The government diverted almost all of the money it received in Phase One of the Global Fund for work specifically with men who have sex with men (MSM) to other programmes, according to a new study, which also found that existing programmes here for the vulnerable group are small scale.
“In the most extreme case, funding for MSM programmes supported by the Global Fund in Guyana dropped by 96% between initial proposal and final budget,” said the report released yesterday by amfAR, The Foundation for AIDS Research and the Center for Public Health and Human Rights (CPHHR) at Johns Hopkins University.
According to the study, which was conducted by students in eight countries, despite HIV prevalence among MSM in Guyana being nearly 20 times that of the general population, “prevention efforts are hampered by criminalization that prevents many government bodies from directly addressing the HIV epidemic among MSM; programmes, where they exist, are limited to small-scale behavioral interventions.”
The eight countries in the study were Guyana, China, Ethiopia, India, Mozambique, Nigeria, Ukraine, and Vietnam.
The report on the study, titled ‘Achieving an AIDS-Free Generation for Gay Men and Other MSM,’ found that funding to prevent and treat HIV/AIDS consistently fails to reach programnes designed to control the disease among gay men and other men who have sex with men. The report also found that resources dedicated to addressing the epidemic among MSM are “grossly insufficient, and that funding intended for this population is often diverted away from MSM-related services.
“Despite Obama administration leadership in setting bold new targets to tackle global AIDS and highlight the human rights of MSM and other sexual minorities, US government aid intended to prevent and treat HIV infection among MSM continues to encounter obstacles throughout the world,” a press release on the report stated.
Focusing on the eight countries, the report indicated that national governments have failed to adequately tackle the epidemic among MSM. The situation is even worse in countries that criminalise MSM. Guyana still has laws that criminalise homosexuality and the report said this negatively impacts the ability and inclination to conduct research and surveillance regarding MSM in Guyana.
The study on Guyana, which was done by research consultant Joel Simpson, found that MSM-specific programmes in Guyana are, by and large, limited to behavioral interventions; they include community outreach, peer education, peer counselling, VCT, and referrals to health services, almost exclusively provided by civil society.
Most of the persons interviewed by Simpson agreed that the law on same-sex sexual practices influences the government’s reluctance to provide targeted health and other support programmes to MSM, which are needed to reduce their vulnerability to the epidemic.
“With the partial exception of the Ministry of Health, criminalization restricts government entities from being involved in MSM-specific programming in many important ways. One respondent pointed to the reluctance of the Ministry of Home Affairs to provide HIV prevention services (such as condoms) in prisons and the army because of the legal regime criminalizing sex between men,” the report said.
Most respondents, the report said, agreed that the criminalisation of same-sex activities is the main reason that stigma and discrimination against same-sex sexual practices and MSM are rampant throughout Guyana society. There was general consensus too that such laws further entrench stigmatizing cultural and social attitudes, which in turn lead to significant self-stigma and limited self-esteem among members of the population.
The impact is also substantial regarding health and HIV programming and interventions, the report said.
It noted that MSM-related stigma and discrimination constrain research and surveillance, including the construction of sound sampling methods, which means that little data or viable estimates exist even as to the size of the population.
Importantly, the report said that in Guyana stigma and discrimination regarding MSM are also rampant in health facilities, though some interviewees said the discrimination among health workers has decreased over the years as a result of training and sensitization. However, it was noted that although some HIV services in Guyana are open to all in need, and many MSM access them, few prevention or social services targeting MSM currently exist.
The Guyana Government, the report said, provides extremely limited support for MSM-specific HIV programming. The government also does not provide funds for MSM research directly—largely because most, if not all, HIV research is donor funded. The government provides support for research indirectly through the work of NAPS staff, but no direct funding is provided. According to one respondent in the report, the government’s reluctance to get directly involved underscores its overall discrimination against the MSM population even in comparison with other at-risk groups. He said, “They [the Guyana government] only do the pre-requisite BSS/IBBSS research on the MSM population. They do other kinds of research with other populations, but not with the MSM population.”
The study participants identified a number of recommendations aimed at improving the access of MSM to comprehensive HIV services. Most focused on eliminating current barriers and/or creating new opportunities for greater awareness of MSM-specific issues in the health sector and overall society.
Chief among the recommendations was the call for the government and Parliament to repeal laws criminalizing same-sex sexual practices and cross-dressing and for civil society advocates working on HIV issues to consider this a major advocacy priority.
It was also recommended that the government and Parliament should consider and pass laws prohibiting all forms of discrimination against sexual and gender minorities. Such steps are critical to reducing stigma against MSM, which greatly limits their ability to access health and social services in Guyana.
Meantime, the authors of the report indicated that while exciting, recent scientific results in the field of AIDS present the opportunity to begin to control and ultimately end the global epidemic, should the HIV prevention and treatment needs of MSM not receive greatly expanded attention, “these communities will be left behind and progress against the overall epidemic will be limited. In an era of increasing use of biomedical prevention tools, it is important to identify services that meet the needs of MSM in diverse settings and to bring these lifesaving services to scale.”
This report documents the tangible connection between health and human rights, pointing to the need to advance on both fronts in order to make progress. It also discusses notable progress among national and multilateral systems in addressing the needs of MSM, but also reveals a public health response that remains “dangerously inadequate, stymied, and ultimately undermined by stigma and discrimination.
“It will be impossible to achieve an ‘AIDS-Free Generation’ if MSM are left behind. Respect for human rights and public health both demand a more equitable and effective response to the AIDS epidemic among this population from both donors and affected country governments,” the report warned.
It pointed out that a recent World Bank report demonstrated the critical importance of tackling HIV incidence among MSM to control overall national epidemics, and a new “investment framework” proposed and the need for more strategic use of resources, including increased investment in the HIV-related needs of MSM, injection drug users, and sex workers.
amfAR, The Foundation for AIDS Research, is one of the world’s leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy. Since 1985, amfAR has invested nearly $325 million in its programmes and has awarded grants to more than 2,000 research teams worldwide.
