Social exclusion and lack of HIV prevention programmes for men who have sex with men (MSM) is escalating new HIV infections in major cities in the developing world. Shockingly, twenty five years into the AIDS epidemic, only 1 in 20 MSM are said to have access to HIV prevention programmes.

The invisibility of MSM in many low- and middle-income countries across the globe is contributing to inadequate resources being given to HIV prevention programmes despite MSM accounting for significant proportions of new infections in those countries, delegates were told at the XVII International AIDS Conference (AIDS 2008), which comes to an end today.

Criminalisation, prejudice, social hostility and human rights abuses towards MSM are boosting the spread of HIV.

“Homophobia continues to fuel the spread of HIV – in countries with concentrated epidemics and in countries with generalised epidemics alike,” said International AIDS Society (IAS) Executive Director Craig McClure.

“This must change. Research has demonstrated over and over again that reducing the social exclusion of men who have sex with men through the promotion and protection of human rights is not only consistent with, but a prerequisite to, good public health. IAS considers it a major priority to put this evidence into practice – everywhere and now.”

Men who have sex with men have an average 19 times greater chance of being infected with HIV than the general adult male population in low- and middle-income countries. In some countries MSM are more than 100 times more likely to be infected.

For example, in the Republic of Georgia, MSM were about 24 times more likely to be infected than the general population; in Senegal – 27 times more likely; in China – 45 times more likely; and in Mexico – 109 times more likely. HIV prevalence rates among MSM populations in some regions already approach those of Sub-Saharan populations, with epidemiological studies indicating 16% of MSM in Latin American communities now infected.

Furthermore, a review of the UNGASS Country Reports showed that only 10 of 128 countries (7%) were able to report that at least 60% of MSM have access to HIV prevention programmes.

While the situation varies to some degree in each region and country, in most regions resources allocated to MSM-focused HIV prevention and care are seriously disproportionate to their contribution to national HIV infections. Most countries in Asia, for instance, spend less than 1% of their HIV and AIDS budgets on MSM, yet 5-20% of new HIV infections arise from sex between men.

“Perhaps the most dangerous misperception in relation to men who have sex with men and HIV is that the overall downturn in the HIV epidemic and the increase in rights won by gay men and lesbians in the West are a reflection of the true state of affairs of gay, bisexual and other MSM globally,” said Global Forum on MSM and HIV Co-Chair Robert Carr.

“In fact, nothing could be further from the truth. Gay, bisexual and other MSM are largely invisible in many parts of the developing world, and in the majority of cases subject to varying degrees of discrimination, violence and human rights abuses.”

Experts believe that the emerging consensus over the link between vulnerability stemming from rights-abuses and the increasing impact of HIV and AIDS on MSM globally means new models of challenging social exclusion and including MSM participation in prevention programmes must be found.

“Twenty years experience in some high income countries and a few global south countries clearly indicate that the three keys to reducing HIV among gay men and other men who have sex with men are first and foremost, creating a safe, supportive environment; second, supporting grass-roots community organisations, and third, investing in comprehensive programs,” said Carr.

“A peer-based approach to designing effective and locally appropriate HIV prevention and care programmes ensure that MSM infections are kept low – but these programs cannot operate effectively in a hostile or discriminatory environment,” concluded Carr.

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