July 23, 2012
Men who have sex with men(MSM) remain at substantial risk for HIV infection in almost every nation across the globe. The situation is even more glaring in highincome nations such as the United States, France, the United Kingdom and Canada -- where overall HIV trends are declining except among Black MSM. And in many nations, discrimination, stigma, and criminalization laws present significant barriers to creating an AIDS-free generation.
These were just a few of the themes at Stigma to Strength: Strategies for MSM, Transgender People and Allies in a Shifting AIDS Landscape, the day-long pre-conference to the 19th International AIDS Conference sponsored by the The Global Forum on MSM & HIV. More than 800 delegates from 100-plus countries attended to discuss the health and human rights of MSM and transgender people, according to conference organizers. This was the International AIDS Conference's fifth biennial pre-conference and the largest so far.
The forum opened with a plenary speech by Congresswoman Barbara Lee, the California Democrat and fierce advocate for HIV/AIDS funding. Lee recently introduced landmark anti-HIV criminalization legislation.
The Global Commission on HIV & the Law's Michael Kirby also spoke, slamming homophobic bias in research and prevention. "Homophobia is so irrational and unscientific," Kirby said to much applause. The United Nations-backed panel released a report two weeks ago that found punitive laws in more than 60 nations that criminalized HIV transmission or exposure "cost lives and stifle[d] the global AIDS response."
One young delegate from Nigeria agreed. "It's critical that we ensure people get comprehensive HIV prevention and other health services," said Olumide Makanjuola, the director of programs at The Initiative for Equal Rights, an Abuja-based NGO that advocates for sexual minorities.
Nigeria is one of four African nations that boast the death penalty for same-sex behavior -- and legislators recently considered more extreme legislation. "LGBT health rights are routinely violated in Nigeria," added Makanjuola.
Perhaps the most compelling research was announced by Kevin Fenton, M.D., Ph.D., director of the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Dr. Fenton reminded the audience that there has been a soaring number of seroconversions among Black American men who have sex with men -- and new data show that "globally Black men who have sex with men are 15 times more likely to be HIV-positive."
The new data was published in the special July 2012 "HIV in Men Who Have Sex with Men" issue of The Lancet. The lead author: White House Office of National AIDS Policy's Gregorio Millett. Other contributors include Dr. Fenton, Emory University's David Malebranche, M.D., MPH, and Columbia University's Patrick A. Wilson, Ph.D.
"We see the tremendous variation from Africa to Canada, the Caribbean and elsewhere," said Dr. Fenton. "The most glaring disparity is in the United States."
But the "tide is turning" against the epidemic and there is finally potential that "we can have an AIDS-free generation" -- even among Black gay and bisexual men -- Dr. Fenton said after the preconference. "That means we have a range of highly effective tools in which we can bring this epidemic to an end. Now the real work begins of implementation, scaling up and targeting different tools to those communities at most risk."
Last week, the Food and Drug Administration approved the antiretroviral medication Truvada to reduce the risk of HIV infection in uninfected individuals, a strategy is known as pre-exposure prophylaxis (PrEP). Daily use of the cocktail -- a combination of Truvada and/or Viread -- has shown up to 75 percent efficacy in preventing HIV transmission.
This could ultimately become a powerful tool to use among Black gay men -- but with a major disclaimer. Adds Dr. Fenton: "PrEP is not going to be effective for everyone. We're going to have to target this to men who are at greatest risk for infection and are willing to take the medication as directed. And we've learned from various studies that adherence to the medication is critical. "
The MSMGF event also featured more than 20 breakout sessions. One that expanded on Fenton's plenary was "Strengthening the Response to HIV/AIDS among Ethnic Minority MSM and Transgender People in the Global North." Dr. Wilson moderated and panelists included Andrea Lamour-Harrington, a transgender black women who represented U.S. Positive Women's Network.
Lamour-Harrington was a public face to the "extreme" socioeconomic disparities faced by Black trans women, who are more than likely to be killed, suffer violence or sexual abuse, HIV/AIDS and discrimination.
"There are so many laws on the books that allow police to harass us," said Lamour-Harrington. "In Philadelphia there is a law called Obstruction of Highway.' Police can search me or ask for identification if I'm standing on the street. Most of those arrested are Black and Latino trans women. And the only way we can change these laws are through conferences such as these."
Rod McCullom has written and produced for ABC News and NBC, and his reporting has appeared in EBONY, The Advocate, The Body and many others. Rod blogs on politics, pop culture and Black gay news at rod20.com.