Uganda made international headlines late last year after lawmakers in the East African country proposed legislation to impose the death penalty for some gay Ugandans -- as well as lengthy prison terms for their friends, families, and even landlords. The news, decried by human rights advocates, came amid an ongoing rash of brutal antigay attacks in African nations.
Now, the violence is prompting a new wave of warnings from public-health experts. In countries already ravaged by AIDS, the brutality and stigma may be fueling a dangerous surge of HIV infections among gay and bisexual men, according to a study released by Johns Hopkins University and the World Bank at a preconference event for the biennial International AIDS Conference, being held this week in Vienna.
"Kenya, Malawi, Zambia -- nations with stunningly high infection rates among the general population -- are now seeing double those rates among men who have sex with men," explained study author Chris Beyrer, director of the Johns Hopkins Center for Public Health and Human Rights.
The research breaks new ground, offering first-ever HIV prevalence estimates among MSM in countries that traditionally have only tracked infections among heterosexuals. The results were released at an event hosted by the Global Forum on MSM and HIV.
In Kenya, where a group of gay HIV educators was recently beaten, doused with kerosene, and nearly set afire, up to 15% of MSM are now living with HIV -- more than double the 6% prevalence rate among all Kenyans -- the study revealed.
In Malawi, 11% of residents are HIV-positive -- compared to 21% of the country's MSM. And in Zambia, where lesbian women have become targets of "corrective rape" by men who seek to "cure" their sexual orientation, one in three MSM is living with HIV, compared to 15% of the general population.
The study adds new evidence to what AIDS researchers have long suspected -- that homophobia leads to increased HIV risk.
"Due to stigma, a significant number of these countries simply fail to track HIV among their MSM," George Ayala, the Global Forum's executive officer, told The Advocate. "Equally troubling is that such stigma can completely derail lifesaving programming that MSM desperately need: HIV-related services, prevention work, outreach, and even epidemiological studies that would help us understand the full scope of this crisis."
According to Ayala's organization, only one in 20 MSM has access to the HIV treatment and prevention services they need. Yet on average, they are 19 times more likely to be HIV-infected than the general population.
"It's a dangerous cycle," Ayala explained. "LGBT oppression deals a devastating blow to self-image, and that can lead to high-risk sexual behavior and injection-drug use. If you or your friends are viciously beaten because you're a sexual minority, then HIV risk is probably not your first concern."
The solution, Beyrer said, lies in a sharpened focus on human rights for MSM and expanded access to HIV prevention and treatment targeting gay men.
"We must improve outreach, interventions, and access to care for MSM in these countries," Beyrer said. "The argument that gay and bisexual men are a trivial sideshow in the global fight against AIDS is wrong."
Major funders in the AIDS fight agree. "Allowing gay men to be the target of hate crimes, arrest, or detainment isn't just unacceptable, it's absurd," said Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The Global Fund provides a quarter of all funding for HIV services worldwide.
Ayala points out that invisibility -- or outright neglect -- of MSM pervades even the AIDS community. Only 2% of this week's IAC sessions will focus on gay men, he said.
The study may even help to explain a resurgence in HIV among U.S. gay men, who now account for one in two new HIV infections nationwide. "Back home, 22 LGBT people have been brutally murdered because of their sexual orientation just this year," said Democratic California congresswoman Barbara Lee, who coauthored legislation to launch the Global Fund. "We cannot stop HIV among MSM when they live in fear."
Ultimately, success may hinge on the availability of funding for MSM-focused programming.
"Our vision of [ending] AIDS will never see the light if we do not see the end of criminalization [of homosexuality]," said Michel Sidibe, the head of the Joint United Nations Programme on HIV/AIDS, which coordinates the U.N. response to the global epidemic. To expand outreach to MSM, Sidibe believes that "a new commitment to financial support is absolutely critical."
But for some advocates, the strength of that commitment remains to be seen. "I tried to work with the U.N. on homophobia," said Robert Carr, the director of policy and advocacy at the International Coalition of AIDS Services Organizations. "They gave me $10,000 and told me to do whatever I wanted with it. So I held one meeting for 45 LGBT people -- and none of them ever came back."