Battling Homophobia is Key to Ending AIDS ... Worldwide

Peter Piot, the tireless outgoing founding director of UNAIDS, put it bluntly in an address to the pre-conference MSM Global Forum on August 1:

"Homophobia - in all its forms - is one of the top five barriers to ending this epidemic, worldwide. The fight against the epidemic is entering a new phase, and if governments and NGOs and international organizations like my own do not take up the fight for gay rights, and the rights of all people with diverse sexuality, we will not end AIDS."

He went on to say that in nearly every country (including the USA) the resources devoted to prevention, research and care among MSM are vastly smaller than their numerical weight in the epidemic would compel as a matter of fairness and effectiveness.

Earlier presentations at the MSM forum had reviewed in detail what we know, and what we don't know, about the epidemic among MSM in various countries and about how the disproporionate impact on MSM everywhere is a general drive of the epidemic.

In Latin America, MSM are the major affected population throughout, and in much of the Caribbean as well. In Asia, MSM are a significant part iof the epidemic in India, Thailand, Indonesia, Vietnam, Cambodia, and China.

In most Asian countries, MSM are the third part of the "triumvirate of concentrated epidemics," including commercial sex workers and injection drug users (and, of course, some MSM belong to all three groups).

Even in the continent of "generalized" (as distinct from concentrated) epidemics, emerging studies show that MSM play a surprisingly large role. In cities as diverse as Alexandria, Egypt; Khartoum, Sudan; Mombasa, Kenya; Dakar, Senegal; and Gabarone, Botswana, MSM contribute from 15-30% of the new HIV infections each year, and their incidence rate is much higher than other population groups.

Yet, very little effort has been devoted to exploring HIV and MSM in most countries, until very recently. Once the decision has been made somewhere to start looking, enormous barriers remain. Cultural terms of reference vary widely, as in the fact than in most non-Western countries, sexual orientation or diverse sexual practice is not usually a basis for identity, as in "I am a gay man."

Most of the experience studying gay and trans sexuality is in the "global North" countries, and does not necessarily translate well to the "global South." For instance, even though about 30% of the HIV cases in Ho Chi Minh City (formerly Saigon), Vietnam are MSM, not even one person acknowledged same-sex practice in the first ever representative survey of 10,000 residents.

A major reason for our lack of knowledge is the same reason why gay men and other MSM are systematically ignored or downplayed in HIV prevention messages and funding and why gay men are subject to arrest, imprisonment, beatings and death in many parts of the globe: Homophobia, stigma, discrimination.

Piot highlighted the public information campaigns of the Mexican government health department against homophobia as noteworthy exceptions to most government's either ignoring homophobia or actively promoting it. He also noted that the battle has to be fought within international agencies including the UN and even UNAIDS where he himself has encountered and fought against homophobia among staff and among local government and NGO collaborators.

Piot stressed that all AIDS agencies and organizations must ally with and support emerging gay and trans rights movements around the world, though we must also be careful in how we do so in countries where repression is extreme and the risk to open activists is high. He said we must also fight to make this a highlighted part of all more general human rights agendas and campaigns and must fight, if necessary, to bring this urgency to the leadership of all human rights movements.

Finally he stressed that "we must be or become prevention activists, not just treatment activists." He described the risk of medicalizing and "normalizing" HIV prevention as high, and dangerous.

As another staffer from UNAIDS said, "Much of the global AIDS treatment community figures the best and only way to respond to the MSM epidemic is have everyone show up at an STD clinic every three months ands get their book stamped that they have had an HIV test and gotten STD treatment."

Piot stressed this would be foolish and harmful, because normalization into systematiucally homophobic health care and treatment systems will leave the barrier of homophobia in place. "We must reject medicalization! We must reject normalization! We must support community mobilization and human rights struggles!"

Yesterday's First International March Against Stigma, Discrimination and Homophobia down the main boulevard of Mexico City was an inspiring testament to the potential power of an international mobilization against homophobia. Tens of thousands of people marched in a colorful panoply stretching more than two miles.

The Mexican Secretary of Health and the national "AIDS Czar" were in the vanguard, but were soon followed by other contingents who denounced the Mexican government for various things including criminalization of sex workers and suppression of indigenous populations.

Contingents from across Mexican gography and sivil society marched with their own t-shirts, banners and chants. The diversity of sectors and approaches was stunning in its richness, and sometimes directly confronted each other. Several contigents were from faith-based organizations, most of them somewhow related to Catholicism. Some had hand-made Bibkle quotes that preached acceptance for all.

One large group (apparently working as a pressure group within the church) chanted repeatedly for the Catholic bishops to accept and promote condom use. Another groups, calling themselves the Apostates of Mexico, boldly said, "If your religion discriminates against you, renounce it! Debaptize yourself! Disaffiliate!" The headquarters of a large international bank towered over the gathering place for the march, and even had contributed to its sponsorhsip in some way. Yet there was a large contigent of its workers with banners denouncing the bank for firing openly gay and HIV positive workers.

It was exciting to see such a huge gathering, gloriously decked out, with the energy of solidarity and common purpose, even if sharp differences about how to reach that purpose. The Mexican majority there clearly appreciated the solidarity of a thousand or more marchers from around the world who are here for the conference. It reminded me of the early days of gay pride marches in North America, when they were still political and courageous and before they became entirely corporate and lifestylist.

It reminds me that we have the power to fight homophobia around the world, if we mobilize, and link with all the other struggles for social justice that are also at the root of ending AIDS.