be, in the long-term, there’s a loss of control, potentially your drive being affected.” Read more about chemsex Carl Collison, journalist and the Other’s Rainbow Foundation fellow at the Mail & Guardian, wrote a comprehensive article for that publication about his experience with chemsex, and his resulting addiction. Carl’s article provides insight into a world that he got out of, as he describes it, “relatively unscathed”. Carl’s story is hard-hitting, honest and worth a read.

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. Episode 4 of The Steam Room focuses on daytime sex – a relatively common practice among the community of men who have sex with men. What is daytime sex and how does it differ from sex at other times? We spoke to Bruce Little, Content Creator at the Anova Health Institute, to find out what daytime sex entails. Little describes daytime sex or daytime hook-ups as a sexual practice where men who have sex with men meet up with other men during quieter times of their day, for instance during a lunch or tea break. Men who have sex with men typically find each other via a social networking app, like Grindr, and then meet up in a public bathroom or other spaces to have sex. Before dating apps were as widely used as they are now, gay men would often meet in areas that were known as so-called “cruising spots” where men would meet to solicit sex with other men in public spaces – this is known as “cottaging”. The profile of the typical MSM who has daytime sex is difficult to pinpoint. While there are thrill-seekers who enjoy the risks involved with random hook-ups, there are also individuals who may be relatively averse to risks, but still engage in daytime sex. What are the risks involved with daytime sex? Bruce Little advises that having sex without using condoms and a water-based lubricant is always risky, no matter what time of the day or night it takes place. This is especially valid when men are having anal sex, due to the additional risks that this sexual practice carries, although having oral sex without protection still poses the risk of pharyngeal gonorrhoea, or gonorrhoea of the throat. Daytime sex and STIs: how to protect yourself The higher risk profile of anal sex necessitates that all men who have sex with men take extra care. This is also applicable to men who have oral sex, as this also comes with potential risks. Men who have sex with other men are at a higher risk of HIV infection and transmission, as well as infection and transmission of other STIs like syphilis and gonorrhoea. No matter what time of day you are having sex, you should always make use of condoms and water-based lube when engaging in any kind of sexual activity. Men who have sex with men should heed the following guidelines: • Use condoms In conjunction with a water-based lubricant, high-quality condoms dramatically reduce the risk of transmitting STIs. Be careful not to use oil-based lubricants, which could dissolve the condom, rendering it ineffective. • Get tested Men who have sex with men are at a higher risk of contracting STIs than MSW (men who have sex with women) and WSW (women who have sex with women), which is why it is highly advisable to get tested for HIV and other STIs every six months, even if you use protection. • Be ready in the moment A sexually active MSM should always have lubricants and condoms at hand, on the off chance that they might have a sexual encounter. • Pay attention Having an open and honest discussion with your partner about your status not only keeps things comfortable, it is also the responsible thing to do. Use enough lube and make sure that the condoms you are using are not damaged in any way. Certain minor things – like not brushing your teeth directly before oral sex (this can cause tiny abrasions which could be passageways for STIs) and paying attention to not aggravate any sore spots in the anal area – will also do a lot to ensure your peace of mind throughout your encounters. • Keep track of your health After engaging in any act of MSM, pay particular attention to your body. In the hours and days following a sexual encounter with another man, keep an eye out for any burning in the genital or anal area, or anything abnormal like rashes or fever. Should anything seem out of sorts, consult with a medical professional immediately, as it’s always better to catch things that are out of the ordinary early. Who to contact If you are based in Pretoria and surrounds, and would like to discreetly access healthcare services aimed specifically at men who have sex with men, you can contact OUT, a professional service organisation focusing on direct health and mental health services, research, mainstreaming and advocacy for Lesbian/Gay/Bisexual and Transgender (LGBT) people. All services are provided for free. Daytime sex can be exciting and exhilarating to take part in, but it is important that men who have sex with men are especially careful when hooking up with people they have just met. If you are a man who has sex with other men, consider taking PrEP as a precautionary measure against HIV infection. PrEP, or pre-exposure prophylaxis, consists of a range of antiretroviral treatments that aim to prevent infection with HIV. PrEP can be prescribed by all private practitioners and medical aids cover the costs of treatment, but should you want to acquire it anonymously, you will have to order it privately through a medical practitioner. Various NGOs also offer treatment with PrEP, free of charge. Click on the player below to listen to our full discussion about daytime sex on Episode 4 of the Steam Room, brought to you by the National Department of Health’s Phila programme.

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. Episode 3 of The Steam Room focuses on another part of the MSM demographic: After-nines. We spoke to Bruce Little, Content Creator at the Anova Health Institute, to find out more about After-nines. What is an After-nine? “After-nine” is a slang term for a man that is generally known to be, or identifies as heterosexual, but will visit certain venues or people after 9 o’clock in the evening to engage in sexual experiences with other men. Why do people have sex like this? Even in a time where people are believed to be more enlightened and accepting, society still tends to be critical of gay and bisexual men, and there is still quite a bit of stigma attached to being gay or engaging in homosexual acts. This is why some men prefer to hide this identity from their communities and families. Even so, Little says that men sometimes engage in clandestine sexual activity because of the taboo associated with it, which adds an element of excitement to the sexual activity, making it more enticing. How prevalent is this phenomenon? It is very difficult to gauge exact numbers, as these people don’t want to be identified or found out, but we do know that After-nines exist from the secondary evidence given by the gay and bisexual men who engage in sex acts with them. Do After-nines face more stigma than the general MSM population? One could argue that After-nines do not face the amount of discrimination associated with homo- or bisexuality because their communities generally do not know that they engage in sexual activity with other men. To society, these men may appear heteronormative, as they are often married and have children, fitting the profile of a heterosexual person. However, After-nines are sometimes scorned by the LGBTQ community, because of their decision not to come out. What health issues could After-nines face? Like all men who have sex with men, and because of the higher risk profile of anal sex, After-nines have a higher risk of HIV infection and transmission, as well as infection and transmission of other STIs like syphilis and gonorrhoea. After-nines should take extra care and always make use of condoms and water-based lube when engaging in sexual activity. This group’s hidden existence means that they often do not access health services tailored for and aimed at men who have sex with men. This makes it exceptionally hard for healthcare providers to reach After-nines and supply them with information and treatment. STIs and the psychological impact of being an After-nine Paula Quinsee, relationship expert, TEDx speaker and the author of Embracing Conflict emphasises that After-nines have a personal responsibility to practice safe sex to protect themselves and their partner(s) against HIV and other STIs like chlamydia, syphilis, pubic lice and herpes. Practicing safe sex means taking every possible precaution when engagaing in sexual activities with other men, including condoms, water-based lubricants and pre-exposure prophylaxis (PrEP). Knowing your status is extremely important, and Quinsee advises that After-nines get tested for HIV and other STIs at least every six months, and on a monthly basis if you are a person who is very active sexually. Bruce Little from the Anova Health Institute says that there is often a big psychological impact on After-nines as well. Like anyone who is in the closet, After-nines frequently experience a sense of isolation and loneliness, because of the heavy burden of the secret they are hiding. “Everyone you know doesn’t really know you, and one cannot help but wonder, do these people really love me?” says Little. The fear of being discovered and exposed is ever-present, and may have a significant psychological effect on After-nines. Little advises that After-nines go online and educate themselves about the health and psychological consequences that being a man who has sex with men may have. Visiting websites like We the Brave and Health4men will provide all the necessary information about safe sex, HIV and other STIs. Little draws attention to the fact that many people do have STIs, but are asymptomatic, rendering the infections invisible to the naked eye, although they can still be transmitted. Knowledge is power, and being educated about all the risks will hopefully make the risk of infection smaller, which does a lot in terms of minimising feelings of shame and insecurity. In terms of coming out, Little says that a decision to be open about one’s sexuality does sometimes come with the risk of discrimination based on religious or cultural beliefs, which can sometimes come with the additional danger of assaults or attacks. Should you decide to come out, it is important to ensure that you are in an environment that is safe and where you can take care of yourself. Of course, there’s always another party involved other than the After-nine and their sexual partner(s), and wives or partners who suspect that their significant other may be engaging in sexual activity with other people should also take the necessary precautions to protect themselves. This includes insisting on the use of condoms when having sex and taking PrEP as a precautionary measure. The emotional toll that being an After-nine has could also extend to the spouses and partners of a person, but Little believes that transparency and honesty is the key to having a well-rounded life. Additional measures like the use of all possible cautionary measures – condoms, lube, PrEP and/or antiretroviral medication – are indispensable to protect everyone involved. Who to contact If you are based in Pretoria and surrounds, and would like to discreetly access healthcare services aimed specifically at men who have sex with men, you can contact OUT, a professional service organisation focusing on direct health and mental health services, research, mainstreaming and advocacy for Lesbian/Gay/Bisexual and Transgender (LGBT) people. All services are provided free of charge.

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. After an introduction to MSM in Episode 1, Episode 2 of The Steam Room focuses on MSM first-timers. This week, we spoke to Bruce Little, Content Creator at the Anova Health Institute, to gain insight into the experiences of MSM first-timers. What does it mean to be an MSM first-timer? An MSM first-timer is a man who is having sex with another man for the first time. Little says that a more open-minded society where sexuality is considered to be more fluid has led to more men becoming curious and less inhibited by the norms of society. This has lead to a greater willingness to experiment within the realm of sexuality. What should first-timers keep in mind before diving into MSM? Little recommends that first-timers take it easy. When embarking on your first sexual experience with another man, it is important that both parties give their consent and are preferably not too inebriated by alcohol or drugs. Pacing yourself is also important – don’t force yourself to do anything that you’re not enjoying or doesn’t feel right. “It’s supposed to be a pleasurable and enjoyable intimate experience with another person. Take your time and don’t expect yourself to be this stellar porn star the first time you have a sexual experience with another man,” says Little. What about the stigma surrounding MSM? We live in a time where there is still some stigma surrounding MSM, and you do need to be careful about promoting your sexual orientation in certain communities. Little recommends that you consider your environment. “Make sure that you’re safe and not in a situation where you could come to harm or be the victim of someone else’s ignorance or stupidity”. You can do this by choosing safe spaces and platforms where you will be supported when being open about your sexuality and exploring your sexual fluidity. Little maintains that shame is not exclusively the domain of people who fall within the LGBTQ+ spectrum, as many cisgendered and heterosexual people are also faced with issues surrounding shame. However, men who have sex with men should keep a rational and analytical perspective surrounding their shame about MSM and the reasons for it. In this regard, Little says that deep introspection is important: “Do you have a rational reason for feeling shameful about your sexuality or your desire to experiment, or are you just adopting someone else’s discriminatory perspective?”. We also spoke to Dr. Itzio Barraldi, a Pretoria-based family physician who specialises in men’s health and HIV treatment, about the physiological implications that MSM may have. What are the main differences between MSM and MSW sex? Dr. Barraldi says that anal tissue is more permeable by viruses and bacteria than vaginal tissue, due to a difference in density. Anal bleeds may lead to a higher entry level for pathogens, and the overall potential for the transmission of HIV and STIs is greater when engaging in anal sex. What are the best defence methods when engaging in MSM? Dr. Barraldi recommends the consistent use of condoms and a water-based lubricant when engaging in MSM. Using an oil-based lubricant may damage condoms, leading to a higher risk of infection, but using enough water-based lubricant is paramount. “When having anal sex, the old adage is that too much lube is almost enough.” In terms of PrEP, how can it be acquired discreetly? PrEP, or pre-exposure prophylaxis, is a new tool that is doing a lot to control the spread of HIV. Treatment with PrEP is, in essence, antiretroviral treatment to men who are HIV-negative. In the case of the virus entering the body, two antiretroviral drugs are already there to block its replication and prevent infection. Should a man get infected by HIV, an third drug will need to be added to the combination of two antiretroviral drugs that are used with PrEP as soon as possible, as the body could build up resistance to the drugs, which can have an influence on future treatment of the virus. This is why Dr. Barraldi recommends that MSM go for a fourth-generation HIV test before starting PrEP, and again every three months thereafter. Fourth-generation HIV tests have a shorter window period of just 4 to 21 days, as opposed to the traditional finger-prick HIV tests’ larger window period. PrEP can be prescribed by all private practitioners, and medical aids cover the costs of treatment, but should you want to acquire it anonymously, you will have to order it privately through a medical practitioner. Various NGOs also offer treatment with PrEP, free of charge. How do you stay safe when engaging in oral sex? Although the risk of transmission of HIV and other STIs is generally lower with oral sex, Dr. Barraldi advices that any body fluid can still lead to transmission, which is why you should always use condoms when engaging in oral sex. What measures should MSM take? Like gay men in general, men who have sex with men should take special care when engaging in sexual activity with other men. • Use condoms In conjunction with a water-based lubricant, high-quality condoms dramatically reduce the risk of transmitting STIs. Be careful not to use oil-based lubricants, which could dissolve the condom, rendering it ineffective. • Get tested Men who have sex with men are at a higher risk of contracting STIs than MSW (men who have sex with women) and WSW (women who have sex with women), which is why it is highly advisable to get tested for HIV and other STIs every six months, even if you use protection. • Be ready in the moment A sexually active MSM should always have lubricants and condoms at hand, on the off chance that they might have a sexual encounter. • Pay attention Having an open and honest discussion with your partner about your status not only keeps things comfortable, it is also the responsible thing to do. Use enough lube and make sure that the condoms you are using are not damaged in any way. Certain minor things – like not brushing your teeth directly before oral sex (this can cause tiny abrasions which could be passageways for STIs) and paying attention to not aggravate any sore spots in the anal area – will also do a lot to ensure your peace of mind throughout your encounters. • Keep track of your health After engaging in any act of MSM, pay particular attention to your body. In the hours and days following a sexual encounter with another man, keep an eye out for any burning in the genital or anal area, or anything abnormal like rashes or fever. Should anything seem out of sorts, consult with a medical professional immediately, as it’s always better to catch things that are out of the ordinary early. What online resources are there surrounding MSM? There are a number of online resources available to men who have sex with men. Younger men between the ages of 15 and 21 can visit Young Heroes, a website which explores different aspects surrounding sexuality, including sexual expressions and identity, gender expression and identity, as well as information about puberty in general. We the Brave is intended for men from their 20s to their 40s, and has a treasure trove of information about internalised homophobia, online bullying, stigma, HIV prevention and treatment, information about how to protect yourself against STIs, information about HIV prevention and treatment and other topics related to MSM.

The Steam Room is broadcast on GaySA Radio every Wednesday from 19:00 to 21:00, and is brought to you by the National Department of Health’s Phila programme. The Phila programme encourages all South Africans to be inspired to live, and is about keeping fit, knowing about your health and body, eating well and taking action about your health in general. Episode 1 of The Steam Room focuses on MSM, or men who have sex with men. GaySA Radio spoke to Johan Meyer, the Health Manager at OUT in Pretoria, a professional service organisation focusing on direct health and mental health services, research, mainstreaming and advocacy for Lesbian/Gay/Bisexual and Transgender (LGBT) people. What is MSM? The term MSM is an acronym for “men who have sex with men”. These men do not necessarily identify as gay, bisexual or transgender, but do occasionally “bat for the other team”, or have sex with men. They self-identify as heterosexual, and many are happily married to women and have children. MSM prefer being in a relationship with a woman, but sometimes feel the urge to have sex with other men. How prevalent is MSM? According to Meyer, it is difficult to get exact statistics about men who have sex with men, as this is a very hidden group. While gay men are out and proud and bisexual men are also gaining more visibility, men who have sex with men are already struggling with questions regarding their sexuality, and have great difficulty in coming out. In addition to this, the community struggles to understand the concept, as it doesn’t clearly fit into any of the boxes regarding sexuality that society has gotten used to. According to OUT’s estimates, there are roughly 40 000 men who have sex with men in Pretoria alone, and Meyer believes that they add to the existing 11% of men who identify as gay. What issues do MSM face? Due to issues like the community’s disregard for this group of people, men who have sex with men often face stigmatisation, discrimination, and are also quite marginalised – in addition to the existing instances of internalised homophobia that are characteristic of many people who face psychological difficulties regarding their gender and sexuality. All of these factors make men who have sex with men an especially difficult group to reach, both for research and statistical purposes and for health services. According to research done by OUT in 2015 to gauge levels of empowerment and to determine the instances of discrimination and stigmatisation in South Africa on a health and justice level, 49% of the just over 2000 respondents who took part in the survey said that they do experience discriminisation and even hate crimes. As men who have sex with men are sometimes even more marginalised than other groups within the LGBT community, one can assume that these people face the same issues. In addition to societal and psychological issues, men who have sex with men may also be at risk of sexually transmitted infections and HIV, as well as general sexual health issues. Because members of this group are often fearful of coming out, they may avoid visiting their family GP or other public health facilities when they experience issues relating to their sexual health. What measures should MSM take? Like gay men in general, men who have sex with men should take special care when engaging in sexual activity with other men. • Use condoms In conjunction with a water-based lubricant, high-quality condoms dramatically reduce the risk of transmitting STIs. Be careful not to use oil-based lubricants, which could dissolve the condom, rendering it ineffective. • Get tested Men who have sex with men are at a higher risk of contracting STIs than MSW (men who have sex with women) and WSW (women who have sex with women), which is why it is highly advisable to get tested for HIV and other STIs every six months, even if you use protection. • Be ready in the moment A sexually active MSM should always have lubricants and condoms at hand, on the off chance that they might have a sexual encounter. • Pay attention Having an open and honest discussion with your partner about your status not only keeps things comfortable, it is also the responsible thing to do. Use enough lube and make sure that the condoms you are using are not damaged in any way. Certain minor things – like not brushing your teeth directly before oral sex (this can cause tiny abrasions which could be passageways for STIs) and paying attention to not aggravate any sore spots in the anal area – will also do a lot to ensure your peace of mind throughout your encounters. • Keep track of your health After engaging in any act of MSM, pay particular attention to your body. In the hours and days following a sexual encounter with another man, keep an eye out for any burning in the genital or anal area, or anything abnormal like rashes or fever. Should anything seem out of sorts, consult with a medical professional immediately, as it’s always better to catch things that are out of the ordinary early.