Social exclusion and lack of prevention puts MSM at risk

The invisibility of men who have sex with men (MSM) in many low and middle-income countries has contributed to the inadequacy of resources aimed at preventing HIV among them, delegates at the 17th International AIDS Conference were told today.

The criminalization of male-to-male sex, prejudice, social hostility and human rights abuses targeted at MSM have encouraged the spread of HIV, according to the International AIDS Society (IAS).

“Homophobia continues to fuel the spread of HIV in countries with concentrated epidemics and in countries with generalized epidemics alike,” IAS Executive Director Craig McClure told conference delegates.

“This must change. Research has demonstrated over and over again that reducing the social exclusion of [MSM] through the promotion and protection of human rights is not only consistent with, but a prerequisite to, good public health. IAS considers it a major priority to put this evidence into practice – everywhere and now,” McClure said.

MSM have on average a 19-times greater chance of being infected with HIV than the general adult male population in low and middle-income countries. In some states MSM are more than 100 times more likely to be infected than other men.

Henry Neondo, for

In the Republic of Georgia, MSM are about 24 times more likely to be infected than the general population. In Senegal they are 27 times more likely to contract the virus and Mexican MSM are 109 times more likely to be infected than other males.

HIV prevalence rates among MSM populations in some regions have already approached those of sub-Saharan populations, with epidemiological studies indicating that 16% of MSM from Latin American communities are infected.

A review of the UNGASS Country Reports shows that only 10 of 128 countries were able to report that at least 60% of MSM had access to HIV prevention programs.

While the situations varies, resources allocated to MSM-focused HIV prevention and care in most regions are seriously disproportionate to the number of men infected. Most countries in Asia, for example, spend less than 1% of their HIV and AIDS budgets on MSM while between 5% and 20% of new HIV infections arise from sex between men.

"Perhaps the most dangerous misperception in relation to men who have sex with men and HIV is that the overall downturn in the HIV epidemic and the increase in rights won by gay men and lesbians in the West are a reflection of the true state of affairs of gay, bisexual and other MSM globally," said Global Forum on MSM and HIV Co-Chair Robert Carr.

"In fact, nothing could be further from the truth. Gay, bisexual and other MSM are largely invisible in many parts of the developing world, and in the majority of cases subject to varying degrees of discrimination, violence and human rights abuses."

Experts believe that the emerging consensus over the link between vulnerability stemming from rights abuses and the increasing impact of HIV and AIDS on MSM means new models of challenging social exclusion must be found.

“Twenty years experience in some high income countries and a few global south countries clearly indicate that the three keys to reducing HIV among gay men and other men who have sex with men are first and foremost, creating a safe, supportive environment; second, supporting grass-roots community organizations, and third, investing in comprehensive programs,” said Carr.

“A peer-based approach to designing effective and locally appropriate HIV prevention and care programs ensure that MSM infections are kept low but these programs cannot operate effectively in a hostile or discriminatory environment,” he said.

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