[PHP Nepal Vol 4 Issue 5 May 2014] | Following outbreak of the HIV infection in the 1980s, HIV/AIDS has been associated with male homosexuality/gayism. Men who have Sex with Men (MSM) is the group that is most implicated in HIV transmission across the globe; the numbers vary among different countries.
With the introduction of effective Antiretroviral Treatment (ART) in 1996, the life expectancy for people with HIV infection has increased, and the standard of life has improved. The reduced mortality (due to ART) together with new infections has increased new annual HIV transmissions. Thus, increasing the number of MSM living with HIV, which is a serious cause of concern (May et al., 2007; HIV-causal Collaboration 2010 and Saxton et al., 2011).
While there has been a rise in the number of HIV diagnoses among MSM, the true prevalence of HIV and the proportion undiagnosed in this group is still unknown. The under reporting of the actual number of cases may be largely due to the fear of anticipated or experienced stigma associated with being gay and HIV positive. The HIV positive MSM are stigmatized to the extent that the HIV/AIDS epidemic has reinforced attitudes of blame, shame, and moral degeneracy towards homosexuality.
The discomfort and distress that result from anticipated consequences of disclosure underlie the compelling motivation to keep their disease status secret; presenting powerful disincentives to accessing HIV prevention services. The results of revelation are rejection by family, eviction from home, social isolation, discrimination at workplaces and residential areas, and maltreatment within the health-care among others. This often results in delaying the treatment initiation and even postponement of learning HIV positive status for as long as possible until they become symptomatic.
Consequently, the disease follows a chronic, untreated course and many HIV-positive MSM deny their sexual orientation, continue to engage in risky sexual behaviors and avoid utilizing HIV prevention services. Thus, stigma and discrimination are central to multi-level barriers to the uptake of HIV prevention and treatment services.
The HIV/AIDS epidemic and the cultural, political, and economic forces that shape it are community and culture specific. Thus, no two national responses can be identical. Therefore, to respond to the multi-levels of HIV risk among MSM, combination HIV prevention interventions are being used to maximize effectiveness (amfAR 2013). Research and experience recommend that funders and program implementer should be flexible when carrying out HIV interventions specific to local social contexts as it may be very difficult to reduce negative attitudes towards the PLHIV without addressing homosexual stigma.
This calls for a need to address homosexual stigma in the general population involving multiple stakeholders, general public, healthcare providers, community leaders, and the HIV affected MSM communities in the MSM peer outreach, HIV care and treatment service. Designing interventions to maintain a focus towards homosexuality and homosexual stigma might help avoiding internalizing negative consequences that follow addressing their overall health as well.
Targeted interventions are needed for healthcare providers as well. These include training and education of health providers and other staff on the specific knowledge, attitudes, and skills necessary for working with MSM. For instance, setting up MSM-friendly clinics, training of the staffs for confidential record-keeping, providing non-judgmental, non-discriminatory treatment services and counselling on disclosure of HIV status and sexuality to family and peers among others.
Healthcare system guidelines should be developed in consultation with these communities to address discrimination based on sexual orientation and gender identity. The perspectives of providers underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention strategies for these men that may help shape future HIV prevention efforts. These efforts might seem theoretical and unrealistic but if worked on in a comprehensive, rigorous and planned manner, success could be achieved.