Waving the flag for gay men everywhere

The last thing I expected to be doing at the World AIDS Conference was standing on a stage at the Zocalo, the central square of Mexico City, making a speech about justice and HIV treatment access for gay men/MSM in the global South, and accepting a large banner from a group of rainbow-suited Mexican gay activists in front of a cheering crowd.

I’m a reporter, not a presenter, for godsake. Let alone a celeb (two reporters wanted to interview me). The way it happened was this.

I’m on the steering committee of the Global Forum for MSM and HIV, the folks who put on the pre-conference satellite meeting (in fact a miniconference of about 450 gay activists from around the world). The conference was a great success and afterwards we went on the march against homophobia and stigma, a rainbow-bedecked celebration of gayness and general non-family-oriented sexuality (the sex workers’ satellite attended too).

“We’ve got a banner demanding equal antiretroviral access for MSM worldwide,” said the organisers. “We’d like to hand it over to a European representative at the end of the March because the next World AIDS Conference is in Vienna, to symbolise continuity in the struggle for equality and so on.”

So we nominated Tudor Kovacs, the Global Forum’s eastern Europe rep, who made a great speech saying that if he was in his native Romania the march would have consisted of about 100 gay men and 500 police to protect them from the stone-throwing crowd. Joel Nana from Cameroon, one of a bunch of dynamic young activists from Africa, made an emotional (and tearful) one too, explaining that such a march would simply be impossible in his native country. “Go on, Gus,” they said, “make one too.”

So I talked about how I wouldn’t be alive today if the gay community hadn’t demanded HIV treatment in the first place, but how gay men (and sex workers, and drug users) seemed to be last in the queue in the global south when it came to treatment and prevention access. Largely because of stigma, not least from the churches (gesturing to the huge cathedral behind me). That got a big cheer.

And I said I hoped this conference would be a turning point in the recognition of gay men/MSM in the countries where we officially don’t exist, or are jailed or beaten up or are just plain to scared to be open.

And I very much hope it will, but it’s going to be a struggle. I was reading Elizabeth Pisani’s book The Wisdom of Whores on the way over and she has a lot of things so say about how the world adopted an “AIDS affects everyone” ideology because it was too scary and inconvenient to get politicians to do nice things for the people really affected, namely their ‘vulnerable communities’ or (and I’ll go along with Elizabeth in using the terms that don’t appear in policy pronouncements) their fags, junkies and whores.

Well, if you’re in, say, Malawi (HIV prevalence: 12%), AIDS pretty much does affect everyone.

Mind you, the MSM pre-conference heard that even there, when you bother to find out who the gay men are, twice as many of them have HIV as the general population.

But if you’re in virtually any other country outside southern and eastern Africa, and a couple of Caribbean hotspots, AIDS pretty exclusively affects gay men, sex workers and their Johns, and injecting drug users.

And it probably ain’t never going to affect ‘the general population’. At the pre-conference David Wilson, the World Bank’s splendid epidemiologist, gave some examples:

Mexico: gay male HIV prevalence, 25%. General population: under 1%.

Thailand: gay: 25%. General: 2%.

Senegal: 22% versus 1%.

The lower the general HIV prevalence in the country, the more its epidemic is concentrated in ‘vulnerable groups’.

Initially and ironically we tend to find out more about HIV in sex workers and IDUs, because they come to the attention of the authorities more. But when you look for gay men, you find them and you find they always have much more HIV:

China: gay HIV prevalence: 3% and apparently increasing. General prevalence: less than 0.1%.

Even in countries with generalised epidemics, however, gay men have more HIV:

Kenya: gay men: 13%. General population: 8%. South Africa: 35% versus 18%.

What about the countries where HIV is almost entirely driven by injecting drug use?

Well…I remember reading the HIV figures for Ukraine in the UNAIDS report a few years back. At that point there were something like 200,000 people with HIV in the country – 11 of whom were men who’d had sex with men. Oh yeah, right. That’s just the 11 who had the nerve to tell their doctor.

At least now we’ve had some MSM surveillance in that country too and we find that about 4.4% of gay men in the surveys done have HIV compared with 1.6% of the general population. So, nothing like the 61% reported in injecting drug users, but more than likely following close on behind in a second wave…

How you even find your gay men is a challenge in any country where they have every incentive to remain invisible – even, in some ways, to themselves. It’s all done through ‘snowball sampling’ which means recruiting guys-who-know-guys-who-know-guys. You won’t get a representative sample. All you’d get is a snapshot of a subculture.

In Malawi this turned out to be well-educated bisexual (66% had also had sex with a woman recently) urbanites with access to the internet (44% had cruised online). When the same thing was done a couple of years back in Khartoum, they uncovered a population of desperately poor and young street boys selling their bodies. You find gay men everywhere if you look, but the ones you find depend on your method.

This all throws a huge challenge to AIDS activists. Because we can’t say “if you don’t reach out to your gay uncle, your straight auntie will end up getting HIV too.” Because she probably won’t. Instead you have to do the much tougher job of persuading poor-country presidents, not to mention a few bishops and imams, that they should care about the health of people they’re more often condemning to hell.

Quite a challenge. But just to see the banners on the Mexico march – ranging from the ones saying ‘homophobia is a public health problem’ to the handwritten one carried by a middle aged lady that said, in Spanish and English, “I’m proud of my gay son,” gives me hope that the thing some of us have been most scared of and yet hoped for most – a re-gaying of the struggle against HIV, but this time drawing in the energies of gay men/MSM from around the world – may be starting to happen.

The magnitude of the task should not be underestimated though. At the end of the gay men’s satellite there was a sobering presentation from a guy at the Global Fund. The way the Fund was set up is based on the ‘AIDS affects everyone’ ideology. So, one big national consortium bids for one big pot of money which gets distributed, by health ministry people with, if we’re lucky, advice from key activists – to deserving programmes. Which are more than likely not to be the ones targeted at fags, junkies and whore, if the local politicos are in any way typically conservative.

There is hope. I quoted the figures from Senegal. They’re a rare example of an African country which proactively went out and did HIV prevention work – including, a little late in the day, but they did it, work with gay men. A repeat survey done this year shows evidence of a slight decline in gay male HIV prevalence, and also sexually transmitted infection (STI) incidence. And men were less likely to had got an STI if they’d encountered some HIV prevention activity.

So all you have to do is persuade Robert Mugabe, or Mahmoud Ahmedinejad, that the non-existent ‘worse-than-pigs-and-dogs’ gay men in his community need HIV prevention work directed at them. Anyone fancy a go?

Well, yes. One of the biggest cheers at the pre-conference was for Samuel Matsukire, president of the Gays and Lesbians of Zimbabwe. If they can get mutual support and community action together, there is hope for us fags – and junkies, and whores – everywhere.

For the global Forum on MSM and HIV, see www.msmandhiv.org