Most Gay Men Worldwide Can’t Access Basic HIV Prevention
A new survey of more than 5,000 participants worldwide indicates that the majority of gay men -- or, "men who have sex with men" (MSM) -- all over the world find it difficult or impossible to access HIV testing, HIV counseling, free condoms or free lubricant.
Released to coincide with World AIDS Day, the preliminary findings underscored the importance of universal access to HIV prevention and treatment, a central theme of this year’s World AIDS Day observance. Initial analysis of the survey’s results indicates that fewer than half of MSM worldwide have access to even the most basic HIV prevention and services.
Of all respondents, only 39 percent reported easy access to free condoms and barely one in four reported easy access to free lubricant. A quarter said free lubricant was completely unavailable. Large percentages of men reported that it was difficult or impossible to access other essential services as well, including HIV testing (57 percent), HIV education materials (66 percent) and HIV treatment (70 percent).
Conducted by the Global Forum on MSM & HIV (MSMGF) in collaboration with Dr. Patrick Wilson, a professor at Columbia University’s Mailman School of Public Health, the survey was carried out online in Chinese, English, French, Russian and Spanish.
Circulated through the MSMGF’s global networks and those of its partner Fridae.com, the survey included 3,875 MSM and 1,009 MSM service providers participating. Another 375 participants did not identify themselves as MSM or provider. Nearly three quarters of all study participants were from low or middle-income countries.
"Since the beginning of the epidemic, it has been widely recognized that condoms, lubricant, testing and treatment, when combined with community-led behavior change and support programs, are the most reliable tools available in the fight against HIV among MSM," said Dr. George Ayala, executive officer of the MSMGF. "More than 25 years in, it is inexcusable that MSM around the world continue to have such restricted access to these basic lifesaving resources."
"With the excitement surrounding the promise of pre-exposure prophylaxis (PrEP), it can be easy to forget that we already have a rich selection of prevention measures that we know work right now," said Patrick Hebert, senior education associate at the MSMGF. "Today’s findings reinforce the fact that we can’t even get condoms and lube to more than half of MSM around the world. We must look seriously at barriers that prevent MSM in different country contexts from accessing these proven prevention tools."
While reporting on levels of access to currently available HIV prevention tools and services, the survey also explored knowledge about emerging technologies like PrEP, which involves taking antiretroviral drugs before exposure to HIV in order to prevent infection. Perhaps not surprisingly, men in North America, Western Europe and Australia reported more knowledge about emerging prevention strategies than men in Africa, Asia, the Caribbean, Eastern Europe, and Latin America.
Even so, large numbers of men in all regions of the world expressed confusion about these technologies. When asked whether MSM should use PrEP to prevent HIV infection, 40 percent of respondents said, "I don’t know."
This suggests a need for stronger communication and education efforts targeting MSM worldwide regarding these new potential options. Regional differences also emerged regarding experiences of stigma and discrimination. On every measure of stigma related to homophobia, men in Africa, Asia, the Caribbean, Eastern Europe, and Latin America reported higher levels and harsher forms of stigma and discrimination than men in North America, Western Europe and Australia.
"Stigma and discrimination fuel the HIV epidemic among MSM and other high-risk populations," said Othman Mellouk, co-chair of the MSMGF and advocacy coordinator of the International Treatment Preparedness Coalition (ITPC) for North Africa. "Stigma and discrimination undermine access to prevention and treatment programs by forcing MSM underground and away from services they may need. Without addressing the bigger issue of homophobia, we will have no hope of ending AIDS."
The MSMGF is currently working with Dr. Wilson to complete analysis of the full data set and is expecting to release a comprehensive report in early 2011.