By Kevin Frost and Dr. Chris Beyrer
In 85 countries of the world, it is illegal for men to have sex with other men. Male-male sexual relationships are stigmatized, driving men to hide their activities from friends, family members, and health workers, according to a recent report by the International Lesbian and Gay Association. Because these men are forced to live part of their lives underground, they often lack access to basic services, and, as a result, are at increased risk of HIV/AIDS.
Men who have sex with men, or "MSM," is a term that applies to those who identify as "gay," but it also includes many MSM throughout the world whose gender and sexual identities defy Western categorization.Â For instance, in India there are at least three designations: "Kothis" are effeminate MSM who may nonetheless be married to women and have families; "panthis" are masculine men who have sex with kothis; and "hijras," who are often castrated, are often considered to be a third gender altogether.
While these groups often do not identify as a cohesive community, they share a vulnerability to HIV/AIDS. Men who have sex with men are among the most vulnerable populations to HIV transmission worldwide, and yet they continue to be one of the most underserved.Â Today, fewer than one in 20 MSM has access to basic HIV education, prevention services, or care.Â Many will die of AIDS simply because appropriate programs to support them do not exist.
The numbers tell the story.Â Studies in Uruguay and Ukraine have shown prevalence among MSM to be between 20 and 30 percent; in Kenya, the number is a staggering 38 percent. These statistics are comparable to the parts of sub-Saharan Africa with the highest rates of HIV infection. Around the world, these epidemics threaten to take an even greater toll unless something is done.
We have learned many lessons in the fight against AIDS in the West, where the gay community was among the first to be severely affected by the disease.Â Responding to the epidemic in the early 1980s, grassroots gay organizations arose to combat homophobia and fight for increased funding for AIDS research and social services.
Just as grassroots organizations led the fight against AIDS in the West, they are vitally needed in the developing world. Grassroots organizations work because they understand the obstacles facing the communities they serve.Â They know who to reach, how to reach them, and what to say to move this issue to the forefront. Today's challenge is how to learn from our past successes to support burgeoning grassroots movements in Asia, Africa, Latin America, and Eastern Europe.
In response to this global challenge, amfAR, The Foundation for AIDS Research, is launching a new initiative this week that will provide seed grants to grassroots organizations doing innovative work with MSM groups on the ground in the developing world.
These grants will be designed to fight stigma and discrimination, provide AIDS education, fund prevention efforts, treatment and care, and generate visibility and resources for these groups. For too long, squeamish and homophobic governments have failed to provide even the basic tools for MSM to protect themselves from HIV. We must have the courage to stand side by side with the grassroots organizations on the front lines of this epidemic delivering services and demanding greater action from governments and the global institutions charged with protecting vulnerable populations from HIV.
Collectively, we have learned many lessons over the last quarter century in the fight against AIDS. One of these lessons is that, in any culture, the people who can make the biggest difference are those who have personal experience on the front lines of the epidemic. To effectively fight the AIDS epidemic among MSM, we need to enable community-based groups to design and implement their own programs.Â The AIDS activist movement owes its success to its grassroots heritage and its ability to empower the disenfranchised.Â As we move forward, let us remember the lessons of our earlier success.
Kevin Frost is the interim CEO and Vice President for Global Initiatives of amfAR, the Foundation for AIDS Research. Dr. Chris Beyrer is the Director of the Center for Public Health and Human Rights at The Johns Hopkins University.