Coordinated advocacy efforts are needed to change the attitudes of individuals, families, and communities. To maximize their effectiveness, these efforts must engage gay men and MSM, including those with HIV. Universal access to HIV treatment cannot be achieved unless social, legal, and policy environments protect the rights of gay men and other MSM.
Adopt a human rights-based approach to tackling social discrimination.
Governments should adopt these guidelines:
- International Guidelines on HIV/AIDS and Human Rights: These guidelines are consistent with fundamental human rights and should constitute the core of any national AIDS strategy.
- Yogyakarta Principles (Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity): A key policy tool for the advancement of legal reform toward full equality of all people, regardless of sexual orientation or gender identity.
- UN Statement on Sexual Orientation and Gender Identity: Reaffirms the universality of human rights, condemns human rights violations based on sexual orientation and gender identity, and calls on states to ensure that sexual orientation and gender identity are never grounds for criminal penalties.
Advocate for legal reform.
Communities must partner with global health bodies, human rights organizations, and legal institutions to repeal existing and emerging criminal laws and other policies targeting lesbian, gay, bisexual, and transgender people.
- Criminalization of same-sex acts must be repealed to create an environment that allows MSM free access to HIV services and information.
- Other laws that may be used to target MSM and other sexual minorities must be repealed, such as public assembly laws, loitering or public nuisance acts, public indecency laws, and age-of-consent laws that are stricter for same-sex acts.
- Antidiscrimination laws related to HIV, sexual orientation, and gender identity must be enacted to protect the rights of MSM and increase their use of social and health services.
Build capacity for responsive health service delivery systems.
MSM are typically "hard to find" by health systems, but this can be addressed by working with community-based organizations. Primary and specialized health care should be readily available to MSM. Creating awareness of the health and social care needs of MSM among health care providers must be part of strengthening health systems.
- Provider education on stigma can help MSM obtain care without fear of discrimination or harassment.
- Training programs must be organized to dispel myths that providers may have about working with MSM, including those with HIV.
- Guidelines for health care for MSM and professional education on their issues should be routinely made available to all health care providers, from doctors to lab technicians.
- Professional health care associations should ensure that their codes of conduct address sexual minorities and people with HIV, and that they include freedom from discrimination in health care settings and human rights protections. Health care associations should actively speak out against policies that result in negative health outcomes for MSM.
Ensure access to the legal system.
MSM in many countries have no recourse to justice when their rights are violated. In order to address their health care needs, they must be able to assert their rights through the legal systems that are available to the broader community.
- National governments, policy makers, and civil society must create an environment in which victims of discrimination or hate crimes may freely and confidentially obtain legal services.
- Advocates must be helped to create safe spaces where MSM can obtain support in their communities and can receive support from each other. This includes supporting the creation of MSM organizations.
Increase anti-stigma work.
Anti-stigma initiatives are critical to improving access to HIV services and enabling MSM to take charge of their own health.
- National governments and donors must finance programs that combat stigma, discrimination, and violence against MSM.
- Donors should provide funding to groups that support MSM. Such organizations are in a position to act as both watchdogs and service providers, and play a key role in empowering communities to take control of their lives and advocate for change.
Develop more evidence on stigma.
Limited data exist about interventions that lessen the impact of stigma and discrimination on MSM. The "People Living with HIV Stigma Index" is a significant development, gathering data from groups of people with HIV to better understand the nature of stigma. The Stigma Index will help evaluate trends in relation to interventions.
- A comprehensive study of stigma interventions must be done regularly, and "best practices" shared globally.
- Data on stigma, with attention to MSM, should be used to advocate for policy and funding changes that more effectively target the response.
- Resources must be used to scale up interventions that have been proven effective.
- Knowledge gained must be shared among all stakeholders involved in sexual rights and HIV policy.
Coordinate strategic communication.
Messaging strategies must be informed by the personal and collective experiences of MSM.
- The role of the media and its impact on public opinion and policy cannot be overestimated. Regional and global media should be engaged in raising public awareness and addressing hostile attitudes toward MSM.
- Educational strategies designed to promote reporting of discrimination, homophobia, and violence must be developed and implemented.
Adapted from "Social Discrimination Against Men Who Have Sex With Men (MSM): Implications for HIV Policy and Programs" by The Global Forum on MSM & HIV (MSMGF). Charts used with permission from MSMGF.