Health authorities seem to suggest that ” stigma and discrimination” are fundamental to the intractable nature of HIV epidemics among Men who have Sex with Men (MSM).
While the authorities are seeking to suppress actions by institutions such as the church which they (health authorities) deem are responsible for stigma and discrimination MSM are having sex parties.
The fact is , and this is stated by researchers out of John Hopkins, receptive anal intercourse and role reversal (i.e the ability of a man to insert on one occasion and be inserted on another) in MSM networks accounts for 98% 0f the difference in HIV rates between MSM and heterosexuals.
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Lancet Special Issue on HIV in Men who have Sex with Men (MSM)
Summary Points for Policy Makers
Global epidemiology of HIV infection in men who have sex with men
Chris Beyrer et al.
- In 2012, HIV epidemics in MSM are expanding in countries of all incomes. Available incidence data from Thai, Chinese and Kenyan samples of MSM suggest those epidemics are in rapid expansion phases.
- HIV infection rates among MSM are substantially higher than those of general population adult males in every epidemic assessed. A comprehensive review of the burden of HIV disease in MSM worldwide found that pooled HIV prevalence ranged from a low of 3% in the Middle East and North Africa to a high of 25.4% of MSM in the Caribbean.
- Biological and behavioral factors make the dynamics of the MSM epidemic different than for general populations.
o ThedisproportionateHIVdiseaseburdeninMSMisexplainedlargelybythehighper- act and per-partner transmission probability of HIV transmission in receptive anal sex. Modeling suggests that If the transmission probably of receptive anal sex was similar to that associated with unprotected vaginal sex, five year cumulative HIV incidence in MSM would be reduced by 80-90%.
o Many MSM practice both insertive and receptive roles in sexual intercourse,which helps HIV spread in this population. Were MSM limited to one role, HIV incidence in this population over five years would be reduced 19-55% in high-prevalence epidemics.
o Taking both factors (peracttransmissionprobabilityandroleversatility)into account explains 98% of the difference between HIV epidemics among MSM and heterosexual populations—behavioral differences account for 2% of the difference.
Easier access to public health care for HIV-infected gay men
BY INGRID BROWN Associate editor — special assignment firstname.lastname@example.org
Monday, May 26, 2014 55 Comments
HIV-infected men who have sex with men (MSMs) now experience little or no barrier in accessing services at the island’s public health facilities despite Jamaica’s stringent buggery laws which criminalises the practice.
This has been made possible by the Ministry of Health which recently facilitated the Jamaica Forum of Lesbians, All-Sexuals and Gays (J-FLAG) training of some 60 health-care professionals, to sensitise them on dealing with this population.
Minister of Health Dr Fenton Ferguson told the Jamaica Observer that J-FLAG has undertaken the training of a number of health professionals across the island to sensitise them on the need to better treat with this vulnerable population.
Ferguson expressed delight that J-FLAG was able to satisfactorily complete the training programme with the health-care professionals.
“That will be very helpful, as a major concern for Jamaica is the MSMs which is now consistently showing a HIV prevalence rate of 32 per cent,” Ferguson said, adding that he will be reinforcing this point when he speaks at the upcoming graduation exercise for those who benefited from the training.
Meanwhile, J-FLAG said Jamaica AIDS Support (JAS) has always operated a fully functional clinic to treat its clients, including MSMs, who shy away from the island’s clinics and hospitals.
According to Brian Paul, sub-regional co-ordinator of the Caribbean Forum of the Liberation and Acceptance of Genders and Sexualities (CariFLAGS) and advocate for J-FLAG over the last decade, agencies like JAS were empowered to do work with MSMs and transsexuals because the government’s health system was not very embracing of diversity
given that there was a lot of hostility against lesbian, gay, bisexual, and transgender (LGBT) people.
“When you get to the gate security guards would turn you away and nurses and other administrative staff within the compound would have been hostile, and so a lot of LGBT people relied on NGOs like JAS to provide that clinical care,” he told the Observer. “However, over the years with greater exposure and education, the health-care providers at all levels are now more knowledgeable on sexual diversity and because of that they are now more sensitive to the needs of the population, so we are seeing a lot
more LGBT people accessing health-care in the public sector,” Paul said.
He noted that this has been the result of years of advocacy work.
“The national HIV programme has also done a lot to empower its staff and to train persons to be better equipped to deal with the population,” he said.
He noted, however, that while the majority of health care providers at all levels are sensitive to the issues of diversity, there are some
who are still interacting with their own personal prejudices and stigma.
“So they may know very well that their jobs depend upon them being tolerant and embracing of diversity, but their own personal stigma and prejudices are still present. But with the advent of the HIV-redress system and with empowerment of NGOs, less and less are we hearing of reports of real discrimination,” he said.
Paul said J-FLAG’s recent training session with public health-care professionals included persons from deep rural Jamaica as well as the urban centres.
The training, he said, was necessary because some persons were still not sure how to deal with LGBT people.
“Those from the furthest rural parish said they had no idea about these issues and on the rare occasion if they had to deal with a gay or
lesbian client, they were figuring it out as they went along,” he said.
Meanwhile, Dr Ferguson told the Observer that he recently had a major consultation with Pan Caribbean Partners Against HIV/AIDS (PANCAP) as well as a Global Fund official and a number of other high-level stakeholders to address the issues faced by the MSM population.
“It was a two-day consultation on justice for all which is focusing on those most-at-risk such as MSMs and sex workers,” he said.
Dr Ferguson said Jamaica was able to secure US$19 million from Global Fund for its HIV programme.
Jamaica was initially expecting to receive $5 million for the transitional period 2013-2015, but as the alternate member on the Global Fund Board for Latin America and the Caribbean, Fenton said he engaged the international community about the need for upper-middle income countries to continue to receive support.
“We cannot afford to lose the gain of the last decade with HIV and so we are now in a position where we will be getting US$19 million from The Global Fund which I believe coming from US$5 million is significant,” he said.
PANCAP Says Stigma And Discrimination Driving HIV In The Caribbean
Published: Thursday May 29, 2014 | 2:51 pm
GEORGETOWN,Guyana, CMC – The Pan Caribbean Partnership against HIVand AIDS(PANCAP) Wednesday said the testimony of Professor BrendanBain in a highly publicised case in Belize two years ago was“not consistent with the stated goals of PANCAP to reduce stigma and eliminate discrimination".
GEORGETOWN, Guyana, CMC – The Pan Caribbean Partnership against HIV and AIDS (PANCAP) Wednesday said the testimony of Professor Brendan Bain in a highly publicised case in Belize two years ago was “not consistent with the stated goals of PANCAP to reduce stigma and eliminate discrimination”.
“In fact, it is in dissonance with PANCAP’s ongoing work to remove discriminatory laws and affirm human rights,” PANCAP said in a statement.
Professor Bain was fired as director of the Regional Coordinating Unit of the Caribbean HIV/Training (CHART) Network, a move that critics say showed that the University of the West Indies had bowed to pressure from gay rights groups across the region.
Since then, supporters of the academic, one of the region’s leading authorities on the HIV epidemic in the Caribbean and one of the pioneers in clinical infectious disease have been staging silent protests outside the gates of the UWI saying the dismissal was an attempt at curtailing academic freedom.
PANCAP said that although the Partnership is inclusive and members are free to have their individual views and beliefs, it “is of the view that, on principle, Professor Bain’s action was not compatible with his leadership position.
“In adopting an active position of opposing the decriminalization of anal sex between two consenting male adults in private, Professor Bain has undermined the public health and human rights goals of PANCAP.”
PANCAP said that this view communicated to Professor Bain during the 15th meeting of the Priority Areas Coordinating Committee (PACC), a technical committee of the PANCAP Executive Board, held on January 15 this year.
“Professor Bain subsequently resigned as a member of the PACC on 14 March 2014. PANCAP recognises Professor Bain’s significant contribution to the HIV response in the Caribbean including treatment and training and to the work of the Partnership and its governance bodies.”
But PANCAP said that the region is at a critical point where further progress towards an AIDS-free Caribbean is premised on mobilising a strong and coordinated multi-sectoral effort to remove the legal, social and cultural obstacles that prevent universal access to a wide range of comprehensive and high quality health services.
It said currently, 11 Caribbean Community (CARICOM) states have laws which criminalize consensual same-sex relationships between adults in private.
“The Global Commission on HIV and the Law has found that countries which criminalize same-sex sexual activity have higher HIV prevalence rates among men who have sex with men (MSM) than countries that do not; that criminalizing HIV transmission harms HIV prevention and treatment; and that guaranteeing access to reproductive health services can help reduce HIV risk”.
It said specific to the Caribbean, stigma is named as the main reason for the lack of attention to marginalised groups in the prevention efforts, and their general lack of access to HIV-related services, and stigmatising and discriminatory legal and policy measures are common in the regional legal systems.
PANCAP said a 2012 Lancet Study estimates MSM prevalence in the Caribbean to be the highest in the world at 25.4 per cent as compared to one per cent n the general population.
“The UNAIDS Modes of Transmission (MOT) modeling tool estimates that 32% of new cases in Jamaica and 33% in Dominican Republic occur among MSM. Recognizing these challenges, the Caribbean Regional Strategic Framework (CRSF) 2014-2018 is premised on the understanding that ending HIV is not possible until the human rights of all people, and particularly those most vulnerable to HIV, are fully realized.
PANCAP said it is “convinced that HIV-related stigma and discrimination which contribute to the persistence of AIDS in our region can be reduced and/or eliminated through collaborative programmes, partnerships and policies supported by governments, private sectors, faith-based organisations, non-governmental organisations….”
It said it is in this regard it viewed the current situation involving Professor Bain “as an opportunity for the region to engage in a dispassionate, thoughtful and holistic discussion that accommodates differing views and promotes understanding and inclusion”