Observer Intervention: Global Forum on MSM & HIV (MSMGF)

Last week, the Global Forum on MSM & HIV (MSMGF) released the first report from our 2012 Global Men’s Health and Rights Study (GMHR).[1] The study included a global survey of more than 5,000 men who have sex with men (MSM) from over 160 countries and focus group discussions with MSM in Nigeria, Kenya, and South Africa.

In nearly every country around the world, gay men and other MSM face higher rates of HIV than the general population, and this is further exacerbated by the discrimination they face in health care settings. The global survey indicated that only one third of MSM can easily access condoms, lubricant, HIV testing, and HIV treatment. Levels of access differed by country income level, with reduced access to services more commonly reported in lower income countries.

The MSMGF research team also conducted analyses to identify barriers (factors associated with lower access) and facilitators (factors associated with higher access) that impact the ability of MSM to obtain condoms, lubricant, HIV testing, and HIV treatment. The survey revealed that homophobia and stigma from health care providers play a significant role in reducing access to life saving HIV resources for MSM. Conversely, greater comfort with health service providers and more community engagement are associated with higher levels of service access.

Focus group discussion participants explained that the negative consequences of structural barriers like stigma, discrimination, and criminalization were moderated by the existence of safe spaces to meet other MSM, safe spaces to receive services, access to competent mental health care, and access to comprehensive health care. Participants described MSM-led community based organizations as safe spaces where they could celebrate their true selves, receive respectful and knowledgeable health care, and in some cases receive mental health services.

The study’s results point to a number of policies and strategies that can help to address the discrimination MSM face in health care settings and the disproportionate burden of HIV among gay men and other MSM:

• MSM-led community-based organizations (CBOs) must be supported as a vital component of the HIV response. This includes creating a policy environment in which MSM-led CBOs can thrive and provide services without harassment from authorities and intolerant community members. It also means providing sufficient funding to MSM-led CBOs to support the provision of HIV services, competent mental health care, and comprehensive health care to MSM.
• Structural barriers like stigma, discrimination, and criminalization must be addressed if we are to increase access to HIV services for MSM globally. Again, providing sociopolitical and financial support to MSM-led CBOs to lead these efforts will be extremely important.
• LGBT health must be mainstreamed as part of general health care in the public, private, and non-government sectors. Community-led sensitization must be combined with appropriate clinical and patient management modules in both in-service and post-service training for health care providers. These health care providers – including community health workers, pharmacists, nurses, and physicians – should be evaluated based on not only their technical expertise, but also competence in creating a welcoming environment for LGBT clients.

Achieving these goals will require coordinated action on the part of policy makers, funders, civil society, and health care providers. However, in so doing, we can create the structural environment we need to do address these entrenched inequities effectively.