The Invisible Men: Gay Men and HIV/AIDS
By Gabriel McGowan
August 5, 2008
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This week, the world’s attention turns to Mexico City, where thousands have gathered at AIDS 2008 -- the XVII International AIDS Conference (IAC) -- to discuss the latest developments in HIV/AIDS research, prevention and care. This year’s conference theme, "Universal Action Now," highlights the dangers of HIV-related stigma with a call for programs and policy that are grounded in the realities of an expanding epidemic and not dictated by discrimination or bias. But halfway across the world in Uganda, a very different picture unfolded recently at the annual HIV/AIDS Implementers’ Meeting in June, where more than 1,700 policy and program leaders gathered to exchange information on HIV prevention and care. Three LGBT demonstrators were arrested by police after peacefully protesting an announcement by Ugandan officials that no HIV/AIDS resources would target men who have sex with men (MSM) -- despite recent studies showing that one in four gay Ugandan men may be HIV-positive. One of the protesters was subsequently held, and tortured, by Ugandan police. |
While shocking, the incident reflects a widespread and troubling omission from the global AIDS conversation. Men who have sex with men, who are at heightened risk for HIV infection around the globe, are often left out of key global prevention and treatment initiatives.
"Among LGBT Americans, HIV/AIDS is openly and inextricably linked with the history of our community," explains Dr. George Ayala, executive officer of the Global Forum on MSM & HIV (MSMGF), for which AIDS Project Los Angeles serves as secretariat. "A comprehensive HIV prevention or care plan that excludes MSM might seem unthinkable, but it’s actually quite common."
A recent policy brief from the Joint United Nations Programme on HIV/AIDS (UNAIDS) revealed that fewer than one in 20 MSM around the world has access to HIV prevention, treatment and care -- and the number drops far further in lower-income areas.
The numbers are grim -- if statistics are even available. A recent review of reports from the United Nations General Assembly Special Session on HIV/AIDS revealed that, of 128 lower- to middle-income countries surveyed, 71 percent failed to report whether their MSM population had access to HIV prevention programs. Sixty-two percent did not know how prevalent HIV was among MSM in their country. And only 10 of the countries surveyed could verify that at least 60 percent of their MSM had access to vital prevention programs.
Most countries in the survey spend less than 1 percent of their total HIV/AIDS budget on programs that target MSM, though this group accounts for up to 20 percent of total new infections. Too often, funds are instead allocated to HIV programs targeting the general population, even when a focus on high-risk groups would be the most effective use of limited resources.
And MSM are indeed at high risk. A recent study out of Johns Hopkins University reported that, on average, MSM are 19 times more likely than the general population to be infected with HIV/AIDS in low- and middle-income countries. In some countries, that number skyrockets to more than 100 times. And while 63-85 percent of MSM in Australia, Europe and the United States have been tested for HIV, testing rates in much of Africa, Asia and Latin America are often lower than 20 percent. The epidemic among MSM may also herald its spread to other populations: In Asia, a series of studies routinely reported that 30-50 percent of MSM there also have sex with female partners.
This dangerous disconnect between MSM and the HIV education and services they urgently need is fueled by a political climate of sanctioned homophobia. LGBT people face arrest in 85 countries for openly stating their sexual orientation.
In Central America, sexual minorities are harassed by police and healthcare providers. In China, India and Egypt, they are openly persecuted. And punishments range from life imprisonment in Uganda to death in countries like Mauritania, Sudan and parts of Nigeria.
Throughout the world, threat of incarceration, social hostility, prejudice and other human rights abuses drive MSM away from targeted HIV prevention interventions -- if such services exist at all.
Back in Mexico City, in advance of AIDS 2008, the Global Forum on MSM & HIV has organized "The Invisible Men: Gay Men & Other MSM in the Global HIV/AIDS Epidemic," a two-day forum preceding the conference to address these issues on the international stage. The event is produced by the Global Forum’s Secretariat, AIDS Project Los Angeles.
Throughout this pre-conference, experts are examining how the lack of research on HIV and MSM contributes to a dearth of HIV prevention, treatment and care resources targeting their unique needs. Researchers, community-based experts and human-rights advocates are presenting more than 50 workshops and poster presentations on topics ranging from HIV research among MSM in Africa to prevention strategies with male sex workers in Mombasa and public policy reform efforts in Asia and Latin America.
In all, more than 450 participants from over 80 countries (half from the developing world) will join top officials from the World Bank, the executive director of UNAIDS and the head of host country Mexico’s National AIDS Program to attend the pre-conference.
"The significance of this event cannot be understated," Ayala says. "It’s an opportunity for gay men, other men who have sex with men and our allies to network, share information and re-energize ourselves for the work ahead. This is a powerful statement about the importance of our collective voice."
But once the pre-conference concludes, the focus on MSM and other sexual minorities may not carry through to the IAC. By some estimates, less than 5 percent of the conference’s 596 presentations will center on MSM or transgender issues. Only one of the conference’s 17 plenary speakers will spotlight MSM. And none of the IAC’s 12 special sessions will focus on sexual minorities. This at a conference set in a country where MSM are 109 times more likely to contract HIV than the general Mexican population.
"Our issues remain underrepresented at large international gatherings and conferences on HIV/AIDS," Ayala explains. "Even when epidemiologic and behavioral research indisputably supports prioritizing sexual minorities, there is often a shameful neglect of our needs in discussions about policy, programs and resources, and this only fuels the widening disparity in resources. This is unacceptable and must change."
For more information on MSMGF’s work, visit msmandhiv.org. For more on the Forum’s secretariat, visit apla.org.
Gabriel McGowan is communications specialist at AIDS Project Los Angeles.
© Copyright 2008 by IN Magazine
