New Study Shows Structural Factors Play Major Role in Access to HIV Services for Gay Men Worldwide

Global survey finds homophobia, comfort with service provider, and community engagement make significant impact on access to condoms, lubricant, HIV testing, and HIV treatment

November 29, 2012 (Oakland, Calif.) – A large-scale study of gay men and other men who have sex with men (MSM), conducted by the Global Forum on MSM & HIV (MSMGF), indicates that only one third of MSM can easily access condoms, lubricant, HIV testing, and HIV treatment. Combining a multi-lingual online survey and focus group discussions, the study suggests that structural barriers like homophobia play a significant role in blocking access to HIV services for MSM, while greater comfort with health service providers and more community engagement are associated with higher levels of service access.

The MSMGF’s study aimed to identify factors that affect access to HIV services for MSM. The online survey conducted earlier this year included 5779 men from 165 countries.  In addition, the MSMGF collaborated with African Men for Sexual Health and Rights (AMSHeR) to conduct focus group discussions with 71 MSM across five cities in South Africa, Kenya, and Nigeria.   

Of men who participated in the online survey, only 35% reported that condoms were easily accessible, 21% reported easy access to lubricant, 36% reported easy access to HIV testing, and 42% reported easy access to HIV treatment. Levels of access differed by country income level, with reduced access to services more commonly reported in lower income countries. 

Percent of MSM reporting that condoms, lubricant, HIV testing, and HIV treatment are easily accessible, organized by country income level using World Bank country income classifications

“Such poor levels of access at the global level are unacceptable,” said Dr. George Ayala, Executive Director of the MSMGF. “The differences in access by country income are especially important to note as the Global Fund moves into a new funding model where countries are grouped into bands by income level. Even in upper middle income countries, MSM still have extremely low access to services. Without targeted funding to MSM and other key populations, the new funding model may continue to deteriorate levels of access for the groups most affected by HIV.”

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.

Adjusting for country income, greater access to condoms, lubricants, and HIV testing were associated with less homophobia, greater comfort with health service providers, and more community engagement. Among participants living with HIV, higher access to HIV treatment was associated with less homophobia and greater comfort with health service providers.  Greater access to lubricants and greater access to HIV testing were also associated with less outness (the degree to which others know of one’s sexual orientation) and fewer negative consequences as a result of being out, respectively.

“As we collectively forge ahead into the new territory of treatment-based prevention, it is clear that many of the old challenges remain,” said Noah Metheny, Director of Policy at the MSMGF. “Addressing structural barriers remains essential to realizing the potential of HIV interventions for MSM, and it becomes more important with each new prevention and treatment option that is made available. Investments in the development of new interventions must be accompanied by efforts to increase access.”

The quantitative data from the online survey was supplemented with qualitative data from focus group discussions, helping to place barriers and facilitators in the broader context of the sexual health and lived experiences of MSM. Focus group discussion participants identified barriers and facilitators that were highly consistent with those found in the online survey, and many participants explained the ways that structural barriers at the policy, cultural, and institutional levels cascade down through the community and individual levels to block access to services for MSM.

Focus group discussion participants described how structural barriers like stigma, discrimination, and criminalization force MSM to hide their sexual behavior from health care providers, employers, landlords, teachers, and family members in order to protect themselves and maintain a minimum livelihood. The inability of MSM to reveal their sexual behavior to health service providers was linked to misdiagnosis, delayed diagnosis, and delayed treatment, leading to poor health prognosis and higher risk of transmitting HIV and other sexually transmitted infections to partners. 

Conversely, focus group discussion participants explained that the negative consequences of structural barriers 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 findings underscore the urgent need to improve access to essential HIV services for gay men and other MSM worldwide,” said Dr. Ayala. “Interventions must both disrupt the negative effects of barriers and bolster the protective effects of facilitators. Study participants clearly indicated that community engagement and community-based organizations are central to moderating barriers and promoting service access. Successfully addressing HIV among MSM will require a real effort to address structural barriers, and the findings from this study suggest that investing in MSM-led community-based organizations may be the best way to do that.” 

Entitled, “Access to HIV Prevention and Treatment for Men Who Have Sex with Men: Findings from the 2012 Global Men’s Health and Rights Study (GMHR),” the full report can be found on the MSMGF’s website at: http://www.msmgf.org/files/msmgf//documents/GMHR_2012.pdf.

Media Contact:

Jack Beck

510.332.0786 (m)

510.271.1956 (o)

jbeck@msmgf.org

The Global Forum on MSM & HIV (MSMGF) is an expanding network of AIDS organizations, MSM networks, and advocates committed to ensuring robust coverage of and equitable access to effective HIV prevention, care, treatment, and support services tailored to the needs of gay men and other MSM.

GMHC Releases New Report, "FENCED IN: HIV/AIDS in the U.S. Criminal Justice System"

In conjunction with World AIDS Day (12/1), Gay Men's Health Crisis released a new report, "FENCED IN: HIV/AIDS in the U.S. Criminal Justice System," which addresses the dual epidemic of HIV and mass incarceration in the U.S. and offers policy recommendations to improve the health of affected communities.  This comprehensive report documents how mass imprisonment often destroys relationships, healthcare regimens, and employment opportunities for formerly incarcerated individuals.  As a result, communities with high rates of incarceration also tend to have high rates of HIV infection.  The state of HIV care and prevention inside prisons and jails is also examined, and comparisons between states in the U.S. and countries across the globe are explored.

Some recommendations in the report include:

• Prisoners should be recruited to become peer educators about HIV epidemiology and prevention. These leaders should also conduct outreach to fellow prisoners about the benefits of HIV testing.
• Prisons should avoid the use of solitary confinement under any circumstances, especially of prisoners living with HIV. Solitary confinement can make access to treatment and medications extremely difficult and irregular.
• Condoms and other prophylactic devices should be made readily available to inmates without having to request them from medical staff, via vending machines or other dispensaries.

"Through this report and other work statewide and nationally, we at GMHC assert our commitment to combatting the AIDS epidemic within corrections systems," stated Marjorie J. Hill, PhD, CEO of GMHC.  "Prisons and jails are crucial battlegrounds in the fight for an 'AIDS-free generation,' and they remain a top priority in our policy work."

Many of the maps and other visuals in FENCED IN were drafted by the Legal Action Center.  The report also includes an opening statement from Mr. Hilary Shelton, the Director of the NAACP Washington Bureau and Senior Vice President for Policy and Advocacy.

Click here to read the comprehensive report.

Feet Walking Forward: The Life of William Brandon Lacy Campos

 by Aundaray Guess

When I signed into Facebook Saturday morning, I was prepared to post something witty about my need for coffee to get my weekend going. I was expecting to see in my News Feed the usual praise for God, posts about wild Friday-night experiences and a few Instagram photos of folks posing in the mirror. What I wasn't expecting to see was a post about a friend who, it seemed, had passed. My heart raced, and I immediately went to his page, and there it was, a long list of people commenting on the passing of a great warrior. His Facebook page gives his full name as William Brandon Lacy Campos, but his friends knew him simply as Brandon.

Brandon, who was anything but simple, passed late Friday. He was truly a unique man. He has been described rightly as a warrior, an author, an advocate and a blogger, and most importantly he has been described as a good friend to all. He battled drug abuse and homophobia and wrote candidly about his HIV-positive status. As a gay man of color living with HIV, he literally bared his soul for all to see, and in that nakedness he exposed the many injustices that the disenfranchised have to endure. He spoke out not just for gays and those living with HIV but for those who may have felt that they had no voice. He didn't use his male privilege with abandon but instead recognized that as a male with certain privileges, it was his duty to make sure women had the same rights. In his own words Brandon described himself as "a poet, playwright, journalist, amateur chef and life commentator doing his bit to put his foot in the asses of the regressive masses, while putting filling and nutritious food on plates of folks that ain't got much and deserve better." And -- oh, yeah! -- he was a tough-as-nails feminist!

I admire him most for his writings on HIV. In this day and age, when having HIV still carries such a stigma, he refused to let anyone place him in a box. He was a great intellect who could effectively communicate the experience of living with HIV and not only point out the injustices that those living with HIV must endure but stand on the front lines, daring anyone to try to silence him. He was an accidental activist who may not have been the quietest person, but that's what we needed, someone to get up in people's faces and let them know, "We're going to talk about this shit, and the train ain't leaving until we're all strapped in." A college-educated man, he had letters after his name, but he didn't let those letters define who he was. He also didn't just hang with intellectuals but made himself available to anyone, no matter what road he or she walked. So whether you had a Ph.D. or a degree in street smarts, he was there for you. He knew we all had a story to tell.

Don't get me wrong: Brandon would do some crazy shit. Sometimes the posts on his Facebook page would qualify as too much information, but in all honesty he did what a lot of us are so afraid to do: He lived. He made his life have meaning and a purpose, and he didn't forget to have fun. He loved to love, and he loved to be in love. And that's what I feel made people gravitate to him. Simply look at his Facebook page and you'll see people from all walks of life. You'll see a rainbow of genders, sexual orientations, nationalities and perspectives. And just from reading the last few days' posts, you'll see that he was someone who took the time to actually connect with people face-to-face, person-to-person, and who cooked from his soul as he fed not only stomachs but hearts. That's rare in this age of social media and texting.

It's a wonder that he was able to make so much time for people, as he was very active in the queer community. Starting in his teens he was there giving a voice. In his 20s he co-chaired the National Queer Student Coalition. He sat on the board for the Audre Lorde Project and was co-executive director of Queers for Economic Justice. He was a constant blogger who brought up timely issues on his widely read blog, My Feet Only Walk Forward, and as a fierce spoken-word artist in his book It Ain't Truth If It Doesn't Hurt, which was published last year. I can hear Brandon saying, "Guess what, bitches! You can get it on Amazon.com, plus it's in e-book form. Boo-yah!" And with his "Naked Poetry" series on YouTube, he let it all hang out and left you with something to think about.

I knew Brandon personally when I lived in Minnesota, which he was also from. With the state being over 80-percent white, we LGBT people of color had to find each other. I always joked that he followed me to NYC. That may not be the case, but I do know that I followed him in his activism as he inspired me to start blogging and telling my own story of living with HIV. I was amazed that he was able to put it out there and in his words. It gave me the strength to do the same. What Brandon did was throw a big rock in the deep water, creating ripples of people who were also inspired by him. I let him know this when I saw him at a performance that we both attended.

Brandon didn't belong to me, to you or to anybody at the top of his Facebook friends list. Brandon belonged to everyone who met him, because his spirit is in all of us. His blog was aptly titled "My Feet Only Walk Forward," because with such a huge load to carry, he knew forward was the only way to go. I hope I and others make Brandon proud as we pick up that load and become the voice of justice. When we do it, we do it in honor of Brandon. And if we encounter people with closed ears and minds, we'll do what Brandon used to say: "We're just going to beat them silly with a piece of ham hock until their damn neck snaps back into reality."

I hope I got that right, Brandon, and thank you for inspiring me to be naked.
______________________________________________________________________
Mr. Guess' article was originally posted on the Huffington Post on November 14, 2012.

All Hands on Deck for People Living With HIV and AIDS After Hurricane Sandy

By Janet Weinberg

It happens almost every four weeks: A surge of clients comes to Gay Men's Health Crisis (GMHC) in pursuit of meals and bags of groceries. For people living with HIV and AIDS whose main source of income is their Social Security disability checks, money often runs out near the end of the month. At that point they are not able to buy food, and they come in for help.

Many have to survive the "in-between days" until their next Social Security check arrives. I expected the end of October to be no different, but then Hurricane Sandy arrived in its cataclysmic fury. As a tragic result, many people in NYC living with or affected by HIV and AIDS were hit hard. Our clients are among the poorest and most vulnerable New Yorkers, and the outcome of the hurricane continues to have a disproportionate impact on them. These men, women and families continue to be without housing, food, electricity, clothing and HIV medications and need basic humanitarian support and someone with whom they can talk. In fact, on Monday, October 29, despite the severe storm warnings and the rain, several clients braved the weather to walk from as far away as the Bronx and Brooklyn to our offices on West 33rd Street for a hot meal. This was their only meal of the day, and for some the only meal until GMHC was able to reopen the following Wednesday. Well over 400 meals were served in the heart of the crisis, even when subways had not resumed service, with clients walking long distances to receive food and support.

HIV-positive clients haven't been the only ones in crisis. One high-risk, HIV-negative client needed to see three staff persons -- our psychologist, our attorney and our benefits advocate -- because the crises he was experiencing seemed insurmountable. The rest of that week hundreds more came through our doors needing urgent care. Our Meals Program's food supplies, including items such as bread and salad ingredients, began to dip because trucks had stopped delivering. Though our chef, Wilson Rodriguez, is very creative, worrisome feelings started to set in about what could happen during the week of November 5 if deliveries did not resume. When a person living with HIV or AIDS does not have food to eat, there are serious consequences, particularly if their HIV medications have to be taken with food. Therefore, adhering to treatment becomes jeopardized, and anxiety about food takes root. Each day we were reminded how critical it is that we are here for our clients, providing meals and bags of groceries, linkages to housing and crisis counseling.

Even with the emotional intensity of the week, there were heartwarming, inspiring moments. I was deeply moved when board members, volunteers and staff members found ways to travel to our offices, pitched in to cook and serve meals and distributed bags of groceries from our Keith Haring Food Pantry Program. This was a significant, "all-hands-on-deck" situation. Several clients told us how appreciative they were that we remained open. "If you weren't open today, I would have eaten nothing but peanut butter," shared one gentleman.

Close to the end of that week, our Meals Program finally received a food delivery. At the same time we were even able to host a wedding ceremony at GMHC! Two of the agency's friends, Lawrence Neil Chanen and John Eryn Burkhalter, were married in my office. Their wedding faced cancellation due to the hurricane. I took photos, and my spouse, the Hon. Rosalyn H. Richter, an associate justice of the appellate division of the New York State Supreme Court, officiated. It was a touching event. GMHC provided yet another safe space in the aftermath of Hurricane Sandy to this couple.

During the second week after the hurricane, we made a decision to cancel our annual fundraiser, Fashion Forward, in order to continue focusing on our core mission: providing direct support to people living with and affected by HIV and AIDS. A new relief fund, Hurricane Relief Forward, was launched to continue our disaster relief work, as our efforts increase daily with the growing demand for immediate services.

It is clear that the recovery from the hurricane has only begun, and it will be a long journey to heal and rebuild. Yet what is even clearer is the importance of all of us pulling together to be of service to each other. Our hands and our hearts are on deck.

_________________________________________________________________________

Janet Weinberg’s article was originally published in the HuffingtonPost on November 13, 2012.

Hurricane Relief Forward Fund Created by GMHC Following Cancellation of Fashion Forward Event

Later today, Thursday, November 8, would have been the night of our annual fundraiser, Fashion Forward, which honors the nexus of fashion and AIDS activism.  Yet following the devastation caused by Hurricane Sandy, and the impact it has had on our clients, GMHC cancelled the event to focus on our core mission--serving people living with and affected by HIV and AIDS.  To achieve this mission, a new fund was created by GMHC, Hurricane Relief Forward, for our disaster relief work.  This unrestricted fund includes a matching program, initially sponsored by four of our most generous donors and we now ask for support.  The program has started with $33,500, so we are seeking donations which will be matched, thus doubling the contributions.

Donors to the fund include members of the GMHC Board of Directors, with the founding donation being from Board member Craig de Thomas, the Chief Executive Officer of Insignia National Title Agency, LLC.  Craig explained, "It was heart-wrenching to see how many of our clients were in great need and despair after the hurricane hit NYC.  Volunteering was not enough and that's why I am determined to put my resources where they will have an impact. I am honored to step forward with financial support."  To donate to GMHC's Hurricane Relief Forward, please visit our website--gmhc.org.  For questions, please contact (212) 367-1281 or email Sherry Card at sherryc@gmhc.org.

As a result of Hurricane Sandy, many New Yorkers living with or affected by HIV/AIDS were hit hard.  GMHC's clients include some of the poorest and most vulnerable New Yorkers, and Hurricane Sandy had a disproportionate effect on them.  We were saddened to cancel Fashion Forward, but know that under these circumstances, it was the correct decision.   As we worked through last week, it became clear the disaster's aftermath was much worse than what we originally anticipated, so we are concentrating our efforts on addressing these needs.

Many of our clients continue to be without housing, food, electricity, clothing and HIV medications--and need basic humanitarian support.  On Monday, October 29 and Wednesday, October 31, several clients braved the weather, walking from their homes in the Bronx and Brooklyn to our offices on West 33rd Street for a hot meal.  This may have been their only meal of the day.  Well over 400 meals were served in the heart of the crisis, even when subways had not resumed, with clients making their way long distances to receive food and assistance.  We sent home care packages with clients on Monday knowing that they might not have access to any food on Tuesday, October 30, and we were not able to be open with the closure of the subways.

Not only HIV-positive clients are in crisis, one high-risk, HIV-negative client needed to see three staff persons including our psychologist, attorney and benefits advocate because the crises he was experiencing seemed insurmountable.  The rest of last week, hundreds more came through our doors needing urgent care.  It continues to be critical that we are here for our clients, providing meals and bags of groceries, linkages to housing and crisis counseling.  One client on Staten Island called in dire panic as her home had been destroyed and she had not been able to find temporary housing.  GMHC immediately took action and now she is safe in a temporary shelter.

Our clients who live in areas without power had problems accessing their HIV medications and needed immediate intervention.  We worked with our pharmacy contacts to successfully resolve their issues. 

Our Mental Health Services have provided daily crisis counseling and the numbers of clients needing to talk remains high.  Our Meals Program and Keith Haring Food Pantry Program continue to have high volume, with more people needing assistance than prior to Hurricane Sandy.  Our Case Management department continues to address housing needs of many clients, some of whom have been dislocated by the hurricane.

GMHC remains focused on our core mission in the hurricane's aftermath.  Hurricane Relief Forward, dedicated to assisting people living with HIV/AIDS, allows us to continue our disaster relief work as our efforts increase.  Seth Rosen, JD, Managing Director of Development at GMHC, noted, "On the day before the hurricane, and the week following it, I helped serve meals and tended to immediate needs of our clients.  I was deeply moved by the experience and how our staff, board members and volunteers stepped up in those difficult days.  With this new fund, we will be able to increase our support for those impacted by Hurricane Sandy."

GMHC is especially grateful to the abundance of Fashion Forward donors, who upon learning of the difficulties being faced by our clients, graciously allowed their funds to be utilized for these efforts. 

To donate to GMHC's Hurricane Relief Forward, please visit our website--gmhc.org.  For questions, please contact (212) 367-1281 or email Sherry Card at sherryc@gmhc.org.