At a huge international HIV/AIDS conference, TheBody.com spoke with several individuals that hail from some of the toughest countries in the world when it comes to being gay and HIV positive. Read to the voices of these men and women as they respond to the question: What's Life Like for HIV-Positive Gay Men in the Country Where You Live or Work?
Paul Semugoma, M.D., Uganda
I'm Dr. Paul Semugoma. I work in Uganda with KULHAS, which is Kuchus [gay men] Living With HIV/AIDS.
What is life like for HIV-positive gay men in Uganda? It's not easy, because they are living in a kind of double closet.
In Uganda, gay men living with HIV/AIDS are very closeted. They have a double stigma, due to the fact that they are gay and to the fact that they are HIV positive. The community has discriminated against them, so they want to hide the fact that they are positive. They don't want anybody else to know, so it's kind of a tough life. When they get sick, they don't have anybody to help them. They can't fall on the community for help, and at the same time, when they go back to their family, their families can cast them away because they are gay.
It's a tough life, and they might reveal to their families that they are positive, but they don't reveal that they are gay. Sometimes they might reveal to their community that they are gay, but they don't reveal that they are HIV positive. So they lead a double- or triple-standard life, which has to be balanced somehow all the time. That is their kind of life.
We hope that it can be changed. We are working on changing that. But at the moment, that is what it is.
Ian McKnight, Jamaica
I'm Ian McKnight. My present job is with the Caribbean Vulnerable Communities Coalition, which is a Caribbean coalition of NGOs [non-governmental organizations] that do work with marginalized groups, among which we work with MSM [men who have sex with men].
In the Caribbean, men who have sex with men suffer extreme discrimination and stigmatization. We have seen where that has resulted in people being beaten, people being killed in Jamaica. We saw that recently in Nassau. We see, for example, where the violence is catching on in countries like Antigua and St. Lucia. We're also seeing deaths, and we're seeing people threatened.
I think on a day-to-day basis, persons have to be very conscious of how they display their sexuality. Particularly, I'll narrow it down to Jamaica and say that Jamaican LGBT [lesbian, gay, bisexual or transgender] individuals have to be constantly careful of how they live and how they manifest their sexuality. That is a very high-pressured psychological state to live under. Many people find themselves having to look over their shoulders, having to wonder if people are seeing them, wondering if people are knowing what their sexuality is about.
Thankfully, persons are able to rise above that very intense psychological pressure to do their own work, to execute their own lives on a day-to-day basis. People are living productive lives. They go to work on a daily basis. Some people live together as couples. Some people rear children together as couples. Some people are in very good positions. It is true, too, that even [for some of these people], people know that they're homosexuals. People in their immediate circle at work may know, respect and engage with them on that level. But the wider knowledge, the wider public knowledge, is what becomes a much more threatening situation.
I feel that it's also important to state that there is a community. People come together to just to hang out and chill. People come together for educational purposes, so there are programs in place for the LGBT community, predominantly around safer sex and HIV issues. People party, of course.
There's that level of community. There's a very intricate underground network. When something goes wrong or something goes well, the ripple effect is felt very quickly. If someone needs help, people know the sources to go to, to call, to get help, and to address some of these issues.
In many instances, there is a protective network. Something might happen -- for example, something happens where somebody is discriminated against in a particular place. There are individuals who can make strong representation at the very highest level. Sometimes, even though it's done behind the scenes, it is very, very powerfully felt. People experience the impact of discriminating against a member of the LGBT community.
I think it's important to talk about young people. There's a group of persons who are very young who don't give a damn about what people think or say, who live their lives in a much more open way than many older persons do. For them, it's really pushing, pushing and pushing it to another level.
We see guys who are cross-dressing, some of them in public, which is amazing. Some have been beaten as a result of it, but others continue, and many of them are even challenging their teachers in school.
One fantastic story that came to us was: A guy was discriminated against verbally in his high school, and he said to them, "If you don't apologize, I'm going to tell JFLAG [Jamaican Forum for Lesbians, All-Sexuals, and Gays] and let JFLAG come down on this school." He got an apology from the school because they felt that having the wrath of JFLAG on them was not going to be something that they would entertain.
JFLAG has a very powerful and public stance. I've heard radio announcers joke. They have a kind of semi-comedy slot. One morning I heard one of them [telling] a joke which had a gay character, and he said, "Oh, God. I don't know if I should do that because JFLAG is going to be on my case in a couple of days." Things like those, small though they be, are some indicators that things are happening, things are changing.
From a policy level, a higher level, we are in negotiations with health officials. We are in negotiations with the police, all to make this better. I think we have to also bring attention to bear on the church, Sunshine Cathedral, which is a safe place for LGBT members and their family members to come and worship. That's a fantastic thing that's happened, where we have worship services of up to 100 persons on a monthly basis. People travel for two and three hours to get to these services. It's just a beautiful thing. It has a blog going with LGBT Jamaican-specific spirituality posted on it. ... It has a lot of powerful stuff on it. It actually uses a lot of local, cultural things and really is turning around, rewriting, the history for LGBT persons.
Venkatesan Chakrapani, M.D., India
I'm Dr. Venkatesan Chakrapani from India. I'm with the Indian Network for People Living With HIV.
A person who is a man who has sex with men as well as HIV positive has to face double discrimination from the society, meaning being both positive as well as being MSM, which is not accepted in the general public, as well as within the HIV-positive community. Sometimes an MSM living with HIV may not be affected by the mainstream positive people. In that way, they are facing discrimination, but from the general public, from the health care providers, as well as from the mainstream positive people.
Also, when they go for treatment in the government hospitals, they also face discrimination from the health care provider, especially if [the provider is] going to ask their sexual history and find out that they are MSM as well as positive.
So there's discrimination from the health care system that will also mean that they may not even want to go to health care providers and talk about [being] positive [and] that they are MSM, which means that both the treatment as well as prevention messages are not being properly delivered to them.
Anita Radix, M.D., Grenada/New York
My name is Anita Radix and I'm originally from Grenada, which is in the Caribbean. I recently relocated to New York. I'm a physician. I work with HIV-positive patients.
Of course it's very different in New York, but when I was working in the Caribbean it was a very difficult situation to work as a physician with clients who were really not able to access care. Especially for MSM, there's a great deal of invisibility. A lot of people don't want to disclose their sexuality or what they're doing.
As one of the few "out" physicians -- I'm a lesbian physician -- I did get a lot of MSM clients who felt comfortable coming to me. But, for the majority of people, they don't [access care].
The other issue is access to medication. Even if you're diagnosed, the country you're in -- because I worked in several islands -- you can get tested, but they don't have rapid testing. It takes a long time to get the results. When you have the results, there's an issue with confidentiality. Often, people on the street will know your diagnosis before you're told the diagnosis. That's one of the first issues. There's a lot of stigma. People are seen in the hospital and everyone knows what they're there for.
Then, of course, there are other issues, like access to medications. If you need it, you may not get it. The medications are expensive. Even if you get the medications, maybe, in the country you're in, you may not be able to have your CD4 count or your viral load [tests].
None of the islands I worked with have resistance testing. They're probably, if you think about it, maybe 10 years behind where we are in New York, on all fronts.
Ruben del Prado, Guyana/Suriname
Hi, I'm Ruben del Prado. I'm the UNAIDS country coordinator working in two countries in South America. One is called Guyana and one is called Suriname.
Being gay in both countries is quite different. In Guyana, for instance, the laws of the land are still very much discriminatory of homosexuality. In Suriname, they're not. That immediately gives it a different perspective. In Guyana, being HIV positive and gay is a double jeopardy. It is very, very difficult. In Suriname, of course, being homosexual is a lot less repressed, but being HIV positive is not easy.
Joseph Akoro, Nigeria
My name is Joseph Akoro. I'm from Nigeria. My organization is The Independent Project for Equal Rights [TIP]. Basically, what we do is we work on human rights and also HIV/AIDS issues in the LGBT community in general.
Our special focus [is on] young people, because we know that these people are the most vulnerable to HIV infection and human rights violations based on sexual orientation, which affects sexual behaviors, whether protected or unprotected.
To be HIV positive as a young person and a gay man -- or a man who has sex with men, however you identify -- in Nigeria is bizarre because the law discriminates against you having sex with a man, so you do not have any access to health care as someone who has sex with a man. Also, the government does not even provide those services because they do not acknowledge men who have sex with men.
As people with a great passion for young people and securing the future, TIP is actually working to set up a community center where LGBT people can meet and be themselves, get HIV prevention, care and treatment if there is [treatment available.]
We also think that HIV prevention is way beyond condoms and lubricants. We need to do something about the social welfare. We need to talk to them about their sexual identity, how to deal with their sexual identity, and how to observe protected sex, even despite their sexual behavior.
All of this we're looking at in Nigeria for young people -- in Lagos, where we are based and, of course, we could expand this as time goes and also as funding allows.
I'm going to be talking about the population that we serve because I know them better than every other population. Those are the young LGBT people. As a young person who is gay, lesbian, bisexual or transgender in Nigeria, you cannot be open about your sexual orientation to your family. You're subjected to being ejected out from your family's home if you actually disclose this.
Young LGBT people live under this fear because once you're ejected from home, then you're subjected to every human rights violation, which includes health, your life, and everything like that. It's very risky to be open at home.
Michel De Groulard, Trinidad and Tobago
My name is Michel de Groulard. I am a UNAIDS regional program advisor in the regional office of Trinidad and Tobago for the Caribbean.
I have been living in Trinidad for a number of years in different capacities, so I know Trinidad pretty well and I know the gay community pretty well as well. I am really concerned about the young people, the young gay men in Trinidad and Tobago. Some of them have been infected at the age of 15 or 16. Most of the time they have been raped by older men, not knowing at that time what was really happening to them. But because of that, they got infected with HIV.
Therefore, you have young guys at the age of 20 who have been HIV positive for the past four or five years. This has become all their life. All their life is centered around their HIV status, because it has impacted their life so much in terms of their studies, in terms of how they relate with their family, in terms of what could be their future professionally, that their life is only being HIV positive. Therefore, they commit themselves to helping others, which is a good thing. But I am a bit worried about these guys whose life will only be HIV. That's one aspect.
The second aspect is that there are a lot of networks that are developed through the Internet, in particular, to make contact among gay men, which makes things much easier than before to know each other. But all these networks are also a lot about sex. Those young guys who are 18 or 19 who don't know too much, they tend to trust the Internet people who are saying that they are HIV negative and ready to have, sometimes, their first sexual experience with somebody that they don't know. They tend to trust based on nothing -- only that the Internet is saying that they are HIV negative. That is a big worry.
Orchid Gowe Hunter, Jamaica
My name is Orchid Gowe Hunter and I'm a nurse working for Jamaica AIDS Support for Life for the past 12 years. I have been working with MSM, sex workers, heterosexuals and a wide cross-section of persons living with HIV/AIDS.
For MSM and their family members, from what I have observed, most families, most of these persons are not accepted by their family members -- just a few. For those who are not accepted, most of them are merely turned out on the streets, abandoned by their family, or are discriminated [against] in society, and family members also discriminate [against] these persons. Life is not so nice in Jamaica for MSM right now.
For me, in this field, I accept persons for who they are, no matter what their sexuality or their lifestyle. I use prayer. [I know that] no matter what a person's sexual orientation is, they are still a human being. I know that God accepts each and every one. I'm hoping that one day the entire population -- or the world -- will see a person for who they are, not their sexuality or their lifestyle.
Caleb Orozco, Belize
Caleb Orozco. I'm from Belize. I am the president of the United Belize Advocacy Movement. We're the only MSM organization in the country. We were inspired by a multicentric study in development, and we've never looked back since 2006.
What's life like in Belize? It depends upon your age group and your class group. For [those in] the age group of 18 to 24 who are closeted or who are HIV positive, the experiences are different.
Right now I have a client who is 18 years old. He developed AIDS only three months [after testing HIV positive]. He also has herpes and the person he loved gave it to him deliberately.
He has to pretend with his mom that he got [HIV] from a woman because his mom is homophobic and so is his father. He has to pretend to be straight with his church group because they also have homophobic issues, being non-denominational and evangelical in nature.
But what's interesting about him is his character. He has been honest enough to tell all of his partners that he has slept with that they have been exposed, that they need to go get tested. That is an amazing accomplishment for somebody who's 18 years old! He also looks forward to staying in school. My organization is helping him with food support to ensure that he finishes school.
Of course, there are the other character issues. He tends to vomit to try and keep thin -- bulimic-type symptoms. He drinks [alcohol] once in a while, even on an empty stomach, or doesn't eat [in order] to keep his figure, as he would say. So all those issues we have to deal with in terms of that one person, as it is his life on the street.
I personally try to treat my relationship with each person as a partnership. You do your part, I do your part, and we'll be fine.
There's another person who is a client, but who also works with me as an educator. He got infected from a tattoo. Somebody was HIV positive and used a contaminated needle to infect him. He actually just [had his] sexual debut about a year ago.
What has happened is that even though he doesn't have his parents around, he has family -- his sisters -- and they're very supportive. He himself is taking it upon himself to seek out a PWHA [people with HIV/AIDS] support group to educate himself about what's going on. What I asked him to do was to be a peer educator for that other client we have. His commitment is to text him regularly and to keep him informed and to keep his hopes up, because they live in two separate parts of the country.
Olanrewaju Onigbogi, M.D., Nigeria
My name is Olanrewaju Onigbogi. I work as a public health physician at the University College Hospital in Ibadan, Nigeria.
I would like to start by giving people a perspective of Nigeria. Nigeria is such a big country, and I work as a researcher in Ibadan, which is in the southwestern part of the country. Many national HIV rates aren't really correct, so the best you can have are regional rates based on work that people have actually done in their region. So I'll be talking strictly about my work around the area where I live.
The HIV situation in Nigeria: I can say it's stabilizing. It was getting worse a few years ago, but now the rates are going down. The data also show that the infection rates are going down.
However, the problems are still far from being over, because if education is not continued, people are likely to go back to high-risk behaviors. The greatest problem we have in Nigeria really is with high-risk behaviors, specifically among men who have sex with men, because many of them do not have access to HIV education. When they do, they don't have the resources to get condoms and lubes.
Most prevention services just target providing condoms, but with men who have sex with men, they actually need lubricants [lubes]. The lubes are still pretty expensive. That's the greatest problem I think we're having now with prevention services, especially with regards to MSM.
A few years ago, it was a lot worse. It was really difficult to get people to come out to say they were in the lesbian/gay/bisexual/transvestite community. Any kind of sexual orientation that was different from heterosexual, it was almost impossible to come out, to identify with it.
Initially it was like hardened resistance. It's gone to cynicism and discrimination. Like, OK, that's them, but we keep them at a distance. The laws are clear about it. The laws are still very strict and rigid. Sometimes people could go to prison for as long as 10 or 15 years. Because of the laws, the policemen can actually pick up people and harass them, even if they're not really keen about enforcing the laws. That's the other issue. The laws criminalize MSM, but enforcement is not really done. It's more harassment. That's a problem.
Like I said, it was a lot worse a few years ago. Now many more people are coming out. The government probably has greater problems to battle with, but the greatest problem people have is with their immediate families -- the parents and the siblings. That's the greatest problem they have. The government has other problems -- many other problems -- but the greatest problem that people really have is with their own families. That's where the discrimination really starts.