Poster Gallery at the 2008 MSM Pre-Conference

Vagner Almeida

The Butterflies Are Living Day By Day (pdf)
Authors: Vagner de Almeida and Richard Parker

How trangenders and gay communities can survive their days in countries that do not respect the Human Rights?

In Brazil officially one homosexual is killed everyday and many others are not reported.

Based in life histories the films documentaries “The Butterflies” and “Living Day By Day” bring to the public hate crimes, homophobia and exclusion promoted by Brazilian society.

The film unveils the reality of homosexual youths in the outskirts of metropolitan cities, suffering from the effects of poverty and misery, without compromising their dignity and their creativity. Homosexuals, drag-queens: the real Brazilian who carries the “Woman in the Bag”, experimenting with the possibilities and pushing the limits of gender and sexuality, and they face discrimination with force, courage, and determination… They fight for the right of difference, and they demand, in diverse ways, that their difference is respected. In these films, we have brave people that Brazilian television does not show and the midia insists to discriminate and put aside. The films are more than denouncing the impunity of these hate crimes against transgender, homosexuals, gays, and other non-heterosexuals, theses documentaries tries to bring together the collective voice of resistance of all who struggle for citizenship and for the affirmation of life as supreme and universal.

 

Stefan Baral

A Systematic Review of HIV epidemiology and risk factors among MSM in Sub-Saharan Africa

Background: The epidemic of HIV in Sub-Saharan Africa is driven by multiple factors, yet the role of male same-sex behaviors has been largely excluded from HIV surveillance and research. Epidemiologic data for MSM in Africa are among the sparsest globally, but there is evidence that male to male sexual contact is a risk for men on this continent as on all others. Grassroots efforts are underway to characterize HIV risks of MSM beyond calling for recognition of their existence. A greater understanding of the drivers of infectious disease epidemics among these men is needed to design prevention and surveillance strategies and advocate for funding for these efforts.
Methods: A systematic review using the QUORUM protocol.

Results: As of January, 2008, there is published HIV prevalence data available for MSM in Kenya, Senegal, and Sudan. Prevalence rates in these studies ranged from 9.3% in Sudan, 21.5% in Senegal, and to 43% in Kenya which are all higher than the general population prevalence in these countries. Studies of prevalence of HIV risk factors were available from other countries including Zambia and Nigeria suggesting high rates of unprotected anal intercourse and low levels of HIV related knowledge among African MSM.

Conclusions: African MSM are underserviced and marginalized. HIV rates are higher than among other men, and there is limited knowledge of the health related risks of anal intercourse. Efforts at increasing access of MSM to health and social services have largely been driven by community based organizations rather than nationally funded HIV programs. These efforts have been hampered by the systemic stigmatization targeting MSM in much of Africa manifesting in violence, anti-sodomy laws, and exclusion from AIDS strategies. To comprehensively address the HIV epidemic, African national AIDS strategies should allocate funds based on evidence, ensuring that the right to healthcare is respected for all those at risk.

 

Graham Brown

Issues: NetReach was a peer-based sexual health promotion outreach program targeting Australian men who have sex with men (MSM) via Internet chat rooms and profile sites. It was a collaborative effort of the AIDS Councils of Western Australia, South Australia, Victoria, Queensland and Tasmania and the Australian Federation of AIDS Organisations.

Description: In essence peer volunteers and staff entered existing commercial online chat rooms in a similar way to peer outreach at social, community and sexual venues. The program was implemented in a way that aimed to respect and support the users of this virtual environment and the online community they had created. During the brief development and trial period there were 304 outreach shifts, with exposure to 27,672 people and 460 in depth online discussions. 18 months after the end of the trial period AIDS Councils were interviewed to discuss the sustainability of program and why some had maintained the interventions and why some had ceased Internet outreach in this format.

Lessons Learned: The online environment may change significantly in as little as six months, requiring the delivery of online outreach programs to be modified. Planning, funding and evaluation arrangements need to reflect this. Involving participants from the online community in the project was critical to maintain a level of cultural acceptance and credibility, adapt to rapid changes inn culture and technology, and to sustain a reflexive approach. Feedback from AIDS Councils 18 months after the trial period focused around the challenges of sustaining outreach with limited numbers of participants or capacity to track direct impact verses the need to be part of the developing context of online communities.

Next Steps: Organisations looking at online outreach need to consider their infrastructure, connections to online cultures, and flexibility of funding requirements before embarking on an investment into online outreach.

 

Earl Ryan Burrell

1The Desmond Tutu HIV Foundation, 2Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; 3Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA; 4Gladstone Institute of Virology and Immunology, University of California, San Francisco, USA

Background: Men who have sex with men (MSM) in South Africa occupy a broad range of socio-economic strata. To date, there has been no assessment of whether socio-economic status (SES) influences sexual risk patterns or HIV serostatus of South African MSM. This specific knowledge is required for HIV interventions to be both targeted and effective.
Methods: We conducted two anonymous, venue-based sexual-risk behaviour and HIV prevalence studies among 751 self-identified MSM in greater Cape Town; one in relatively affluent urban communities and one in surrounding under-resourced peri-urban communities. A demographics and sexual risk behavior questionnaire was administered and HIV assessed through standard ELISA procedures of oral mucosal transudate specimens.

Results: To date, 506 men have enrolled and had their specimens analyzed. Preliminary analysis revealed an overall HIV prevalence of 13.2% (67/506) with a significantly higher peri-urban prevalence of 30.9% (21/68) compared to 10.5% (46/438) among urban MSM (p<0.01). The mean age was 29.7 (SD 9.03, 17–66), with peri-urban MSM significantly younger (p<0.05). There was no significant difference in gay or bisexual identification, while 2.9% (2/68) of peri-urban MSM were transgender identified compared to 0.2% (1/438) of their urban counterparts (p<0.01). With no significant difference between the two groups, the mean number of male sexual partners was 4.7 (SD 15.23, 0-300), with 48.0% (242/504) reporting inconsistent condom use. However, peri-urban MSM were more likely to have reported anal intercourse with a male partner (p<0.05), been diagnosed with an STI ever (p=0.01), participated in transactional sex (p<0.01), and had an HIV test in the previous 12 months (p<0.05) when compared with urban MSM.

Conclusion: While more data are needed, there is clear stratification of HIV prevalence and key risk behaviours between peri-urban and urban MSM in Cape Town. Resources are urgently needed to provide targeted HIV risk-reduction programs to South African MSM communities.

 

Moises Cascante & Leonardo Sanchez

A community based-research approach to understanding the needs of transgender sex-workers in the Dominican Republic (pdf)

Background: A local AIDS service organization in the Dominican Republic has recently developed a social and educational space for transgender sex workers conducting HIV/AIDS prevention work in the area. In its development stage, a volunteer/consultant was contracted to conduct a needs assessment. Stigmatization forces individuals to be far removed from health care, employment and educational services. It also contributes to lack of social support therefore a better understanding of the harsh realities transgender face is recommended for program development.

Methods: Research methodology included a series of field observations, focus groups and in-depth interviews. Conversations were recorded, transcribed and analyzed. All data collected was confidential and meetings were private. Focus groups explored HIV knowledge and experience, societal dilemmas as it pertained to being transgender, gender identity and health access. Additional field observations included onsite visits to street work, homes, strategic planning meetings, dinners and parties. The findings were reported to community members and staff.

Results: Approximately 30-40 individuals contributed to the needs assessment and had at least visited the host organization once. Though about 95% of individuals understood HIV transmission, few had access or felt restricted to seeking health services. Their testimonies spoke clearly to having experienced stigma and discrimination. Stories included being excluded from family, schools and medical facilities. The group prioritized police harassment as their primary problem. Gender identity varied between individuals.

Conclusions: Developing rapport and a non-judgmental approach increased understanding and access to personal information. The wealth of information collected was useful for appropriate intervention planning. Transgender sex workers are experts of their lives. Social support and an active role in their health may lead to stronger community ties, increase access to useful and relevant health information and improved behavioral outcomes. A peer-based intervention is most recommended.

 

John Harold Estrada

Introducción: Después de que la prevalencia de VIH entre HSH habí¬a descendido, la literatura informa sobre aumentos entre grupos de HSH en distintas partes del mundo, lo que obliga a preguntarse por las posibles causas de este fenómeno.

Objetivos: Exponer las consideraciones epidemiológicas de la infección en los HSH alrededor del mundo con énfasis en América Latina-Caribe. Hacer referencia a los factores sociales que determinan el tránsito de las polí¬ticas de prevención de lo epidemiológico-conductual a una perspectiva contruccionista del género y la sexualidad desde un enfoque polí¬tico-económico. Revisar el contexto cultural de los estudios de sexualidad entre hombres.

Material y métodos: Revisión sistemática de literatura con cerca de 100 artí¬culos publicados con datos de prevalencia y comportamientos de riesgo de HSH de todo el mundo, con énfasis en América Latina-Caribe.

Resultados: La prevalencia de la infección por el VIH en HSH en algunas ciudades oscilan entre el 5% y el 40%, valores por encima del observado en la población general (1%), lo cual permite afirmar que la epidemia se encuentra concentrada en poblaciones de HSH y tiene el carácter de devastadora. América Latina aporta el mayor número de infecciones nuevas de VIH en HSH después de los Estados Unidos. La transmisión sexual del VIH entre hombres tiene características muy particulares, ligadas a prácticas sexuales específicas como la penetración anal y el sexo oral y a diversidad de situaciones psicológicas, sociales, culturales y políticas, que determinan las condiciones en que se realizan dichas prácticas.

Conclusiones: Los riesgos específicos de los HSH exigen políticas de prevención específicas para esta población. Una estrategia de intervención para HSH debería estar constituida por un discurso que promueva el respeto y la equidad de género, revalorice la sexualidad y permita la libre expresión y ejercicio de las diversas orientaciones sexuales, entre ellas la homoerótica.

 

Jerome Galea

Epicentro: A new community-directed organization for gay men in Lima, Peru (pdf)

Twinning is a collaboration between organizations in developed and developing countries to address organizational core components like delivery system re-design, capacity building, practice guidelines, and active mentoring. UCLA, Pangaea Global AIDS Foundation and San Francisco AIDS Foundation are collaborating with gay men in Peru to provide research, clinical, programmatic, and organizational development support for a new Gay Men’s Community Center offering HIV/STI services in Lima, Peru: “Epicentro”. Though networks of MSM exist in Peru, there is not yet a cohesive community necessary to collectively fight AIDS among gay men. Through twinning, we have adapted the model of the SFAF’s Magnet community center-HIV/STI testing site in San Francisco to urban Peru’s sociocultural context. Though twinning with UCLA/SFAF/Pangea has provided essential experience and advice on strategic planning, organizational structure, and financial development for the local organization, Peruvian community members assume all decision-making control and planning responsibility. Multiple levels of vision and substantial investments of time, patience, and financial resources are necessary to develop gay community organizations in areas without visible gay communities. Through Epicentro, gay men in Lima will create a self-sustaining model and locate the center within an international network of organizations to fight the spread of HIV among MSM globally.

 

Clemon George

Mabwana Black Men’s Study: Who are the Black Men who Have Sex with Men in Toronto? (pdf)

Black men who have sex with men in Toronto are at an increased risk for HIV infection yet research evidence to inform programs and services for these men is lacking. This study was developed to improve our understanding of BMSM communities and networks in Toronto.

Methods: Respondents completed a self-administered questionnaire between June 2007 and January 2008. Recruitment was done at diverse environments frequented by Black men. In this presentation we focus on HIV testing, as an indicator of the response to a social marketing strategy aimed at increasing HIV testing.

Results: 168 men were recruited of which half were recruited at Gay Pride. Over half of the men were under 31 years (range 18-61). 144 men had previously tested for HIV (19 had not) of which 71 had recently tested. 75% were HIV negative. Correlates of “ever tested for HIV” were: being born outside of Canada (p=0.009); having an African or Caribbean identity (p=0.04); having a gay or bisexual identity (p=0.002); being 21 years or younger (p=0.02); having friends or family with HIV (p=0.03); having friends/family who died of AIDS (p=0.01). Correlates of recent HIV testing were: being 21 years or younger (p=0.04); knowing someone with HIV (p=0.01).

Conclusion: A high proportion of BMSM in Toronto have tested for HIV with recent testers being younger men. There appears to be no association between seeing our recent social marketing campaign and HIV testing. This may be due saturation with our prevention messages suggesting new strategies should be employed.

 

Jeffrey Grierson

Background: There has been a recent increase in interest in the experiences of men who have sex with men (MSM) throughout the Asia-Pacific region. The rise in behavioural surveillance and tailored interventions represents a belated recognition that sex between men occurs in all societies, and that in particular social and cultural contexts, sexual practices between men carry a high risk of HIV transmission.

Methods: A total of 105 one-on-one semi structured interviews were conducted in Indonesia and Thailand in five sites: Surabaya (25); Batam Island (10); Manado (20); Chiang Mai (25); and Bangkok (25). Eight major thematic domains were used: sexual network evolution and overlap; partnership formation and sexual health risk; sameness and difference within and between networks; the place of women in participants’ lives; sexual practice; the importance of communities and contexts; the transformative role of inter-country and regional mobility; and the locally and regionally experienced effects of globalisation and internationalisation on male-to-male sex.

Results: We report on these key domains across the five sites. This study shows that people move through identities over lifetimes and across contexts. Many men do not identify consistently and unproblematically with sexual identities, and even less identify with a sexuality category like MSM. Men gather together in a range of settings and contexts. While these offer the possibility of male-to-male sex, only occasionally are they organised around sexual opportunity. In addition, these settings are rarely constituted solely of men who currently engage in male-to-male sex.

Conclusions: The findings of this project have clear implications for research and health promotion practice. Interventions designed around identities or categories of sexuality (including MSM) will fail to reach many men who engage in male-to-male sex. This study has demonstrated the value of focussing on male-to-male sexual practices, rather than on individuals or on presumed predisposing identities.Jeffrey Grierson
Country of research: Indonesia, Thailand

 

Background: In developing health promotion interventions for sex on premises venues (SOPVs) it is critical to understand the place they have in the communities that access them.

Methods: An anonymous, self-complete questionnaire was administered to men attending the Midsumma gay community carnival in 2007. The survey consisted of 21 items assessing participant characteristics and knowledge and attitudes relating to SOPVs and their patrons.

Results: A total of 287 surveys were returned. Mean age was 39 years. 50% were in a regular relationship. 51% had had an HIV test in the previous 12 months and 8% of the sample was HIV positive. 8% had had an STI in the previous 12 months. 46% had met a sexual partner at an SOPV in the 12 months prior to survey. Generally attitudes indicate little community disapproval of venues and their patrons. Respondents tended to disagree with statements that characterise patrons of SOPVs negatively. There was fairly comprehensive rejection of the premise that closing venues would reduce HIV/STI infections or reduce the amount of sex gay men had. When asked to rate how they might feel telling their gay friends that they had met a new boyfriend at a number of different places, men were significantly less comfortable reporting SOPVs than other settings (including online sites). Generally SOPV users were more strongly supportive of SOPVs and demonstrated a more nuanced conceptualisation of patrons.

Conclusions: Understanding what the peers of SOPV patrons believe about the venues and their customers can help us to tailor messages that can: address stigmatisation of users if this is evident; target specific populations in “insider” language; mobilise patron expectations of venue standards; suggest approaches that embed SOPV practice in broader social and sexual practices; or avoid reinforcing typologies that distance patrons from the target message.

Country of research: Australia

 

Norman Gutiérrez, Javier Medina, David Morales, Evelyn Gonzalez-Figueroa, Omar Baños & Moises Cascante

Local Ties, Global Reach: HIV Prevention Among MSM (pdf)

Increasingly, individuals and organizations must work together locally, regionally, and internationally in order to maximize resources and create opportunities. However, the nature and processes of these bilateral and multilateral collaborations are largely un-documented or perhaps their well-intentioned plans fall through. Common reasons for alliances not to reach their goals have to do primarily with misunderstanding socio-cultural contexts, and lack of trust and commitment. Establishing shared agendas and opportunities for equal exchanges, on the other hand, may lead to improved collaborations. This program describes the phases of a successful partnership between non-governmental organizations (NGOs) in Latin America and AIDS Project Los Angeles (APLA) in California. It connects the universal concerns that surface in collaborations and describes several phases worthy of consideration among organizations and individuals forging partnerships abroad: 1) developing the collaborative relationship and establishing kinship; 2) identifying pivotal concerns; 3) generating sources of commonalities and differences experienced by the different countries; 4) formulating recommendations and strategies that inform future activities; and 5) managing expectations regarding limited resources and the prioritization of shared goals.

By partnering with Community-Based Organizations in Latin America, APLA seeks to generate an increase in the delivery of HIV awareness initiatives, technical assistance, print material development, feasibility studies, and strategic analysis and evaluation services concerning MSM. These activities fall under four cores: Prevention, Research, Training and Advocacy (PRTA). The acronym is enunciated as PueRTA, or door, a door to exploring and understanding HIV in Latin America.

APLA has partnered with CONGA (Coalition of Gay Organizations in Central America) to discuss HIV prevalence amongst gay men and other men who have sex with men in Central America. The result was an extensive advocacy and prevention tool titled, “No Mas en el Tintero.” Officially launched in Nicaragua in 2007 and later presented in Los Angeles in 2008, the publication offers strategies and recommendations for individuals and groups working with MSM populations. APLA aims to strengthen regional ties between civil society groups in the region, make the connections between Central America and a thriving migrant community in Los Angeles and help structure advocacy campaigns that target government and society centered on the human rights of sexually diverse groups.

In another highly innovative collaboration with Fundación Comunicación Positiva (FCP), based in Bogota, Colombia, APLA and FCP propose a culturally-sensitive prevention education initiative, titled, ““Hamwat’a – “Metamorfosis de un medio sin alas” (A Centered Metamorphosis without Wings)” that will train healthcare providers, community leaders and HIV advocates in Latin America who provide services to people living with HIV (PLWH). Trainees will obtain information on communication and multimedia skills for the production of prevention and treatment-focused websites and materials based at their home organizations. APLA & FCP’s training strongly emphasizes the notion of accessing HIV information from a human rights and universal access to health care perspective. Existing information is highly technical, culturally inappropriate, and lacks advocacy. Both APLA and FCP have expertise in media, web and educational material in prevention and thus will join forces to initiate this effort.

 

Jakob Haff

Background: An increasing percentage of Danish MSM practise unsafe sex (US, unprotected anal intercourse with a partner of opposite or unknown HIV-status). The risk of becoming infected or infecting others with HIV increases with the number of US encounters. Therefore it is not immaterial whether US is practised once or twice per year, or if it is practised more frequently.

Method: In the Gay Men’s Sex Life Survey in Denmark in 2006, participants were asked to state their HIV-status, and how many times they had had US during the last 12 months.

Results: Among 3,141 respondents an overall 33% had practised US. Among these, 675 stated number of US encounters: 48% reported US 1 or 2 times, 39% reported US 3-20 times, and 13% more than 20 times. Among HIV-negative MSM who had practised US, 56% reported US 1 or 2 times, while this was true for 36% of HIV-positive MSM (p=0.002). Among HIV-negative MSM, 7% had practised US more than 20 times, in contrast to 18% of HIV-positive MSM (p=0.002). Among HIV-negative MSM the median number of US encounters was 2, and among HIV-positive MSM the median number was 5.

In a logistic regression-analysis controlling for age, homo-/bisexual preference, urban/rural dwelling, education, and having tested for HIV within the last year, HIV-status remained the only significant independent variable for having had US more than twice. Compared to HIV-negative, HIV-positive MSM had an OR of 2.2 (CI95% 1.3-3.7) for having had US more than twice.

Conclusion: Whereas US encounters reported by HIV-negative MSM most often occurred only once or twice (i.e. an accident), HIV-positive MSM reported a high incidence of US encounters. This indicates that US is a habit among a considerable group of HIV-positive MSM. It is important to find ways to target this group in order to improve HIV prevention among MSM.

 

Phillip Keen

A 'natural experiment' in the impact of disinvestment in prevention: How differences in funding of HIV prevention programs in different parts of Australia correlate with divergent HIV diagnosis rates (pdf)

Author: Phillip Keen, Don Baxter, Simon Donohoe - Australian Federation of AIDS Organisations.

Abstract: Changes in the level of resourcing of HIV prevention work across different state jurisdictions in Australia may explain the emergence of substantial differences in the rates of new HIV diagnoses between those jurisdictions.

 

Zoryan Kis

Preparations in 2007 for the 2008 UNGASS report were conducted according to the UNGASS Guidelines on Construction of Core Indicators: 2008 Reporting, several surveys were carried out to collect data on Percentages of HIV+ most-at-risk populations. A linked epidemiological and behavioral surveillance on HIV infection among MSM was carried out in four cities of Ukraine, being the first complex research able to provide reasonably reliable data on HIV+ MSM prevalence. Although a number of surveys have been carried out before, they were either local with a small number of MSM tested, or behavioral researches with no epidemiological data.

Of 359 MSM tested 38 were positive. However, the percentage of HIV-positive MSM varied, ranging from 4.4% in the capital Kyiv to 23,2% in the port city of Odessa. (See table attached for further data).

In another survey, by the Network of PLWH, of 317 MSM tested, 51 were positive, thus a making it 16% of the sampling, which also demonstrated a potentially very high prevalence of HIV amongst MSM.

Only the prevalence rate for the capital city (4.4%) has been reported as a national UNGASS indicator (as required by the UNGASS guidelines).
As there was no testing in rural areas, a median indicator (9%) would more accurately reflect the real picture.
Lessons learned: UNGASS reporting the indicator for the capital city is not always useful. Although HIV prevalence in Kyiv is relatively high, it appeared to be much lower than in other major cities, and thus not indicative for the whole country.

 

David Lewis-Peart

Giving Thought: Recommendations for Prevention Programming with Black Men Who Have Sex With Men (pdf)

Issues: Despite Black men who have sex with men (BMSM) accounting for significant numbers of new HIV infections in Ontario,(Public Health Agency of Canada, 2006), few specific services, research, and strategies exist which address HIV prevention for this group. Lack of healthy community space, targeted services, and historical presence of BMSM in research add to their existing risk.

Description: The project undertaken by the Black Coalition for AIDS Prevention (Black CAP), determined common themes and trends regarding BMSM needs, capacities, and barriers to HIV prevention with the assistance of 25 key informants active in research and service provision within the African/Caribbean, HIV/AIDS, and Youth service sector. Feedback from informants were audio recorded, interviews reviewed, and common themes identified. Local and international epidemiological data, and research was then used to corroborate information. A panel of local experts and a sub-committee of BMSM youth were also used to validate the themes later used in the report, Visibly Hidden: Rethinking BMSM and HIV Prevention.

Lessons Learned: The layering of homophobia, racism, poverty, and HIV stigma, as well as a lack of inclusive service provision place BMSM at risk of HIV and STI transmission. Programming should focus on dissemination of relevant information, and also on the building of practical skills for change in social and sexual behaviour. Programs should recognize the dynamic and often situational identities lived by BMSM, and work to make visible these realities.

Next steps: Launching of the BMSM sexual health resource site getthelowdown.ca, and THINK print campaign developed using reccomendations made in Visibly Hidden. Campaign resources depict various BMSM identities, addressing a range of issues using illustration. In tandem with the social marketing campaign, trained therapists, and BMSM peer educators will offer online support in addition to agency-based group life-skills interventions. Partnerships will be made with organizations servicing similar populations outside of Toronto.

 

Alan Li

Caught Between Homophobia and Racism:
Effects of Discrimination Upon the Sexual Behaviour of Men Who Have Sex With Men (MSM) From Ethnic and Racial
Minority Communities (pdf)

Background/Objectives: The Ethno-racial MSM Research Working Group was created by the AIDS Bureau of the Ontario Ministry of Health and Long-Term Care to promote inclusion of culturally diverse communities in the development of evidence based policies and interventions.
Our study’s key objectives were to identify issues of concerns and relevance affecting ethno-racial MSM in relation to HIV prevention and to recommend community relevant policy and program initiatives

Our Approach: We carried out one-on-one interviews with 10 prevention workers and 7 focus groups (n=71) with MSM from the target communities (African, Caribbean, Chinese, South Asian, Southeast Asian, Portuguese and Spanish).

Our questions explored factors affecting risk behaviors, perceptions on the effectiveness of current interventions, and potential gaps in policies, programs and research.

Results were analyzed thematically using N-Vivo 7.0 and draft reports were presented back to the target communities for validation

Key Findings: Participants reported complex challenges that affect their ability to effectively engage in safer behaviors including:
• Social Exclusion and alienation
• Cultural, religious and identity issues
• Stigma and discrimination
• Informational and knowledge gaps
• Lack of appropriate service and community support

This poster will focus on findings resulted to informational barriers that impacts HIV prevention and related recommendations

Myths and Misconceptions of HIV Infection: Participants reported many myths, misconceptions and misinformation related to HIV infection:
Some believe it is a white men’s disease:“I have a friend from India who says he will only use condoms when he’s having sex with white people. He says Indians from India are safe, they have this thing in their minds” (a south Asian participant).

Some believed non-gay identified men of colour were non-sexual or less promiscuous and therefore not at risk for HIV infection Some thought that there was a cure for HIV/AIDS Some believed STIs could only be contracted through anal sex and considered other sexual activities non-risky Some considered urinating after unprotected anal sex will prevent HIV infection Some men assumed it’s impossible to get HIV if you are the inserter during anal coitus. “I have heard numerous times that if I’m a top, the risk for me is minimal to none in contracting STIs. I have also heard from many men of color that if they have a healthy piss after sex, the acid in the urine will kill or push out any bacteria within their penis and prevent an STI.” (MSM prevention worker). “If you’re a top you don’t get AIDS!” (Portuguese speaking MSM).

Information Gaps on HIV Infection: Participants identified the following gaps in knowledge related to HIV infection Detail and specific information about different types of condoms Risk for re-infection by different strains of the virus “I thought if two guys were HIV positive they could have sex without condoms because they were already infected. I really only learn about this (re-infection) after I became a volunteer.” (Portuguese speaking MSM) Information on risks of getting other STIs besides HIV Information on complications of HIV and treatment available “A minor disease like HPV will cause the death of an AIDS patient” “If you find out within the first 6 months of getting infected, your life expectancy is more likely to go beyond 20 years. If you delay finding out for a year or 2, your life expectancy likely decrease to 15 or 10 years.” (East Asian MSM) Epidemiological data on how HIV affects different ethno-racial communities in Canada. The lack of such information fosters denial and distancing of the epidemic by various ethnoracial MSM

Information barriers for newcomer MSMs: Newcomer MSMs have unique informational needs and face unique barriers in addition to the lack of safer sex and HIV information in their own languages: Lack of information on safe space to access information and services related to sexual health Lack of culturally sensitive information addressing sexuality and sexual identity Lack of information on social and sexual etiquette in environments where MSMs meet for sex Language barriers in negotiating safer sex “As a newcomer I’m seeing a new world. I’m just arriving in a new city. I don’t know the dynamic of the city, I don’t know what people are doing, and this culture’s like telling me let’s have sex barebacking. The thing is, I don’t speak English. Me no English. So, come on, come on, baby, boom! There, risky sex.” (A Spanish speaking MSM)
Invisibility of Negative Impact of HIV: Another key gap in knowledge and information identified relates to the lack of personal contact and knowledge of someone HIV positive amongst the peer groups of many younger MSMs, the absence of personalized knowledge foster denial and lessens the impact of prevention efforts “This guy he says he tested positive in 1983 but when I saw him, there was no single sign, nothing seems visible on him to indicate you know? Maybe if it’s back in Africa, you look at AIDS patients in my country over 60-70% of the families have had (a person with AIDS) in the house. That experience is very touching and it influences behavior. Unlike here, here’s a man 20 year plus with no sign at all.” (African MSM) Impact on Policy and Practice In order to be effective, HIV prevention efforts with ethno-racial MSM need to include language specific and culturally sensitive materials that address their realities.

Information that address both the scientific and human aspects of HIV must be made available to at risk MSMs, These include information on HIV transmission, disease progression, treatments and side effects; information on the physical, emotional and social challenges faced by PHAs; and information that promotes understanding and compassion for PHAs.

Specific information for newcomers on gay culture and how to access support needs to be made available in different languages and be accessible through various medium such as settlement services and internet Information needs to be accompanied by capacity building efforts to deal with coming out issues, to enhance self esteem, self efficacy and sexual disclosure.

 

Misedah Lourence Zedekiah

Transgender Populations and HIV Risk in Kenya
M. Lourence, Nairobi Kenya

Those who identify as transgender make up a segment of our population that has a high HIV risk. Research conducted in other parts of the world show that while making up 1 % - 5% of the general population, the transgender community has an infection rate estimated by experts as low as 15% to highs of 60%. However, due to the high rates of pervasive relentless stigma in Kenya related to transphobia, medical resources, support and HIV/AIDS education are difficult to access. Where as there have been studies in Mombasa and in Nairobi on Gay and Bisexual men, there has been no study conducted on Transgender Women (MTF) hence being left out yet they are a vulnerable other in the MSM community. Accurate data is therefore hard to assemble about Transgenders in Kenya. There is therefore a need to: conduct research geared towards understanding the transgender community in Kenya, providers be educated as to the needs of the transgender community and prevention messages and education in a manner sensitive to the needs and the concerns of the transgender population in Kenya.

 

Lydia Makoroka

MaBwana: Promotion and recruitment for research with Black men who have sex with other men (Black MSM) in Toronto (pdf)

Background: In Ontario, HIV prevalence estimates indicate that people from Africa and the Caribbean are disproportionately affected by HIV, and that African and Caribbean men account for two-thirds of all infected people from those regions. However, no studies exist on vulnerability to HIV among African and Caribbean men in Ontario. Research efforts are hampered by homophobia, a legacy of racism and HIV/AIDS stigma. The MaBwana Black Men’s Study was launched in 2006 to examine vulnerability to HIV among Black MSM.

Methods: In 2006 we conducted in-depth interviews with nine key informants from organizations serving Black MSM, and other Black MSM who are knowledgeable about their communities in Toronto. Participation was voluntary and consent was obtained. The purposeof the interviews was to develop approaches to promotion and recruitment that resonate with Black MSM. One member of the research team led the interview, and another recorded the notes of the discussion. The interviewer and recorder then validated the interview notes.

Results: The key findings indicated that promotional materials should be subtly designed and worded to maintain discretion, but widely available through trusted networks. Black AIDS service organizations, queer Black networks, party promoters, events patronized by Black MSM, websites frequented by Black MSM and bathhouses were recommended as points of promotion and recruitment. From June 2007 to January 2008, we recruited 168 survey participants and 24 men for in-depth interviews, mostly during events in Toronto, or through postcards and personal contacts from trusted sources.

Conclusion: Successful recruitment of BMSM requires a thorough understanding of how homophobia, racism, and HIV stigma within the Black community can deter BMSM from engaging initiatives about sexuality or HIV. BMSM will engage in research that is sensitive to their realities and that provides a safe, comfortable space to share HIV/AIDS issues affecting them and their communities.

 

Javier Medina, Norman Gutiérrez, Omar Baños, Evelyn González-Figueroa

Gay men, our lives & HIV in Central America & the Caribbean (pdf)

Issues: Approximately 200,000 people are living with HIV/AIDS in Central America (World Bank, 2006). Prevalence rates reach an estimated 17% in some countries, and the main mode of HIV transmission is men who have sex with men (MSM). Despite the urgency, prevention efforts are disproportionately unavailable for gay men and MSM in Central America. The influx of migrants from Central America into Mexico and the US creates opportunities to bridge ongoing STI and HIV/AIDS prevention efforts multilaterally; maximizing resources and creating opportunities.

Description: We describe the process and findings of one such collaborative endeavor, a recent effort between APLA and participating organizations of CONGA that has resulted in No Mas en el Tintero. This historic publication summarizes gay men’s needs and organizing efforts in Central America. The publication presents the interconnectedness of intellect, the human element and a united commitment to curb HIV infection among multilateral sectors. Here, stigma and enforced silence prevails, infringement upon human rights is the standard, and HIV incidence continues to rise.

Lessons Learned: It is beneficial to: 1) Create an exchange of knowledge about the repressive HIV/AIDS issues faced by gay men and MSM in Central America 2) Enhance the understanding of the interconnectedness of HIV/AIDS prevention, treatment, advocacy and policy. 3) Identify commonalities and differences experienced by the different countries;4) Formulating recommendations and strategies that inform future activities; and 5) Managing expectations regarding limited resources and the prioritization of shared goals

Next Steps: Collaborate with local partners to implement strategies informing local programmatic efforts around prevention and advocacy; and disseminate No Mas en el Tintero, in the USA.

 

Michael Meulbroek

Issues: HIV Prevalence and Incidence; Men who have Sex with Men; Early HIV detection; Peer Counseling, Cohort Study.

Description: Data in the Barcelona area show that HIV prevalence in MSM is about 20% and almost 50% of the men newly diagnosed are MSM. Although in the Autonomous Community of Catalonia alternative HIV testing sites (anonymous) and seroprevalence surveys work since 1994, little data are available on changes in HIV incidence. In 2006, Projecte dels NOMS-HISPANOSIDA created in Barcelona’s gay area a community-based center for MSM, BCN Checkpoint, in order to: 1) give peer counseling about HIV transmission and risk perception, 2) promote an early detection of HIV infections, and 3) introduce the rapid HIV test. Men with major number of sex partners or with identified risk behaviors were suggested to do an HIV test every 6 or 12 months. During 2007 BCN Checkpoint has performed 1.098 HIV tests to 941 different persons - with a fourfold increase in the number of tests performed in regard of 2006 - and 37 HIV infections were detected (equal to ± 10% of all new HIV diagnosis in Barcelona).

Lessons Learned: BCN Checkpoint as a concept has been well accepted by the Barcelona MSM community and will permit to obtain more insight into HIV incidence. The changes in testing practices within MSM suggest that a community approach for voluntary testing and counseling gives better results and is more cost/effective than an approach to general public.

 

Garrett Prestage

GAY MEN WHO ENGAGE IN GROUP SEX ARE AT INCREASED RISK OF HIV INFECTION AND ONWARD TRANSMISSION: THE THREE OR MORE STUDY (pdf)

Group sex has been associated with HIV seroconversion among gay men. We examined risk behaviour among gay men who participated in group sex in Australia.

The Three or More Study (TOMS) was an anonymous survey of men who engaged in group sex with other men. Detailed information about their most recent group sex encounter was collected.

About one quarter of Australian gay men engage in unprotected anal intercourse (UAI) with non regular partners in the previous six months, whereas among the 994 TOMS participants, 27.5% reported UAI with non regular partners at their most recent group sex encounter, and one in five reported UAI with any partners they did not know to be the same HIV serostatus as themselves. In multivariate analysis, not having a clear intention to use condoms, not knowing oneself to be HIV-negative, attending a private sex party, and engaging in group sex at least monthly were independently associated with UAI.

Gay men who engage in group sex are more likely to engage in risk behaviour than are other gay men, often in the context of group sex encounters. Group sex among gay men should be a high priority in HIV-prevention efforts.

 

Stephen Scott

Australia - Thailand: HIV/AIDS Community Sector Partnership (pdf)

In 2006/07 a capacity-building partnership project was implemented between ACON in Sydney and the Rainbow Sky Association of Thailand (RSAT)in Bangkok. This project aimed to establish an ongoing relationship between the two organisations through mutual capacity development exchanges that focused on key organisational needs for both ACON and RSAT. The partnership was a bilateral activity resourced through trade, rather than development funding. The project has been successful in building different capacities within each organisation and leading the two organisations into further collaborations.

 

Arnaud Simon

Issues: MSM in Europe remain highly vulnerable with regards to HIV as revealed by the high proportion of MSM among newly diagnosed cases of HIV in many countries, studies revealing a high proportion of MSM engaging in high-risk sexual behaviours as well as alarming trends regarding several other sexually transmitted infections in several countries.
Description: As part of the AIDS ACTION EUROPE partnership, the NGO AIDES organized in Paris, France in June 2007 a pan-European Gay Health Seminar with 45 NGO delegates active in HIV prevention and support with MSM from 21 countries (mostly from Central and Eastern Europe).

Lessons Learned: Thanks to our proximity with local and various MSM communities, local NGOs play an essential and multifaceted role in the frontline of the responses to the HIV epidemic among MSM. This includes (1) informing in targeted and tailored ways about HIV and other sexually transmitted infections (promoting risk-reduction strategies including the use of condoms and water-based lubricants) (2) working with behavioural researchers to document precisely the specific risks faced by MSM (3) enabling the mobilisation at all levels of gay men living with HIV (4) Experimenting always with innovative approaches such as internet-based projects that reach very large numbers of users of gay online forums. However, the sustainability of such essential health services remains uncertain in many countries, especially in Central and Eastern Europe. Many governments remain most reluctant to commit to improving the health of MSM and many NGO projects with MSM depend upon international funding that - overall - is decreasing in the region.

Next Steps: We need to more effectively use the potential of existing networks and institutions working for MSM health and thus overcome the political and financial hurdles. AIDS ACTION EUROPE along with other networks will actively integrate the health of MSM as an advocacy priority.
Countries involved: Belgium, Croatia, Czech Republic, Estonia, France, Germany, Greece, Ireland, Latvia, Lithuania, Macedonia, the Former Yugoslav Republic of, Netherlands, Poland, Portugal, Romania, Russian Federation, Serbia, Slovenia, Spain, Sweden, Ukraine

 

Kumar Prasad Timilsina

Objectives: We investigated HIV prevalence and incidence and related risk factors among young Nepal and Cross Boarder side between Nepal and India men who have sex with men (MSM).
Design: We conducted a cross-sectional survey.
Methods: A venue-based sample of 496 young Nepal and India MSM in In Nepal and cross Boarder between nepal and india completed face-to-face questionnaires and received HIV counseling and testing.
Results: HIV prevalence was 2.6% and annualized HIV incidence was 1.8% per year. In multivariate analysis, being Nepali born, having 51+ lifetime sex partners, and having attended a “circuit party” (multiday large MSM gatherings) were associated with HIV infection. Forty-seven percent of the sample reported unprotected anal intercourse in the past 6 months.
Conclusions: The current levels of HIV prevalence, HIV incidence, and sexual risk behavior suggest an emerging HIV epidemic among young Nepal and cross boarder side of nepal and india MSM in Nepal.

Kumar Prasad Timilsina

In contest of nepal MSMs and MSWs are high risk behaviours in sexual encounter because most of MSM and MSW have violence,discriminated,stigmatizes,poor,illitrate and confused for the transmission of HIV between Male having sex with male and not aware to the journal peoples and Remote peoples. More than 3 % peoples, male who have sex with male they all having righ risk behiviours community.
Mostly MSM and MSW were Married with girls.90 % homosexual people were married and they are doing unsafe sex with multiple partner in nepal.

 

Chung To

We would like to share our experience in several projects in China, including: conducting community based outreach in MSM venues in 6 cities in China, operating a national 800 toll free counseling hotline for MSM on HIV, organizing community based capacity building workshops our involvement in a recent 500 MSM survey.

 

Michael Toole

Peer education in the Lao People’s Democratic Republic:  Accessing men who have sex with men and women (pdf)

Accessing bisexual men for peer education: Lao PDR has an adult HIV prevalence around 0.1%. HIV prevalence among 540 young men who had male/male sex during the previous 6 months surveyed in Vientiane (2007) was 5.6%, higher than any other Lao population group. 50% of participants were characterised as “masculine-acting” men, 45% reported being primarily attracted to women, and 57% had ever had sex with a woman. 21% of bisexual men had exchanged sex for money, both with men and women. 43% of HIV-positive men reported having sex with a woman in the previous 3 months. Burnet Institute has extensive experience with peer education and outreach among young men with a range of sexual identities and sexual behaviours. Since 2005, we have trained groups of “general young men”, “gay and transgender” men, men who sell sex, and gender-normative bisexual men as peer educators in Vientiane. In December 2007, we were easily able to recruit 30 young bisexual men for training as peer educators. We believe that in the Lao context of relatively permissive, but private, attitudes to sexual behaviour it is possible to recruit through word-of-mouth networks relatively large numbers of bisexual men to train and support as peer educators.

 

Cheikh Traore

Issues: Available data in the UK, suggests that action to improve the health and well being of Black gay men should address four main areas:1)Sexual health and HIV/AIDS 2) Racism, discrimination and alienation - black gay men and the wider gay community 3) The needs of younger black gay men 4) Homophobia in wider Black communities Description: In July 2007, the Black Gay Men’s Advisory Group (BGMAG) organised the first leadership summit of its kind in Europe. 20 ‘leaders’ from various cities and communities around the UK were invited to attend a summit in Oxford. BGMAG gathered data on the health and well being needs of black homosexually active men and held workshops, discussions and presentations on key topics.

Lessons Learned: 1) The denial of ‘power’ that Black gay men experience on many fronts limits the success of existing HIV prevention and community development approaches. 2) Uniting key leaders around the country is a unique opportunity to map community development and structures for Black gay men. 3) Building on the social capital that Black gay men possess is an essential method to increase their access to social support and to enable them to exercise their rights. 4) The development of efforts to challenge homophobia in Black communities is an urgent and necessary task for any organisation concerned with the wellbeing of black gay men.

Next Steps: “In the Life”: an Action Plan for community development with Black Gay Men was produced, and forms the basis of a consultation project with black gay men throughout 2008.

 

Gift Trapence

 

Daniel Tung

 

Jason Weaver

 

Humphrey Wou, Jack Beck, Evelyn Gonzalez

Heart Talk Support Groups Implemented in China (pdf)

Increasingly, individuals and organizations must work together locally, regionally, and internationally in order to maximize resources and create opportunities. However, the nature and processes of these bilateral and multilateral collaborations are largely un-documented or perhaps their well-intentioned plans fall through. Common reasons for alliances not to reach their goals have to do primarily with misunderstanding socio-cultural contexts, and lack of trust and commitment. Establishing shared agendas and opportunities for equal exchanges, on the other hand, may lead to improved collaborations. This study describes the phases of a successful partnership between non-governmental organizations (NGOs) in Central America, in China, and AIDS Project Los Angeles (APLA) in California. It connects the universal concerns that surface in collaborations and describes several phases worthy of consideration among organizations and individuals forging partnerships abroad: 1) developing the collaborative relationship and establishing kinship; 2) identifying pivotal concerns; 3) generating sources of commonalities and differences experienced by the different countries; 4) formulating recommendations and strategies that inform future activities; and 5) managing expectations regarding limited resources and the prioritization of shared goals.

AIDS Project Los Angeles (APLA) and AIDS Relief Fund for China (ARFC) have teamed up to start a new project that would introduce a different kind of prevention effort to MSM service providers in China. The project aims to equip grassroots community-based organizations from eight different cities with the technical assistance required to co-design and launch a two-month series of weekly small-scale discussion groups with young MSM focused on a wide range of psychosocial issues these young men deal with on a daily basis. Entitled “Heart Talk Support Groups,” the program is designed to build and strengthen protective factors against HIV, including social networks and positive self-identity (J. Ramirez-Valles, 2002). With its pilot round currently funded and operating as of March 2008, APLA and its collaborators propose a comprehensive second round of activity, including evaluation of data, development of a facilitator’s guide and a curriculum for subsequent rounds of the projects.

 

Jian Gang Zhao

E1 Policy determinants and constraints

Cross-cutting Theme: 6. Tracking Progress & Accountability

Issues: Though some progress has been made since its participation in the PSN including more sharing on each MSM group’s activities, resources, information and experience, the current practice of Chinese government not allowing CBOs to get registered and international donors’ capital has to come into China through a governmental go-between channel has prevented the coordination mechanism from fully functioning for its preset purposes.

Description: The HIV/AIDS programs targeting MSM were conducted in China since 2002 with funding from China-UK STI/HIV Prevention Project as well as FHI of USA and the International HIV/AIDS Alliance. However, the lack of information, communication, coordination and collaboration among international donors, Chinese governmental health sectors, academicians and professionals, local NGOs and the MSM groups / volunteers, has hindered the overall efforts to combat China’s pandemic in an effective way, all of which resulted from this institutional barrier. The situation could even deteriorate in the near future with the prevalence rate climbing up higher.

Lessons Learned: This institutional barrier has been manifested in favor of government over MSM communities in the following aspects: the monopoly of power and benefits; the control of willingness; predomination of action; utilization of relationships; unfair domination of resources causing waste and drainage thereof and propagating AIDS corruption and its disclosure.

Next Steps: A research report will be submitted to our main donor/USAID appealling that effective coordination measures should be adopted to avoid project duplication, and the funding should not be withheld and wasted at the administrative (governmental) level while advocacy should also be made to call upon Chinese government to open up its support on policy, organizing, resources and technologies. Other specific suggestions and advice alike will also be given to domestic NGOs, academicians and professionals, as well as the MSM groups / volunteers.
Country of research: China