December 7, 2010
Oakland, Calif. -- A new collection of in-depth interviews with men who have sex with men (MSM) and transgender people around the world indicates that stigma and discrimination play a central role in blocking access to life-saving HIV prevention and treatment services. The qualitative study, commissioned by the World Health Organization and conducted by the Global Forum on MSM & HIV (MSMGF), adds to a growing body of literature that points to the importance of addressing human rights violations as a necessary pillar of an effective global AIDS response.
"It is well known that there is a strong connection between human rights violations and the spread of HIV," said Dr. George Ayala, Executive Officer of the MSMGF. "These interviews paint a clear and often disturbing picture of exactly how things like stigma, discrimination and violence can interfere with HIV services."
The study draws on 39 open-ended interviews with MSM and transgender respondents from 27 different countries throughout Africa, Asia, the Caribbean, Eastern Europe, Central Asia, Latin America, North America and Western Europe. Despite the diversity of locations represented, respondents identified a common set of barriers to HIV services that was strikingly consistent across regions. Five factors emerged as serious impediments to access: 1) Homophobia and transphobia, 2) HIV stigma, 3) criminalization and repressive policies, 4) lack of awareness among providers, and 5) safety.
"Most MSM do not want to go for treatment for HIV because confidentiality is broken so often by doctors, nurses and hospital staff," explained one respondent from the Caribbean. "It's worse with sexual minorities -- [health care professionals] will disclose openly who is MSM and who is HIV-positive. Most people will just keep things to themselves until they are too weak and sick to go on without care."
"People know they can get support at our office, but the neighbors beat our clients when they come around," explained another respondent from Eastern Europe. "We try to leave our offices to reach people at cruising spots as well, but homophobes know these venues too. It is a challenge to keep outreach workers motivated when they are harassed so frequently."
The study's findings are consistent with the initial results of a recent MSMGF online survey of more than 5,000 MSM and MSM service providers worldwide, which indicate that more than half of MSM globally lack access to basic HIV prevention and treatment services. Only 39 percent of respondents reported easy access to free condoms and just one in four reported easy access to free lubricant. Large percentages of men reported that it was difficult or impossible for them to access HIV testing (57 percent), HIV education materials (66 percent) and HIV treatment (70 percent).
"The goal of these recent interviews was to assess the values and preferences MSM and transgender people have regarding STI and HIV prevention and treatment interventions," said Dr. Ayala. "What we heard was not that one intervention was preferable to another. We heard that any intervention would be welcome -- especially if delivered sensitively -- but that no available prevention or treatment option would succeed if widespread sigma, discrimination and violence are not addressed."
The report, In Our Own Words: Preferences, Values, and Perspectives on HIV Prevention and Treatment, is available for download on the MSMGF's website at: http://msmgf.org/files/msmgf//About_Us/Publications/WHO_Report1.pdf.