Social Discrimination against Men Who Have Sex with Men (MSM): Implications for HIV Policy and Programs

From the Introduction: "This policy brief provides an overview of social discrimination against gay men and other MSM [Men Who Have Sex with Men] as it relates to HIV. It also includes recommendations for concerted action and policy development. A review of literature that demonstrates the linkages between homophobia and vulnerability to HIV disease is presented with related examples. The recommendations are intended for a global audience of advocates, researchers, service providers, public health practitioners, donors and policy makers. The appendix provides a modest list of anti-homophobia resources that are available online and applicable in a diverse range of settings."

From The Global Forum on MSM and HIV (MSMGF), this brief offers evidence of the effects of discrimination against MSM, including a hostile environment that drives them outside the healthcare system and results in higher incidences of HIV prevalence than the adult population of the low- and middle-income countries studied. Scaling up service to MSM, as stated here, "will require appropriately nuanced, multi-sectoral responses. Coordinated advocacy efforts are required to reach multiple layers of institutional and socio-cultural underpinnings including attitudes and beliefs of individuals, families and communities. Importantly, these efforts must meaningfully engage gay men and MSM, including MSM living with HIV to help maximize their appropriateness and efficacy." These responses include the following:

1. Adopt a human-rights-based approach in tackling social discrimination, including international and United Nations guidelines to eliminate stigma focused on and discrimination against gay men and other MSM.
   
2. Build capacity for responsive health service delivery systems:
   • Provider education and sensitisation.
     
   • Context-specific training.
     
   • Guidelines for health promotion and clinical care among gay men and other MSM, and professional capacity development made available to healthcare providers.
     
   • Review of professional health care associations’ codes of conduct in relation to sexual minorities and people infected and affected by HIV to include freedom from discrimination.
3. Advocate for legal reform including identifying and repealing existing and emerging criminal laws and other policies stigmatising and penalising lesbian, gay, bisexual, and transgender (LGBT) communities.
   
4. Facilitate access to social and legal support systems: National governments, policy makers, and civil society must work to create an enabling environment for access to legal services and to create safe spaces where gay men and other MSM have access to social support within their communities and opportunities to receive support from each other.
   
5. Develop a greater evidence base on stigma, improve mapping, and strengthen data integration through knowledge sharing.
   
6. Increase investment in MSM- and HIV-related anti-stigma work from public, private, and philanthropic donors and national governments. Fund LGBT and other civil society organisations that serve as watchdogs and empower communities against discrimination.
   
7. Coordinate strategic communication - "Messaging strategies must be informed by the personal and collective experiences of MSM. Intelligent and evidence-informed communication on MSM- and HIV-related stigma and discrimination is critical to leveraging support and leadership among communities, donors, politicians, and civil society actors, including human rights and faith based organizations.
   • The role of the media and its wider impact on public opinion and public policy should not be underestimated. Regional and global media should therefore be engaged in raising public awareness and in addressing hostile public attitudes towards gay men and other MSM.
     
   • Strong educational strategies specifically designed to promote appropriate and accurate reporting of events related to discrimination, homophobia and violence must be developed and implemented."

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