U.S president Barack Obama’s announcement in May that same-sex couples should be able to marry, and surveys showing a steady upward trend in the proportion of Americans who agree with him, were powerful signals that the remaining stigmatizing and discriminatory policies against lesbians, gay, bisexual and transgender people in the U.S. are unlikely to last.
In Africa, there was, until recently, no such hope – particularly for men who have sex with men, among whom HIV prevalence is four times higher than the general population. Male-to-male sex is illegal in 31 sub-Saharan African countries and can result in the death penalty in four countries. Social hostility against homosexuality is widespread and, in certain countries, it is becoming even more intense. International and local organizations have found it impossible and sometimes dangerous to develop effective and sustained HIV interventions through raising funds; conducting research; tailoring messages, products and services for men who have sex with men; and sharing lessons. My organization PSI, like many international agencies, must strike a delicate balance between serving men who have sex with men and being a trusted partner to local governments.
International and local organizations have made recent moves that could signal the environment for developing and delivering tailored HIV interventions for men who have sex with men could be improving.
Most notably, the availability of data about HIV prevalence and the behavior of men who have sex with men, funding and government responses have improved, despite falling far short of what is required to design effective interventions. The epidemiological studies that exist demonstrate the presence of men who have sex with men in all African populations, consistently higher HIV infection among these men, and that men who have sex with men are also engaged in concurrent or recent sexual partnerships with women.
Meanwhile, through the rise of mobile telephones and social media, local organizations representing the interests of men who have sex with men and increased exposure of local populations to the increasingly fair and equitable treatment of lesbian, gay, bisexual and transgender communities outside of Africa are slowly creating the conditions for national HIV program responses.
International agencies are becoming increasingly aware that funding for programs for men who have sex with men is too low given HIV rates. As a result, dialogue with national programs, however delicate in many settings, is trumping the mismatch between government aspirations for controlling HIV and intervention priorities. Working against this, however, is the very important limitation that these same international agencies are facing funding shortages, resulting in their looking to local governments to increase their contributions to HIV programs. Improving access to and availability of HIV programs for men who have sex with men requires fundamental shifts in perceptions among individuals and partners, in addition to shifts in supporting conditions in families, communities and nations. Stigma and discrimination in official policies and communities create enormous obstacles to HIV prevention and treatment. Access to appropriate health services, products and information is, for them – possibly more so than for any other group in Africa today – in need of courageous leaders and changing public opinion. Today, HIV agencies that devise evidence-based programs must include men who have sex with men among target populations.
Until then, an AIDS free generation is impossible to attain.
STEVEN CHAPMAN, Ph.D is the chief technical officer for PSI, a global organization dedicated to improving the health of people in the developing world by focusing on serious challenges like a lack of family planning, HIV/AIDS, barriers to maternal health, and the greatest threats to children under five.