In many parts of the world, men who have sex with men (MSM) remain the group most heavily impacted by HIV/AIDS. UNAIDS data from 2000 shows that the HIV prevalence among MSM is about 25% in Latin America, close to 10% (and climbing) in Asia, and about 7% in Eastern Europe. Even though there is a dearth of data on the role of MSM in the epidemic from Africa, we do know that in several African cities 20-40% of MSM are HIV positive compared to the general population rate of 0.2-6%.1 Pervasive anti-gay stigma on all continents, however, may inhibit self-reporting of homosexual behavior, so rates may be significantly higher.
Among gay men and other MSM, the need to address HIV related concerns comes with the need to confront stigma, discrimination, violations of human rights, homophobia, heterosexism, and poverty -- the universal issues commonly found to be root causes of the epidemic. Some countries face additional challenges, such as deep tensions between church/religion and state, political and economic instability, weak health care infrastructures, significant challenges in data collection, and anti-sodomy laws.2 Even in 2008, gay men and MSM face arrest if they overtly state their sexual orientation in 85 countries around the world.3
In various countries of Latin America and the Caribbean, for example, laws prohibit "acts of gross indecency" (which may be interpreted as any kind of physical intimacy) between men in public or private. The penalties associated with expressions of same-sex behavior include imprisonment. Such laws lead to widespread intimidation and harassment of gay men and MSM by law enforcement and health care providers.4 Laws are also misused to target and harass gay men in India, China, and Egypt.
Two thirds of African countries ban homosexual sex or, at least, male-to-male sex. Punishments include imprisonment (five years in Cameroon, Senegal, and Ghana; life in Uganda) and death (Mauritania, Sudan, and parts of Nigeria).5
In addition to criminalization, current HIV prevention efforts are not effective in reaching MSM, to the detriment of both men and women. Limited research in Kenya and Ghana has shown that men who have sex with men in Africa do not consider themselves at risk for HIV, since all of the prevention messages thus far have focused on heterosexual couples.6,7
Many men who have sex with men also have sex with women, thus contributing to the risk women face.8,9
Even in countries where homosexuality has been officially decriminalized, lingering homophobia can be equally destructive. The countries of the former Soviet Union remain rife with homophobia, regardless of the decriminalization of homosexual conduct.10 In recent years, nationalists, neo-fascists, and religious fundamentalists have attacked gay pride rallies in Poland and Russia.11 Political leaders in Moldova, Latvia, and elsewhere have attacked gay people and gay rights as western cultural imports alien to local values.12
Catalysts for Continued Change
- The Global Forum on MSM and HIV
At the 2006 International AIDS Conference (IAC) in Toronto, an international network of civil society groups, AIDS organizations, MSM groups, and other agencies formed the Global Forum on MSM and HIV to address this question. This network advocates for improved HIV programming for MSM at the global, regional, and national levels. It works to increase the body of literature about MSM and HIV, with research that is localized and that supports MSM-related advocacy; to secure a long-term commitment to fund MSM programs by public and private donors; to create opportunities for new networks to exchange ideas; and to promote collaborative work among countries and regions. The Global Forum on MSM and HIV also raises human rights concerns affecting MSM, promotes MSM issues at relevant international meetings, and encourages MSM participation in them.
With support from its Secretariat, housed at AIDS Project Los Angeles (APLA), the Global Forum on MSM and HIV is planning a satellite event August 1st and 2nd 2008, preceding the IAC in Mexico City. The goals of the event are to share information; develop strategies for expanding research and resources for HIV prevention, treatment, and care among MSM; and enhance advocacy campaigns to address the repressive laws and policies that underlie data, resource, and service shortages.
- International Programs
APLA recently collaborated with the Coalition of Gay Organizations in Central America (CONGA) to produce the publication No más en el Tintero: Hombres Gay: Nuestras Vidas y el VIH en Centro América y el Caribe (No Longer in the Inkwell [Closet]: Gay Men: Our Lives and HIV in Central America and the Caribbean). No más en el Tintero documents repression of gay men and MSM in an area where corroborating evidence is difficult to generate or difficult to access where available. APLA released the study in November 2007 in Nicaragua at the CONCASIDA Conference (Central American Conference on HIV).
APLA is also analyzing MSM and HIV in China, working closely with local partners to identify training, research, and capacity building opportunities.
For more information about the Global Forum on MSM and HIV, please visit www.msmandhiv.org.
Evelyn González-Figueroa is Associate Director of Programs at APLA. Thanks to Hamad Sindhi, GMHC Public Policy intern, for research assistance.
- Johnson, C. A. Off The Map: How HIV/AIDS Programming is Failing Same-Sex Practicing People in Africa. New York: International Gay and Lesbian Human Rights Commission, 2007, 32-33.
- Roberts, L. & Cohen, J. Learning to Live with HIV; HIV/AIDS: Latin America & Caribbean. Science (2006), 313, 467-490; Coovadia, H.M., & Handingham, J. HIV/AIDS: Global trends, global funds and delivery bottlenecks. Global Health (2005), 1, 13.
- Baral. S., Sifakis, F., Cleghorn, F., Beyrer., C. Elevated Risk for HIV Infection among Men Who Have Sex with Men in Low- and Middle-Income Countries 2000-2006: A Systematic Review. Public Library of Science (PLoS) Medicine, 4(12): e339. doi:10.1371/journal.pmed.0040339.
- Medina, EJ, Toro-Alfonso, J., and Baños. No Más en el Tintero: Hombres Gay: Nuestras Vidas y el VIH en Centro America y el Caribe. Los Angeles: AIDS Project Los Angeles-International Programs and Coalition of Gay Organizations in Central America (CONGA), 2006.
- Johnson, 2007.
- Focused discussion groups conducted by the International Gay and Lesbian Human Rights Commission (IGLHRC), Accra, Ghana, September 20, 2006, Mombasa, Kenya, June 9, 2006; as cited in Johnson, 2007.
- International HIV/AIDS Alliance (United Kingdom). Meeting the Sexual Health Needs of Men Who Have Sex with Men in North Africa and Lebanon (MSM/MALE Project):1; 2006; as cited in Johnson, 2007.
- UN Human Rights Committee, Communication No. 488/1992: Australia. 04/04/94. CCPR/C/50/D/488/1992. (Toonen v. Australia, date of communication: Dec. 25 1991); as cited in Johnson, 2007.
- Horizons Program, Kenya, 18; Horizon Program, Senegal, 11; as cited in Johnson, Off The Map (IGLHRC, 2007).
- MacDonald, Linda. Homosexuality and the law: How attitudes vary across Eastern Europe. The Guardian. June 1, 2007.
- Human Rights Watch. We have the Upper Hand-Freedom of assembly in Russia and the human rights of lesbian, gay, bisexual and transgender people. New York: Human Rights Watch, June, 2007; Human Rights Watch. Uzbekistan: Release Imprisoned Rights Defender. Human Rights News. January, 2004. New York.
- Agence France Presse. "Climate of hate" stalks former communist Europe's gays. June 10, 2006. Warsaw.
- Greenwood, Phoebe A. Crucible of Hate: All across Europe, gay people are demanding equality. But in Russia, Poland and Latvia, their growing confidence is being met with violent resistance from nationalist and religious groups. What lies behind this hysteria? The Guardian. June 1, 2007.
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