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)
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.
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