A new large-scale study – released ahead of World Aids Day – of gay men and other men who have sex with men (MSM) has revealed that only one third of MSM can easily access condoms, lubricant, HIV testing, and HIV treatment.
Conducted by the Global Forum on MSM & HIV (MSMGF), the study suggests that barriers like homophobia play a significant role in blocking access to HIV services for MSM, while greater comfort with health service providers and more community engagement are associated with higher levels of service access.
The online survey, conducted earlier this year, included 5779 men from 165 countries. In addition, the MSMGF collaborated with African Men for Sexual Health and Rights (AMSHeR) to conduct focus group discussions with 71 MSM across five cities in South Africa, Kenya, and Nigeria.
Of men who participated in the online survey, only 35% reported that condoms were easily accessible, 21% reported easy access to lubricant, 36% reported easy access to HIV testing, and 42% reported easy access to HIV treatment. Levels of access differed by country income level, with reduced access to services more commonly reported in lower income countries.
Adjusting for country income, greater access to condoms, lubricants, and HIV testing were associated with less homophobia, greater comfort with health service providers, and more community engagement.
Among participants living with HIV, higher access to HIV treatment was associated with less homophobia and greater comfort with health service providers. Greater access to lubricants and greater access to HIV testing were also associated with less ‘outness’ (the degree to which others know of one’s sexual orientation) and fewer negative consequences as a result of being out, respectively.
Focus group discussion participants described how stigma, discrimination, and criminalisation force MSM to hide their sexual behaviour from health care providers, employers, landlords, teachers, and family members in order to protect themselves and maintain a minimum livelihood.
The inability of MSM to reveal their sexual behaviour to health service providers was linked to misdiagnosis, delayed diagnosis, and delayed treatment, leading to poor health prognosis and higher risk of transmitting HIV and other sexually transmitted infections to partners.
Conversely, focus group discussion participants explained that the negative consequences of these barriers were moderated by the existence of safe spaces to meet other MSM, safe spaces to receive services, access to competent mental health care, and access to comprehensive health care.
Participants described MSM-led community based organisations as safe spaces where they could celebrate their true selves, receive respectful and knowledgeable health care, and in some cases receive mental health services.
“The study’s findings underscore the urgent need to improve access to essential HIV services for gay men and other MSM worldwide,” said Dr. George Ayala, Executive Director of the MSMGF. “Successfully addressing HIV among MSM will require a real effort to address structural barriers, and the findings from this study suggest that investing in MSM-led community-based organisations may be the best way to do that.”