HIV/AIDS Epidemic Raging Among Men Having Sex with Men (MSM): amFAR Announces New Initiative in Sydney to Address the Crisis

by Imelda V. Abaño & Esther Nakkazi
– Philippines/Uganda –

Reporting from Sydney, Australia

One of the greatest public health failures in the fight against AIDS is the world’s inability to prevent widespread HIV infection among Men who have Sex with Men (MSM), according to officials from the Foundation for Aids Research (amFAR). MSM is the most prominent method of HIV transmission in nearly all Latin American countries, as well as the US, Canada and some Western Europe countries. The roots of this public health failure are denial, discrimination and criminalization.

amFAR is launching a new MSM Initiative to focus on three main objectives:

to empower MSM organizations to create a safe space for HIV interventions in the face of poverty, homophobia, poor access to health care and education, drug addiction, incarceration, and to develop locally appropriate, population-specific interventions for prevention treatment and careto build awareness and understanding of HIV epidemics among MSM and to ensure strong policies and increase public funding for HIV interventions by and for MSM

“I am gay and yes, I have been living with HIV/AIDS for the past 23 years,” confesses Peter Schlosser at a special session held for journalists before the 4th International Aids Society (IAS) Conference taking place in Sydney this week.

“When I found out [that] I have AIDS, I got very angry [with] my partner. I was in denial at that time and my family disowned me. I had no one to turn to. I also developed [other] illnesses including cancer. It was a pretty tough time. I quit teaching in a university and was told that I [would] only live just [a] few more years. Everything has been taken [from] me. So [now] I enjoy life to its fullest everyday. At the moment, my family [has become] passionate about my condition and I have lots of friends to support me. Yeah, life is good.”

While AIDS has changed his life, Peter found ways to manage the challenges. Having lived through the history of the AIDS epidemic since the beginning, for years Peter has dedicated his time as a peer educator for People Living With HIV/AIDS in New South Wales. He says he is lucky now: he receives antiretroviral treatment from the Australian government and gets support and counseling through his organization.

“Knowledge and education is the biggest thing to understand[ing] AIDS and people living with the virus. That is why I came out in the open [to] talk about it – to educate people,” Peter says.

As the HIV/AIDS pandemic enters its second quarter-century some men like Peter have managed to take control of their lives and sought ways to obtain treatment and support. But for most MSM worldwide, HIV is still an untamed crisis, particularly in developing countries.

amFAR consultant, Sam Avrett, who is gay and HIV positive, calls for an urgent assessment of current trends in HIV infection among MSM, as well as assessment of the effectiveness of existing prevention strategies, and alternatives for prevention intervention.

HIV has been a threat for 25 years, yet many people believe they are at low risk of becoming infected or infecting their partner. Avrett says that the emergence and growth of the HIV epidemics among MSM is due to a myriad of factors, including: the relative ease with which HIV can be transmitted; the relatively high prevalence of Sexually Transmitted Diseases (STDs) among some groups of MSM; low levels of condom use; having multiple partners; and little awareness of current HIV infection status.

“Despite the vulnerability of MSM to HIV/AIDS, little attention has been focused on these communities. More can be done and should be done regarding the HIV prevalence among MSM,” Avrett stresses. He says that amFAR’s new MSM Initiative, announced on July 24th, seeks to build awareness about this issue in the face of the HIV epidemic. The organization will apportion funds initially targeting seriously affected regions of the world.

“Our funds are still small compared to the need but by the end of the year we are hoping to make initial grants to seriously affected regions of the world like in south Asia, the Caribbean and Africa,” says Avrett.

Kenya is one of the African countries earmarked to receive funding for the prevention of the spread of HIV among MSM; however Avrett did not disclose the amounts apportioned to each region nor did he specify the exact amount of money designated for Kenya’s benefit.

Kenya is the country most affected by HIV/AIDS in Africa. According to a seroprevalence study done last year by the International AIDS Vaccine Initiative (IAVI), Kenya has a 40 percent HIV prevalence rate among men who have sex with men, the highest in Africa. Senegal trails Kenya at 22 percent.

Other countries with high MSM HIV prevalence rates include Ukraine at 27 percent and Uruguay at 21 percent.

HIV/AIDS is also spreading rapidly among MSM in Asia. The worst hit places are Bangkok, Thailand which has a 28 percent MSM HIV prevalence rate, while Andhra Pradesh, the largest state in southern India, and Maharashtra, India’s second largest state in terms of population, with its capital in Mumbai, have 16 and 17 percent respectively. Avrett says there is also a growing epidemic of HIV prevalence among MSM in Jakarta, Indonesia; Kathmandu, Nepal; Chennai, India; Ho Chi Minh City in Vietnam; and Taipei, Taiwan.

The high prevalence rates in Kenya and other developing countries are blamed on a lack of appropriate health messages and support which makes many men who have sex with men unknowingly engage in behavior that increases their risk of infection.

In Kenya up to half the men who engage in MSM do not use condoms and most of them have no access to HIV prevention, information, treatment and care services. They are largely ignored by the government because homosexual sex is illegal.

Even those who seek Voluntary Counseling and Testing services (VCT) are not properly advised, because the curriculum used to train counselors does not include information tailored to sex between men – a crucial missed opportunity for prevention.

With no data available yet as to how many men overall are engaged in MSM in Kenya, the practice increases the risk of transmission: some of the MSM men are bisexual, transgendered or identify themselves as heterosexual. Their partners, unaware that their partners engage in MSM, are often unknowingly infected. (Kenya, like other developing countries, is a place where most HIV transmission occurs through heterosexual relationships and mother-to-child-transmission (MTCT) during childbirth and breastfeeding.)

The UNAIDS report on Global Aids Epidemic 2006 says that less than one in twenty men worldwide who have sex with men have access to the HIV prevention, treatment and care services they need.

And because sex between men carries such an enormous stigma that leads to discrimination, men who engage in MSM are not likely to pursue HIV services.

Sex between men is also significant in the HIV epidemic because it often involves anal sex, which, when unprotected, carries a very high risk of infection. At least 5-10 percent of HIV infections worldwide are estimated to occur through sex between men, though the report says this figure varies considerably between countries and regions.

Avrett points out that most governments have failed even to acknowledge that sex between men occurs or that unprotected sex contributes to the transmission of HIV/AIDS. The failure to provide this basic information means that their programs are denied funding.

MSM’s high susceptibility is still largely ignored, even as countries are beginning to recognize the HIV/AIDS needs of vulnerable groups like sex workers and injectable drug users. Continuing to ignore MSM’s high risk only further fuels the growth of the crisis.

amFAR’s recently launched MSM initiative will be executed through grassroots organizations. To help MSM initiatives to grow and become more effective, and to reduce rates of HIV infection and transmission among MSM in resource-limited countries, amFAR will provide small target grants specifically to provide prevention, treatment, care and support services to MSM.

Grassroots organizations have been at the forefront since the beginning of the AIDS epidemic, delivering services to vulnerable populations and demanding greater action from governments. GayKenya and Galebitra are two of the groups in Kenya that have been working with this at-risk population.

Grants will also be used to foster increased collaboration among organizations by supporting efforts to share information and address new challenges, explains Avrett. “These grants will have an immediate and significant impact on poorer communities with limited resources for MSM. They could also have a multiplier effect, helping to attract funding from additional donors.”

With sufficient funding and support, these organizations are expected to transform community attitudes, drive policy change and mobilize the necessary funding to reverse the alarming spread of HIV among MSM.

However, without prompt and effective action to address the issue, warns Avrett, other countries in the world may witness acceleration of HIV rates among MSM.

Regular contributors, Imelda Abaño and Esther Nakkazi met at the Sydney conference by chance and agreed to collaborate on this article. – Ed.

About the Authors

Imelda Visaya-Abaño began her journalism career in 1998 as a reporter at the Philippine Daily Inquirer, the leading daily newspaper in the Philippines. Her areas of interest are women and children’s issues, science, environment, health, agriculture and education.

In 2002, Ms. Abaño was honored as the Asian Winner of the Global REUTERS-IUCN Media Awards on Environmental Reporting.

She believes in better journalism for better communities.

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Esther Nakkazi is a science journalist currently reporting for the regional, weekly newspaper The EastAfrican, published in Nairobi, Kenya and distributed in Uganda, Kenya, Tanzania and Rwanda. She is also a volunteer editor for oneworld and contributes to Islamonline in Egypt and Realheath in the UK. Esther is currently based in Kampala, Uganda.