Jack Beck of the Global Forum on MSM & HIV (MSMGF) reviews what has now become a regular event preceding the biennial International AIDS Conferences – the pre-conference meeting for men who have sex with men (MSM) and for transgender people.
Why a pre-conference for MSM?
On 17 July, in Vienna, the Global Forum on MSM & HIV (MSMGF) held Be Heard! This, the fourth pre-conference on MSM, was first created in response to shared concerns that sexual minority issues were all but invisible at International AIDS Conferences. From a small inaugural meeting before the 2004 Bangkok conference, the event is now the world’s largest gathering focused on the health and human rights of MSM, with over 100 speakers and 650 participants attending from more than 100 countries.
It’s now time to begin asking critical questions about what this year’s event achieved, what it could or should accomplish in the future, and what its existence says about the IAC and its role in the health and human rights of MSM.
The programme kicked off with speeches from a number of key global health leaders on the current state of the epidemic among MSM worldwide. Speakers included Global Fund Executive Director Michel Kazatchkine, UNAIDS Executive Director Michel Sidibé, and AIDS-Free World Co-Director Stephen Lewis.
Many speakers underscored a core set of themes - criminalisation, stigma, human rights, and access to treatment and prevention.
“We call on legislators to change outdated penal codes that contain prohibitions against same-sex activity. Getting rid of these laws is urgent,” said Michel Kazatchkine in his plenary address.
Michel Sidibé concurred. “The human rights of men who have sex with men and other sexual minorities must be fully protected and respected if universal access to HIV services is to be achieved,” he said. “All people should have equal access to HIV prevention, treatment and care services in their countries regardless of sexual orientation.”
Chris Beyrer of the Johns Hopkins Center for Public Health and Human Rights unveiled the results of a Johns Hopkins/World Bank survey, Global Epidemics of HIV among MSM in 2010. HIV prevalence rates among gay and other MSM have risen as high as 21.4% in Malawi, 13.8% in Peru, and 23% in Thailand, he said. In one of the most significant announcements of the day, he explained the survey revealed that higher levels of HIV-related services for MSM populations would result in lower rates of HIV among the general population - not just in MSM.
Topics in twenty-six small group sessions, the heart and soul of the pre-conference, ranged from recent developments in biomedical prevention, internet interventions, and effective strategies for fundraising to sessions focusing on HIV work in specific regions or with specific MSM subpopulations. The content was planned around results of a multilingual survey asking what MSM, particularly those in low- and middle-income countries, wanted to achieve.
A thought-provoking workshop entitled Nothing about MSM and HIV without MSM Living with HIV! addressed a key theme, discussing the importance of involving MSM living with HIV in devising and running prevention, support and treatment programmes for MSM. It included discussion on whether having HIV automatically conferred expertise or leadership entitlement, and explored issues such as the right of people - who may have half a lifetime of symptom-free living ahead of them - to choose not to publicly identify as HIV-positive.
Advocacy and working with government bodies was also a theme. MSMGF staff led participants through the use of a newly developed Advocacy Toolkit that offers guidance on matters such as prioritising local advocacy issues and designing a campaign for working in hostile contexts.
Dr Mariângela Simão, Director of Brazil’s National AIDS Programme, joined Hong Kong AIDS Concern Executive Director Loretta Wong and others to discuss NGO and health department collaboration in improving access to programmes for sexual minorities.
A session on internet interventions provided international examples of online communities seeding in-person peer support. Yves Yomb from Alternatives-Cameroun explained how - where homosexuality is penalised, funding is limited and harassment and blackmail are common - peer educators befriend and inform men using sexual networking sites. In eastern Europe, Tudor Kovacs of PSI Romania described how he conducted an internet search of MSM contact sites for Romanian MSM who disclosed HIV-positive status, who came to form the core of a support and social group.
In Asia, Nada Chaiyajit and Christopher Walsh of MPlus in Chiang Mai, Thailand, described how they use short, downloadable, animated videos to inform and contact subpopulations such as immigrant male sex workers. Working on a much larger scale, Stuart Koe of the large Singapore-based MSM website www.fridae.com, described launching the world’s second-largest MSM sex survey and an HIV test reminder service.
Soon after the event concluded, conversations began springing up in meeting rooms, online discussion forums and magazine articles about where the event succeeded and what could have been done better. But first, what is the event trying to achieve?
The human rights of men who have sex with men and other sexual minorities must be fully protected and respected if universal access to HIV services is to be achieved. Michel Sidibé, Executive Director of UNAIDS
Some ask whether an MSM pre-conference is necessary. Maybe it was needed before – but hasn’t there been progress in MSM representation at the IAC?
The MSMGF Secretariat did an analysis of the MSM content at this year’s main conference. The results were shocking. Only 2% of all conference sessions, excluding posters, specifically and exclusively concerned MSM. Plenty more mentioned us - but, as we’ve found, lip service is not enough. This population, in low- and middle-income countries, is on average 19 times more likely to be infected with HIV than the general population.
“When I can spend three hours in the poster hall most days having great discussions with people whose abstracts [on MSM issues] have not made it into the main programme…but where I am sitting in oral sessions whose quality is poor, then I know that something is very wrong,” said Mike Kennedy, Executive Director of the Victorian AIDS Council/Gay Men's Health Centre in Melbourne, Australia.
“The quality of the oral sessions was very patchy. The quality of the MSM-related posters - most of which could have been orals, but did not make the cut - were excellent.”
Greg Gray, Key Populations Campaign Co-ordinator for the World AIDS Campaign, agreed. “The pre-conference was far more valuable in bringing the issues of MSM to the table; the IAS has failed to give adequate recognition of the importance of MSM issues in the main conference agenda, particularly issues for positive MSM,” he said.
The MSM pre-conference has been integral to making the International AIDS Conference useful for those working with MSM. How can such an event maximise its benefits for those it is meant to serve from now on?
Xtra! Canada’s Gay and Lesbian News Service ran a thought-provoking article suggesting too much time was spent on new data; the opportunity would be better used for organising action at the main conference to make demands on key leaders.
Others wanted more data - citing the utility of hard numbers when advocating for MSM issues with funders and political leaders.
As evaluation results begin to come in, the MSMGF and partner organisations will continue these debates in efforts to improve future initiatives.
In the lead up to AIDS 2012 in Washington, DC, the MSMGF encourages all who have a stake in the health and human rights of sexual minorities to get involved early on. Connect directly with other advocates around the world by registering at www.msmgf.org and have your opinions heard on the direction of the next MSM pre-conference. The earlier we co-ordinate, the better chance we have to move AIDS 2012 in the right direction.
Jack Beck is Communications Associate at the Global Forum on MSM & HIV (MSMGF). Learn more about the MSMGF at www.msmgf.org.