amfAR, The Foundation for AIDS Research

GRASSROOTS: The MSM Initiative Blog

amfAR's MSM Initiative supports grassroots MSM and transgender organizations responding to HIV, and advocates for effective HIV policies and increased funding for MSM/TG globally.

Belize: Equal Health for All? Doubtful!

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Posted by Kent Klindera, October 19, 2010

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Nurse Bradley and Caleb Orozco at the HIV counseling and testing center in Belize City.

I’m in Belize visiting with the United Belize Advocacy Movement (UNIBAM), which amfAR’s MSM Initiative has been supporting for the past two years. UNIBAM’s leader, Caleb Orozco, has brought me to San Ignacio—a town near the Guatemalan border—to meet with a group of “his people.”  It’s Friday, and, just as it is for most young gay men in the world, Friday night is party night.  We met up with about 10 guys who gather every week at a friend’s house for some good food, music, and dancing.  It was an evening of 20-somethings (and some older teens) being themselves—some single/some couples, but all able to let their hair down. Belize, like most of the world, is a very homophobic place, and letting down your hair can only really happen behind closed doors. What a wonderful scene the party was!

I had spent the prior two days meeting with healthcare workers and health officials, and I was having mixed feelings—at times hopeful and at times depressed.  I met an amazing woman named Nurse Bradley, who has become an authority on MSM health. Initially she was not receptive to working with gay men, but Caleb was persistent. Now, guys come for miles to see her for HIV testing; for antiretroviral therapy; for the management of STIs; and, most importantly, for someone to talk to. 

I also met an amazing 20-year-old UNIBAM volunteer named Michael, who told me that a year ago he used to make Caleb walk 10 feet in front him so that no one would suspect they were friends. Today, Michael has come out himself and is organizing others in Belmopan (the political capital of Belize). And he has taken in five or six young guys who have been kicked out of their homes by their parents for being gay or transgender.

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Michael, a volunteer with UNIBAM, and the group’s leader, Caleb Orozco, in front of a school where a young student was expelled for cross-dressing.

The meetings I had with authorities were distressing, however. The tag line for Belize’s Ministry of Health is “Equal Health for All,” but the government has no official statistics on how many MSM there are in Belize, and so far there has been no direct investment in HIV programming for MSM. Belize is next door to Mexico, whose authorities have clearly documented that MSM are in need of specific investment to reduce the spread of HIV. In our meetings, officials mentioned that an MSM sero-prevalence study is just getting started (with funding from the U.S. Centers for Disease Control and Prevention) but results will not be available until late 2012 at best. Caleb and I asked how many more men will die between now and late 2012, when results will almost certainly show that MSM are at higher risk. Although well-meaning, the ministry representative was not showing the kind of leadership needed.

On a positive note, UNIBAM recently started documenting hate crimes to help make a case to authorities about the dangers MSM face, and it also defended a male student who was expelled from a state-run school for wearing a girl’s uniform (he was re-instated). Most importantly, UNIBAM has filed a case (with support from amfAR) to decriminalize same-sex behavior, a move that LGBT rights groups throughout the Caribbean are watching. Success in Belize could produce a domino effect throughout the region. 

Caleb is amazing. He’s been an activist for more than 10 years and he’s a little tired, but he does an incredible job of cultivating the spirit of activism, especially among the younger LGBT community in Belize.  Personally, I put my faith in the 20-somethings at the party in San Ignacio….and their social support, which will allow them to come out, be proud, and protect themselves. Maybe the political leaders will someday follow?

China: Change Coming From the Top?

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Posted by Jirair Ratevosian, October 14, 2010

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In Baoding, China, Dr. Bian Dong Da runs a makeshift clinic for MSM who have nowhere else to go.

In Baoding last week, we were advised not to be late for our doctor’s appointment. In the midst of festivities for China’s National Day on October 1, we were to meet with Dr. Bian Dong Da, who runs a makeshift clinic for MSM who have nowhere else to go. Some travel over 200 km to see the good doctor! “He treats patients in a humanitarian way,” said Murong Feng of Hebei Light of Love Care Group for PWHA, which refers men living with HIV/AIDS from Hebei and surrounding provinces to his care. As the doctor explained, public health systems set up to serve general populations can be problematic for those most vulnerable to HIV. Indeed, many who visit him have been refused care by the public health system; others go there because they are fearful of discrimination and hesitant to rely on a health system plagued by discrimination and ignorance. Some 5,000 patients have visited the clinic since it separated from the local public hospital five years ago.

China’s post-SARS leadership is alert to the pitfalls of neglecting the country’s public healthcare system, and everyone is on high alert about HIV/AIDS. Back in Beijing a few days earlier—at a WHO meeting to discuss forthcoming recommendations on HIV/AIDS and STIs among MSM and transgender people—there was a buzz about a recent speech at the UN by Premier Wen Jiabao. Dr. Zunyou Wu, director of China’s National Center for AIDS/STD Control and Prevention, opened the meeting quoting from the Premier’s speech in New York: “To fight against HIV/AIDS is the common responsibility of mankind.”

The first-ever WHO consultation entailed direct conversations between senior leaders from the Chinese government, other stakeholders, and openly gay and HIV-positive community representatives working on the front lines of the AIDS response. While impressive to witness, the mood was sober. One after another, Chinese officials acknowledged the alarming increase in HIV among MSM throughout the country. Frustrated by inaction, community reps noted the grave social stigma and lack of appropriate health services that keep many MSM hidden and at risk for HIV infection.

China is not alone. Where estimates are available from around the world—and often little research has been conducted—HIV prevalence among MSM is very high. Yet only a small percentage of prevention funding in high-prevalence countries is devoted to MSM according to a recent amfAR report. In China, despite high-level attention to AIDS and recognition of MSM as a priority in the national AIDS response, the government has yet to develop a plan of action. Subsequently, much-needed resources remain out of reach from community groups working on the frontlines.

While some are optimistic that Premier Wen Jiabao’s words will catalyze change, many we met in China acknowledged that turning the tide will require real partnership between government, stakeholders, and community-based groups.

Dr. Bian Dong Da’s is one of many who remain optimistic. In a country struggling to make progress in the fight against HIV/AIDS, his makeshift clinic and the positive impact of small community-based programs offers a lifeline to many.

Beijing Airport

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Posted by Kent Klindera on 8 October 2010

Beijing Airport: 8 October 2010

We've just left the southwestern Chinese city of Chengdu, capital of Sichuan province, after spending two days with colleagues at the Chengdu Gay Care Centre. The group serves as the secretariat for the China Tongle MSM Forum, an amfAR-supported partner consisting of more than 70 community-based gay men's groups throughout the country.

Fear—from our arrival in China I've noted the damaging effect fear has on efforts to reduce the impact of HIV among MSM. Homophobia permeates society here and creates great challenges for amfAR's partners. Homophobia and the fear that underlies it force gay men (and lesbians) to marry opposite-sex partners and then develop shadow relationships with same-sex partners. Fear of being found out makes gay men especially easy victims for extortion—some men blackmail wealthier gay men, threatening to "out" them and thus ruin their careers or bring shame to their family.

amfAR's project involves supporting a lawyers collective that works with six community-based organization, helping gay men understand that they actually do have rights, and that laws exist that can be used to end extortion. This may not seem to be directly HIV-related, but providing condoms and lubricant only goes so far. Gay men need to have the motivation to use condoms, and freedom from fear is a great motivator. Clearly, this particular project is helping to create hope!

We also spent many hours chatting with younger gay men. While they are still struggling with identity issues, they don't seem to feel as much pressure to deny their feelings and marry a woman. However, some young men say that gay male relationships are not stable and cannot last—because they are men, they say, and that is how they are! Still, these young men are motivated to fight for their rights in a country where rights can be fragile. They complain that their government is not responsive and that many major donors are complicit in not being responsive or supporting NGOs. They walk a fine line, challenging government policy in strategic ways and testing the limits of their freedom to criticize government policy and fight for their rights. I'm proud to be part of amfAR's support for these guys—here, we are really helping shine a "light on their rights," as this year's World AIDS Day campaign urges.