Gay men and other MSM: The right to sexual and reproductive health

By George Ayala and Mohan Sundararaj – The Global Forum on MSM & HIV (MSMGF)

EVERY human being must enjoy the right to sexual and reproductive health, and that includes gay men and other men who have sex with men.

Gay men and other men who have sex with men (MSM), estimated to comprise about 5-10 per cent of the world’s population, have been historically excluded from health and HIV-related programme, policy or financing discussions. They face homophobia and a range of structural challenges that undermine their ability to realize health to the fullest level possible. In every country truthfully collecting and reporting HIV and health data, gay men and other MSM consistently record higher HIV prevalence rates or poorer health outcomes when compared to adults in the general population. Moreover, gay men are seldom, if ever, meaningfully engaged in the design of health and HIV responses meant for gay men. This has left a health sector that is weakly equipped to effectively cater for a population that continues to shoulder a disproportionate HIV and AIDS burden.

Sexual and reproductive health: a holistic approach

Sexual and reproductive health (SRH) of gay men and other MSM cannot be viewed as the mere absence of disease. It encompasses their physical, emotional, mental and social well-being in relation to their sexuality.

‘Coming out’ – a process through which gay men come to terms with their sexuality, which may or may not include revealing their sexual identity to others is therefore integral to mental health. Gay men who realize self and social acceptance, find it easier to seek sexual healthcare or speak candidly to a primary care provider about their sexual health needs. The integration of gay men with mainstream society can thus provide a more equitable and less biased health delivery platform from which they can access targeted HIV prevention, treatment, care and support services and other health interventions.

Gay men and other MSM have unique health needs

The accrual of compelling evidence over decades has led the international scientific community to increasingly regard homosexuality as a normal variation within the spectrum of human sexual expression. But rejection of gay men can begin at home with family members, and can often be compounded by societal ostracism. In many cases, this leads to isolation, abuse, violence or sometimes murder. In over 70 countries, sex between consenting adults of the same gender is considered a criminal offence. Broader society and national governments have failed to recognize gay men’s rights to privacy, non-discrimination and a decent life, fuelling prejudice against them at every level. It is in this context that gay men and other MSM attempt to navigate their HIV and health needs.

Research has shown that these individuals reliably bear higher rates of depression, anxiety, chronic stress, suicidal thoughts, and substance use. Fearing rejection, they may delay seeking health services including mental health care. In some contexts, gay men and other MSM are subjected to sexual abuse, physical harassment, rape and violence and therefore are robbed of any control over their own bodies. Consequently, they are unable to readily access screening services for sexually transmitted infections (STIs), including HIV or necessary prevention information, condoms and lubricants.

Core principles to working with gay men and other MSM

A sound approach to addressing the SRH needs of gay men and other MSM must take into account a broad set of issues and principles.

Principles of practice have long been deliberated by AIDS service providers and advocates, but are often overlooked in policy discussions in favour of a narrow focus on scientific evidence in substantiating HIV-related interventions and SRH programme strategies. The following are some important core principles of practice:

1. The imperative of reducing STI and HIV infection rates should not impinge on personal freedoms.
2. All people, including MSM and MSM living with HIV, deserve the same level of support, health care, support services and political rights as anyone else.
3. All people, including MSM and MSM living with HIV, are entitled to a fulfilling and satisfying sex-life.
4. All people, including MSM and MSM living with HIV, have the right to be self-determining.
5. All people, including MSM and MSM living with HIV, deserve to be free from rape, violence and discrimination and are entitled to adequate legal recourse when these rights are violated.
6. HIV prevention programs and SRH services should not take a singular focus on risks but rather leverage the strengths, resources, competencies, social connections, capacities, and resiliency that are already present in gay men and other MSM and their communities.
7. Pleasure, gender, satisfaction, intimacy, love, and desire are key concepts in a fuller understanding of sex and sexuality among gay men and other MSM and should be included when formulating more meaningful research, programmatic, and policy responses.
8. Researchers, prevention practitioners, and policymakers should consider structural, situational, and contextual factors in understanding HIV risk and in developing sexual health interventions tailored to the specific needs of gay men and other MSM.

Additional resources are available from the Global Forum on MSM & HIV (MSMGF) website: http://www.msmgf.org/

Article from IPPF HIV Update newsletter - Issue 25: http://www.ippf.org/en/Resources/Newsletters/HIV+Update+Issue+25.htm