The HIV pandemic has historically been thought of as either concentrated in specific populations—such as gay men, injection drug–users, sex workers—or generalized across the entire population in sub-Saharan Africa and the Caribbean. But as more and better epidemiological data has become available, the evidence is clear: men who have sex with men (MSM), regardless of whether or not they identify as gay, also are at the core of those generalized epidemics.
MSM in developing countries are 19 times more likely to be infected with HIV than the general population, according to a 2007 literature review.
Even in Africa, at the heart of the pandemic, in Malawi, 21 percent of MSM are infected with the virus compared with 11 percent of the general population, whereas Zambia's rates are 33 percent versus 15 percent, respectively, says Chris Beyrer, director of the Johns Hopkins Center of Public Health and Human Rights.
"The argument that gay and bisexual men are a trivial sideshow in the global fight against AIDS is wrong," he told the Global Forum on MSM and HIV, an advocacy network that met this summer prior to the International AIDS Conference in Vienna, Austria.
That epidemiologic evidence has largely have been ignored by most nations' plans for HIV prevention and care. Cultural values—machismo, homophobia and religion have overridden the data and dominated policy decisions in many places; most recently in the news are Uganda and Malawi.
Some 85 countries still criminalize sexual activity between adults, and eight, including Nigeria and several Islamic countries, impose the death penalty for homosexual acts. Uganda has been embroiled much of the past year in a debate about whether or not to write such a death penalty into their statutes, with evangelical Christians, both local and in the U.S., fanning the flames.
A recent survey of 303 MSM in Kampala, Uganda, found that 37 percent had been physically abused at some point in their lives, 37 percent had been blackmailed and 26 percent had been forced to have sex, according to Joseph Barker, a researcher with the U.S. Centers for Diseases Control and Prevention (CDC).*
Even more troubling, members of this group were five times more likely to be infected with HIV. The overall HIV prevalence was 4.5 percent in adult males in Kampala, 13.7 percent among those participating in the survey and 22.4 percent among those who had experienced violence.
"We have a situation where laws and their arbitrary, inappropriate enforcement are increasing risk and vulnerability—thereby imposing barriers to effective HIV responses for those most vulnerable and the general population," says Jeffrey O'Malley, director of the United Nations Development Programme (UNDP) HIV Group.
Joint United Nations Programme on HIV/AIDS (UNAIDS) Executive Director Michel Sidibe says discrimination against MSM is a human rights issue and unacceptable. But his message seems to be compartmentalized, reserved for preaching to the choir of those working with MSM; his speech to the Global Forum is absent from the UNAIDS Web site.
The recent International AIDS Conference reinforced the trend: Just 2 percent of presentations focused on gay and bisexual men, according to George Ayala, executive officer of the Global Forum.
This trend toward scientific omission has reinforced local social stigma and violence directed against this minority. The results are an amplification of new infections that might otherwise have been reined in, and a continued expansion of the pandemic.
The epidemic in Peru is concentrated among MSM, and the government there is one of the few that has used this information to direct its prevention funding toward that population. It also changed other policies such as stopping the harassment tactic of police raids on gay clubs to help to build trust between the government and community as well as allow for a better delivery of HIV prevention messages.
Peru has demonstrated what can be done, says Steve Morin, director of the Center for AIDS Prevention Studies at the University of California, San Francisco. "There was a need to develop a gay community identity and a human rights movement in order to organize an HIV response," he says.
Robert Carr, director of the International Council of AIDS Services Organizations in Toronto thinks that only a comprehensive HIV program that focuses on human rights will overcome the cultural biases that are inhibiting development of effective programs to reach MSM.
He says HIV programs for MSM must concentrate on key institutions such as the media and government policymakers; confront religious leaders and their claims that homosexuality is both a sin and a legacy of Western colonialism; independently fund agencies serving MSM; and bring the force of U.N. agencies to bear in support of human rights and good governance.
*Correction (11/15/10): This sentence was edited after posting to correct the spelling of Joseph Barker's name.
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23 Comments
Add CommentDid I understand this article correctly? MSM is highly correlated with AIDs yet the author seems to be saying countries that have laws against MSM should be removing those laws. How about men not having sex with men thereby eliminating all AIDs that results from that sex?
Reply | Report Abuse | Link to thisNo- it is obvious that you have not understood any of this correctly, RDH. In fact, words cannot adequately describe how ridiculous your response really is. Your notion of men just 'no longer having sex with one another, problem solved' is the epitome of ignorance.
Reply | Report Abuse | Link to this@RDH - please read this "This trend toward scientific omission has reinforced local social stigma and violence directed against this minority. The results are an amplification of new infections that might otherwise have been reined in, and a continued expansion of the pandemic."
Reply | Report Abuse | Link to thisThe article is suggesting that by including research covering AIDS and MSM that this will decrease public stigma, violence, and new infections. Indeed - the author demonstrates how this was successful in Peru.
I think you missed the second page of the article. It's good stuff.
In the Victorian era England, they decriminalized homosexuality because they found that by keeping homosexuality illegal, it increased a greater social ill: Blackmail.
Reply | Report Abuse | Link to thisIt follows suit that by encouraging a public discourse on MSM, destigmatizing homosexuality, and encouraging harm reduction will best reduce the violence and new infections.
With the apparent abandonment of ANY social consequence to same sex "marriages" it should be of no surprise that the number of HIV positive cases has risen, and will continue, to rise, to pandemic standards.
Reply | Report Abuse | Link to thisSpiff
Hey Spiff,
Reply | Report Abuse | Link to thisHIV/AIDS is already pandemic, and it's spreading most through heterosexual sex.
That much aside, the article deals with rising levels of HIV transmission with MSM. It suggests that with more education and de-stigmatization, that the rates will decrease. See Peru.
I'm glad that we're both concerned with decreasing HIV rates though! Opinions are nice, but if you don't back them up, they're nothing more than a fart in the wind.
Cheers mate,
C
ridiculous comment, RDH. For one thing, eliminating stigma gets people who might not seek treatment for HIV to do so. Treating HIV to undetectable viral load levels mean that spreading HIV becomes much, much, less likely--some believe it's even unlikely.
Reply | Report Abuse | Link to thisThe world population is unsustainable. The only way to save the species is to shut down all medical research, close all hospitals, de-register all doctors. Allow Darwinian selection or accept extinction.
Reply | Report Abuse | Link to thisWe can consider returning to intervention when biodiversity returns in a couple of thousand years.
ChrisTMC. It may not completely solve the problem immediately, but correcting the immoral behaviors including homosexuality and IV drug use and promiscuity would have a tremendous impact on curbing HIV.
Reply | Report Abuse | Link to thisThe idea that stopping the "immoral" behavior that is homosexuality will decrease the spread of HIV is slightly contradicted by the low spread of HIV among lesbian populations. Are lesbians not immoral but MSM are?
Reply | Report Abuse | Link to thisNo, there is no contradiction. Not all immoral behavior results in the spread of HIV, but some does, as I listed. Stealing is immoral, but it does not spread HIV. Homosexuality of the guy-guy type, promiscuity, and IV drug use are immoral and undeniably increase the risk of HIV.
Reply | Report Abuse | Link to thisED2: you forget that in Africa HIV is a heterosexual epidemic and yet somehow that doesn't fit into your concerns about homosexuality and IV drug use.
Reply | Report Abuse | Link to this@Chris TMC
Reply | Report Abuse | Link to thisWhat is wrong with you? How does that hostile answer help anyone? Please regard croftinator's response as a stirling example if you're unsure of how to respond to these situations in the future.
Right on scientific earthling! To somewhat repeat:
Reply | Report Abuse | Link to thisMy first concern is with ever-increasing population and all it's environmental effects. Strictly from that perspective, MSM don't make babies; if they're not careful they may get AIDS and die; in some countries and cultures, if they're caught they die sooner. Allowing us to evolve adaptations to AIDS is the only way we're going to cure it permanently, or to control population.
The more compassionate and preferred view favors 'universal love' and free expression of same between everyone in every mode of relating, as well as extensive use of every possible means to control disease and reduce population .
The only disturbing fact I have realized about gay men and aids is the recent program re-aired on Canadian television covering the new trend for gay men to WANT to be infected with aids! Besides well-to-do gay men having "Lets get Aids Parties", many young men are actually seeking out partners that have aids so that they no longer have to fear becoming infected with it. The parties were shown and described as a commonplace event for all gay men to get together and have sex several times with anyone/everyone at the parties. Condoms are banned at these parties. When I saw this documentary, I swore I would never give one red cent to the cure for Aids unless these particular morons were interviewed prior to treatment and banned from any and all treatment related to the taxpayers dollars. I know this does not reflect on issue in the article but, I just wandered how many readers are aware of this repulsive and derelict behavior.
Reply | Report Abuse | Link to thisI like your view scientific earthling besides,global warming will drive our species to extinction anyway
Reply | Report Abuse | Link to thisIn spite of unparalleled resource commitments and substantial progress made in the fight against HIV/AIDS, much more work needs to be done to stem the epidemic among gay men and other men who have sex with men (MSM). Through its MSM Initiative, amfAR has learned that, by working with local, community-based programs and organizations, we can reach these vulnerable groups in environments where governments are either indifferent or hostile toward them. While we all must continue to help add to the paucity of research the reporter mentions, community-based groups will continue to improve the lives of MSM around the world as long as they receive support from governments and donors. amfAR details some of this courageous work in a report issued around the International AIDS Conference last month its worth a read: http://www.amfar.org/world/msm/article.aspx?id=8885
Reply | Report Abuse | Link to thisTo Amfar-out.
Reply | Report Abuse | Link to thisYou are just another crybaby adding to the cesspool of fools! There is nothing courageous about people keeping stupid people alive and well for reasons that are entirely caused by their own illicit reasons. I am not speaking about the poor people that infected with aids through the derelict actions of others and without their knowledge or bad behavior. The government assistance that is given to these people is out of my pocket. How has one sex related disease become a top priority in our lives? I am an atheist so my attitude is not related to right or wrong. It is the common sense and reasoning that allows people to make an appropriate decision. If you want to stick your D--- in something, you have to retrieve it on your own and whatever goes with it. It should be criminal to even ask me to pay for assisting you with your post climax problem. Should you pay for me to have lifetime therapy and medical care after I had sex with someone that left me unsatisfied, turned me into a sex addict or made me pregnancy; same thing. Keep it in your pants or pay the bill! Oh, crybaby, find a truly needy cause.
Daniel35: MSM have babies. What part about men engaging in sex with women as well as men don't you understand?
Reply | Report Abuse | Link to thisdaij whatever - lesbians don't generally use biological penetrating object for sex. Broomstics and other utensils might do the trick but unlike most toilet plugers they don't carry bacteria and viruses.
Reply | Report Abuse | Link to thisMen who have sex with men (MSM) have been neglected in HIV programming in sub-Saharan Africa, frequently ignored in national strategies and hidden in the face of intolerance, stigmatization, and punitive laws. In Ghana, community-based organizations have been at the forefront of HIV interventions for MSM. Among the small number of CBOs working with this highly vulnerable population are the Accra-based Center for Popular Education and Human Rights, Ghana (CEPEHRG) and Maritime Life Precious Foundation (Maritime) in Takoradi. With the support of PEPFAR, these two organizations have been part of much-needed efforts to reach MSM with prevention messages, condoms, and lubricant and to increase uptake of HIV-related services using cell phone-based communications.
Reply | Report Abuse | Link to thisTo learn more about these pioneering programs, visit: http://www.aidstar-one.com/case_study_cepehrg_and_maritime_ghana
1) People have sex. Your not going to change that.
Reply | Report Abuse | Link to this2) Ingoring gays doesn't mean they are not there, and even countries with death penalties have gay populations in predictable numbers. It's a biological phenomena that's not going away.
3) Discouraging gay couples only encourages closeted sex. And when you make it so that people can't realistically settle down or even give names / be seen ... it usually only leaves anonymous sex with ever changing partners. It hugely increases STD rates among gay men. Even for individuals, even just taking into account parents, gay kids with accepting parents, as opposed to anti-gay parents, are magnitudes less likely to get HIV as adults.
4) Be anti-gay enough, and many gay men will have a girlfriend / wife as cover. It's needed to survive in those cultures, but that also means more risk for heterosexuals.
5) If every person with HIV was put on retrovirals, the disease would be virtually non-existent in a generation or two. It's very hard to spread with undetectable viral loads. Many millions to one kinda stuff, even with unprotected anal sex. Now i know you cant get EVERYONE on the drugs, but promote commitment and safe sex on top of that and your golden.
You are actually suggesting that the promotion of commitments like marriage INCREASES STD rates?
Reply | Report Abuse | Link to thisI think even you wouldn't be shocked to find out that married couples tend to have lower STD rates than people who are punished or even killed for settling down (like closeted gays in anti-gay communities who can't risk relationships more substantial than anonymous sex with passing strangers).