Recently, an Egyptian court sentenced four men each to three years in prison because they are gay and HIV-positive. Taken into custody during a sweep of recent arrests of suspected homosexuals, the men were publicly shamed, forced to submit to HIV tests, and tortured by Egyptian authorities. This type of treatment not only violates international human rights standards, it undermines efforts to prevent the spread of HIV/AIDS.
Around the world, stigma, discrimination and lack of access to health services have sparked alarming HIV epidemics among men who have sex with men, or MSM. Ironically, it was gay men in the United States and Europe who first brought AIDS into the global spotlight, forcing the issue into the public consciousness during the 1980s. These impassioned advocates fought for increased research funding, access to treatment, and a seat at the decision-making table, and they largely succeeded in slowing the spread of the epidemic in their communities.
In many developing countries, however, the story has been far different. Eighty-five countries around the world continue to criminalize consensual homosexual conduct, leaving millions of MSM living in constant fear of arrest and prosecution. ( To be fair, it was only in 2003 that the U.S. Supreme Court declared unconstitutional sodomy laws that criminalized sexual relations between men. )
The condemned men in Egypt were arrested after police responded to a fight between two of the men and then proceeded to round up their friends and associates. Acts of intimidation and persecution such as this only serve to force men who have sex with men underground, preventing them from learning how to protect themselves from HIV, and alienated from treatment opportunities.
This discrimination has also seeped into international efforts to combat the epidemic. For many of the major donor agencies—such as the Global Fund to fight AIDS, Tuberculosis, and Malaria—discriminatory national laws also mean that their funding, which is generally administered by national governments, never reaches men who have sex with men.. When a government arrests, beats, and humiliates people simply for being gay, how can one expect that it will agree to provide medical care to those citizens who are gay and HIV positive? What incentive do men at high risk have to get tested? Complicating matters further, some governments, such as Iran, downplay or explicitly deny that MSM populations even exist within their countries.
This discrimination is fueling an HIV epidemic among men who have sex with men. Researchers estimate that fewer than one in twenty men who have sex with men around the world have access to HIV prevention programs. A recent study found that in 38 low- and middle-income countries, MSM have an average 19 times greater chance of being infected with HIV than the general population. In Bolivia, HIV prevalence among MSM is estimated to be more than 140 times greater than that of the general population. And the U.S. Centers for Disease Control and Prevention recently announced that HIV rates among American MSM under 30 are increasing faster than expected, indicating that young gay men have begun to fall through the same cracks in the system that the previous generation fought so hard to close.
The current situation is unacceptable. History has taught us that ignoring the vulnerable populations is a recipe for the continued spread of the AIDS epidemic. In many countries, fear of stigma and discrimination forces many MSM into marriages. In regions where sexual and gender identities are more fluid and often less clearly defined, MSM frequently choose to get married and have families. In Peru, a recent survey found that 26.5 percent of MSM reported having had sex with a woman in the previous year. The notion that infections will remain confined to the MSM community is simply false.
There are, thankfully, some signs that the situation is beginning to change. Grassroots MSM organizations are beginning to spring up in developing countries, expanding access to education and HIV prevention services. In a recent request for proposals issued by amfAR, The Foundation for AIDS Research, 85 applications were received from groups in Africa seeking to provide HIV services to MSM. The good news: These grassroots groups will work to promote acceptance, spread awareness, and increase access for MSM to treatment and prevention programs. The bad news: With requests totaling more than US$2 million, we are only able to support seven grants in this round.
It is vitally important that other donor organizations and countries specifically include men who have sex with men in their AIDS funding priorities. The international community must demand that countries around the world abolish laws that criminalize homosexuality and denounce injustices such as the convictions in Egypt when they occur. We must continue to fight stigma and encourage greater tolerance so that MSM and other high-risk populations feel safe enough to accept AIDS care and support without fear. The fight against the AIDS epidemic is too important and the stakes are too high to let prejudice get in the way.
Kevin Robert Frost is the CEO of amfAR, The Foundation for AIDS Research.
