Across Africa, HIV infection is significantly higher in some groups. In Senegal, homosexual men are 10 times more likely to be HIV positive than the rest of the population. Phuong Tran reports from Dakar on the challenges of preventing HIV in a mostly hidden community.
In Senegal, homosexuality is considered a moral crime punishable by up to five years in prison and a $3,000 fine.
Abdou Houdia Diop - a doctor at a sexually-transmitted disease clinic run by the Senegalese Ministry of Health - says societal, religious and legal disapproval of homosexuality drives many underground.
"Since homosexuals are a hidden group, it is difficult to treat them, and it makes it difficult to manage their treatment because they may not want to get tested or to come for their test results," he said.
Serif is a 28-year-old homosexual man who works with health officials to get the word out about prevention services to other homosexual men, also known in the health field as MSM, or men having sex with men.
"The life of a homosexual man in Senegal is difficult because he is always forced to hide his identity, his needs. He lives in perpetual fear, in hiding from his family, his colleagues, even health centers," said Serif. "If I were to make known that I am homosexual, I risk being physically attacked. It has already happened."
Dr. Diop recognizes the fear these men have when coming to his center, but says they should not be afraid.
"Some men come in with anal problems, but they do not want to be open because they fear that a doctor will make the correlation between their condition and their sexual practice," he said. "But health professionals are here to treat them for whatever sexually transmitted diseases they may have, and their partners, to prevent a chain of infection."
Diop says there is a high risk the virus can jump from homosexuals to the general population because almost all his patients are bisexual, often because of pressure to appear heterosexual.
"No one knows who is an MSM [men having sex with men]. Sometimes, people will be living with MSM's without knowing their status," he said. "There are MSMs who are married, who have girlfriends and their partners will not know that they are MSM. If an MSM is sick, he can transfer it to his partner."
The director of Senegal's Sexually-Transmitted Infection Division in the Ministry of Health, Abdoulaye Sidibe Wade, estimates his division treats about 2,000 male homosexuals, nationwide.
Wade says this is only a small fraction of the actual homosexual population, because most do not seek HIV services.