MSM and Funding for HIV/AIDS Prevention

The XVII International AIDS Conference ended yesterday in Mexico City. Two leaders from the support group here in Trujillo received funding to attend the conference, and I'm looking forward to hearing all about it from them. In the meantime, an AP article today brought up some issues that are very relevant to combating HIV/AIDS here in Honduras.

In "Global AIDS prevention gives short shrift to gays" reporter Julie Watson writes that "less than 1 percent of the $669 million reported in global prevention spending targets men who have sex with men."

This is despite the fact that "new HIV infections among gay and bisexual men in many countries are rising at alarming rates," and that in many countries the infection rate among men who have sex with men (MSM) is double or triple that of the general population.

In many developing countries, homosexuality is taboo or even illegal. In some places it is punishable by death. Some countries (like Iran) deny that homosexuality even exists. This kind of eyes-closed-and-fingers-in-the-ears denial of reality makes it impossible for public health professionals and institutions to spend prevention resources on one of the populations that most urgently needs it. On top of that, discrimination drives gay and bisexual men underground, making it extremely hard for health workers to reach them.

Ms. Watson goes on to write:

Complicating matters is that in countries from Latin America to Southeast Asia, many men who have sex with men, insist they are not gay. More than 30 percent of Latin American men who reported having sex with men said they also had unprotected sex with women, according to UNAIDS. Many are married.

This is exactly true for Honduras. According to official statistics, nearly 85% of new HIV infections were transmitted through heterosexual contact. In reality, these numbers are almost certainly untrue.

One problem is how the statistics are gathered (when they're gathered at all, which is another huge problem). A person who goes to get tested at a public hospital or health center must fill out a form in which they are asked to state their sexual orientation. This form is filled out in front of the health worker (who is often someone from the same community). Although confidentiality is required by law, it is never practiced. Anyone identifying themselves as gay or bisexual on one of these forms would basically be coming out to their entire community by doing so.

Also, many men who have sex with men never self-identify as homosexual or bisexual. According to machista culture, you're not gay if you're on top, or if you're really drunk. As is stated in the article, most men are married and in many cases don't find out about their own HIV infection until their wives become pregnant and are tested for HIV as part of their prenatal care.

I'd like to say that I know of organizations here that specifically reach out to MSM, but I can't. I'd bet there are some in the larger cities, where homosexuality is more accepted. But in smaller cities and towns, there's nothing. I'm sure that some of the NGOs and GOs that do HIV/AIDS prevention would like to work with MSM, but because it is still so stigmatized here, it's very difficult to reach the population that doesn't want to be discovered.

The article touches upon some strategies for combating HIV among MSM populations. To navigate stigma and taboos, health workers can use sensitive or even coded language in order to ask about homosexual contact without scaring people away. Surveys that quantify infection rates among MSM can help convince public health authorities that action needs to be taken. But most importantly, the stigma and taboos need to be broken down - through education, advocacy and the examples set by those who are willing to go public about their HIV status and their sexuality. We in the support group have focused more on combating the stigma of HIV infection, since on the north coast homosexuality is less stigmatized than in other parts of the country. But I think the support group members who are open about their status and their sexuality have done more to reduce stigma than any public education campaign we might do.