In the global AIDS epidemic, it is the illustration of a vicious circle: People in situations that leave them the most vulnerable to getting HIV have the least access to protection. They have the highest prevalence of the virus that leads to AIDS. Then they have the least access to care.
That may not be news about the situation facing men who have sex with men worldwide, but it is the summation of both the reason for, and the initial findings of a study that sought information that could be used to build structures for healthcare and support where, in much of the world, none exists.
The Global Forum on MSM and HIV — MSMGF — presented the preliminary findings of the study, which used a 30-minute online survey — in six languages including English, French, Russian and Spanish to collect information from men who have sex with men around the world on their access to condoms, lubricants, HIV-testing and treatment, as well as their knowledge of and interest in preexposure antiretroviral treatment to prevent acquisition of HIV (PrEP). The study looked at these issues in the context of the prevailing environments of homophobia, violence toward men who have sex with men, violence toward people with HIV, attitudes of stigma by healthcare providers, and negative consequences for being open about homosexual sex, as well as the counterbalance of community engagement, connection to a gay community, comfort with healthcare providers, and sexual happiness. The study also looked at demographic information — that of the respondents, as well as of the countries from which they responded.
Found through internet listservs, websites and through email blasts, 36 percent of the men who responded came from high-income countries, 40 percent came from countries classified as upper-middle-income, 20 percent from lower-middle income countries, and 4 percent from low income countries. The men themselves, however, tended not to enjoy the benefit of their countries’ resources, with only 10 percent of the men reporting individual high incomes, 44 percent middle incomes, 32 percent low to middle incomes, 8 percent low incomes, and 10 percent reporting no individual income. Of all of the men, nearly all of whom had some level of education, 22 percent had unstable housing situations, and 1 percent were homeless.
Their access to unrestricted HIV services tended to be even less reliable — with about 35 percent reporting “unfettered” access to condoms, 21 percent to lubricants, 63 percent to HIV testing, and of those living with HIV, just 41.8 percent reporting unfettered access to treatment. Higher levels of homophobia and negative consequences for openness on sexuality issues corresponded with less access, community engagement and comfort with provider with greater access.
About half of the men who took part in the survey had what was described as “high” knowledge of PrEP. The less open the men were able to be about their sexuality, the more acceptable PrEP was. The more men knew about PrEP — how much and how long the medicine would need to be taken, that condom use was still recommended, and side effects, the less acceptable it became.
Dr. Sonia Arreola, the researcher who presented those initial findings, acknowledged shortcomings to the research so far — including the limitations of the likely more connected, educated and motivated sample of respondents using the internet. Researchers plan to follow with a pen and paper survey, and further analyze the responses.
But, the findings lent themselves to general conclusions, including the need for global as well as local human rights advocacy efforts, and that rights of gay men and men who have sex with men are essential to effective prevention and treatment efforts, and to using new information to turn down the trajectory of the AIDS epidemic.