'HIV in invisible gays big worry'

Chris Beyrer, a guest editor of last year’s ‘The Lancet’ series on MSMs (men who have sex with men) told bdnews24.com in an interview that these ‘sexual minorities’ are ‘hidden’ in South Asia, “but carry 10 times more HIV infection risk than others”.

“They are not so much in public dialogue and discussions. But the fact is that everywhere we look we see there are substantial MSM populations. “It does not vary much between countries and cultures. It’s roughly the same,” he said on the sidelines of the ongoing International Congress on AIDS of Asia and the Pacific. More than 3,000 participants have joined the Congress from 80 countries in the Thai capital. Beyrer described the MSMs as the ‘key’ population for HIV response for two reasons – higher risk of HIV and lower access to services. “We have to lower their HIV rates and provide services. We have to deal with their human rights to provide them access to the healthcare in a setting that is safe and where they don't lose out on dignity and where they can disclose their actual behaviour and talk about their partners. “The country that fails to do that, will face an ongoing epidemic,” he said. ‘Who are MSMs?’ “It’s (MSMs) a behavioural term,” Beyrer, who is the director of the John Hopkins Centre for Public Health and Human Rights, said. “It does not describe about how people feel whether they are truly gay, whether they are married to women, whether they are attracted to both men and women. “This is a broad category that include all men who behaviourally have sex with other men, including men sex workers who may be heterosexual, homosexual or bisexual.” But he said, commonly they share “higher risk of HIV infections and the stigma and discrimination and the limits of access to healthcare”. ‘Hard-to-reach’ Being invisible, there is no official statistics about the number of gays and bisexual men in Bangladesh. But different surveys put the figure at more than 1.5million. They are criminalised in Bangladesh, according to the UNAIDS latest report that also showed that they are less likely to use condoms than any other high risk groups like sex workers and intravenous drug users. The condom use rate was only 26 percent, despite the fact that anal unprotected sex is ‘very efficient route’ of transmitting HIV. Beyrer said HIV rate among general population in the region was very low, but higher in men who have sex with men. In the Asia Pacific region it varies from country to country in Bhutan and Bangladesh it is much lower than the average 15 percent while in Thailand it is over 20 percent. “The challenge for prevention is that they are hard-to-reach. They are more hidden,” he said stressing on specific efforts like promoting condom, HIV testing and treatment of other diseases focusing them. But it can be changed if a government has political will. “They are ready to assist. They are already engaged. They just need a safe environment where they are free from political harassment or other kinds of harassment and then they can be a real partner in the efforts to stop HIV,” he said citing a South Indian ‘Abahan’ programme where they could reach out to the gays and bisexual men rather effectively. ‘Next generation change-maker’ Beyrer is optimistic. “The next generation is much more open about these issues. They are more willing to explore and discuss. They are more tolerant,” he said. Because of internet “the next generation of gay and lesbian are connected globally in a way that the previous generations never were”. “So everybody is sharing their experience more and standing up wanting to be a part of the society, wanting to express their love, their relationships, to have dignity and to be accepted,” he said. So nobody gets to decide who is not entitled to human rights. Sexual and gender minority people are also entitled to human rights and citizenship rights including in Bangladesh. That is our goal,” Beyrer said. He said it was policymakers ‘responsibility’ to provide services and ensure that “nobody is excluded and health services provide appropriate services to the men who have sex with men and transgender populations. “This is the part of responsibility of the government towards HIV control and also human rights. They are very much interrelated and they are not separate things."