Responding to HIV among MSM: the challenges

Responding to HIV among MSM: the challenges

In the early years of the global AIDS epidemic, it was widely acknowledged that HIV was having a severe impact on MSM in the US and other developed countries where there were visible communities of self-identified gay, lesbian and bisexual people. This led to swift grassroots responses from gay activists, often with support from national governments who realised that carrying out HIV prevention campaigns aimed at gay people was not only the right thing to do on humanitarian grounds, but also something that made sense as a wider public health measure. These early prevention efforts (which included condom promotion and educating men about AIDS) were very successful, and helped to reduce the number of MSM becoming infected with HIV in a number of countries.

HIV prevention poster aimed at MSM in New Zealand

In recent years however, the impact of these interventions has leveled off and HIV is becoming common among MSM in many developed countries. It has also become increasingly clear that there is a desperate need for HIV prevention initiatives aimed at MSM in developing regions such as Asia, Latin America and Africa. However, very few countries in these regions are making sufficient (if any) efforts to stem rising rates of HIV among MSM. Globally, fewer than one in twenty MSM have access to appropriate HIV prevention, treatment, care and support services.⁸

A major reason for this shortcoming is the fact that many countries (87 according to a 2007 report ⁹) have laws banning same sex relations. Where such laws are in place, governments are unlikely to promote any sort of HIV interventions aimed at MSM. Groups or individuals who do try to carry out such campaigns, as much as MSM themselves, may face violence or arrest:

"The police caught me and hit me. They didn’t even give me a chance to explain... I said I was working for HIV/AIDS prevention. They asked to see my ID card but I had forgotten it that day. They took me to jail. After I promised that I would never go to cruising spots again, they let me go." - HIV prevention worker working with MSM in Bangladesh ¹⁰

This kind of discrimination from authorities is sometimes also apparent when MSM who are already living with HIV try to access testing or treatment facilities:

“Our biggest problems are the police and doctors. Many [MSM] people we work with are poor – daily wage-earners – and cannot afford expensive private doctors. When they go to a government health clinic, the doctors taunt them about their sexual preferences. Many prefer to remain untreated rather than suffer discrimination and humiliation." - Christopher Jayakumar, head of the Andhra Pradesh Male Minorities Association, India¹¹

Discrimination such as this stops MSM from revealing their same-sex relations, and may force them to meet potential partners in places that are hidden from the general public. This can make it very difficult to reach them with HIV prevention campaigns.

Experts argue that governments and societies need to adopt a less discriminatory approach if HIV prevention efforts aimed at MSM are to work. This includes repealing laws that criminalise sex between men, introducing laws to reduce human rights violations, and making greater efforts to change public perceptions of MSM. Even in countries where the rights of MSM are legally respected, there is generally a greater need for more commitment towards tackling the problem by donors and governments, as the amount of money put towards campaigns aimed at MSM is often disproportionate to the scale of the problem.

Crucially, more research into the impact of HIV on MSM – particularly in developing countries – would lead to a much greater understanding of the situation and make it much easier to take appropriate action.

"The frightening truth is that, in many parts of the world, we simply do not know how bad the epidemics among MSM groups may be… transmission among MSM is still not tracked in most countries, resulting in a significant research gap. More research is urgently needed to inform more effective HIV prevention efforts.” - Dr. Chris Beyrer, director of the Johns Hopkins Fogarty AIDS International Training and Research Program ¹²