Dr Robert Carr: Moments and Memories

IPPF commemorates the life of Dr Robert Carr—colleague, friend and human rights champion—and will honour his legacy

The global fight against HIV has generated many champions over the last 30 years, and the world has sadly now lost one of its true defenders of human rights—Dr Robert Carr—someone who stood up for those who were often overlooked by many or living in the margins of society. Robert was a man of absolute integrity whose honesty and passion for the greater acceptance of the rights of vulnerable people in the world often cut through the hypocrisy. Robert still had much more to contribute through his advocacy on sexual rights, his role as the civil society co-chair of the Global Coalition on Women and AIDS and on the Board of the Global Forum on MSM and HIV, and his endless championing of issues facing gay and other men who have sex with men around the world. He has gone too soon, but his legacy will no doubt continue to inspire action and commitment in these important areas for many years to come. His spirit will hopefully inspire a new generation of leaders to take up the issues he so fiercely defended.

For many of us at the International Planned Parenthood Federation (IPPF) what started out as a strong working relationship turned into a formidable friendship and camaraderie. Robert had that unique ability to ‘blur the edges’; connect with different kinds of people and link people together. From the Caribbean to Canada to Kuala Lumpur below are some thoughts and reflections from colleagues and friends.

“Robert worked tirelessly for HIV in the Caribbean. It’s like the light of a star has gone out. Collectively we need to ensure that his insights and vision continue to be present in our work. His spirit will inspire us to pay attention to the unnoticed, spotlight what may sometimes be invisible, and persevere with his efforts to serve the most vulnerable communities at home and around the world.”
--Dr Jacqueline Sharpe, President and Chairperson of the Governing Council

"We are grateful that Robert came into our lives at the time that he did. His understanding and mastery of the sexual rights concerns of our Caribbean sub-region has brought our work to the attention of many allies. It is important that we continue the important advocacy work that he begun, or we would have allowed his legacy to die with him."
--Dona Da Costa Martinez, Executive Director, Family Planning Association of Trinidad and Tobago

“Robert Carr was a longstanding colleague and friend of IPPF. His commitment to vulnerable people around the world—through his wisdom as a leader, his insight as a mentor, and his humility as a peer—was inspiring, and will be greatly missed by all.”
--Dr Gill Greer, Director General

“Outspoken, exuberant, passionate, spirited and always smiling, Robert had the same approach to life as he did to his work. And he lived each day to its full. Personally, I have a lost a dear friend and comrade. And the world has lost one of its greatest defenders of social justice.”
--Kevin Osborne, Senior Advisor HIV

“Rob was a powerful and unstoppable force with a strong commitment to human rights. He will heat a debate and always find ways to name the elephant in the room – he was not shy to talk about the need to stop the double standards and hypocrisy that permeates some of our work. He was a person of principles and integrity – and the sweetest man and dearest friend on earth! Working with Rob was amazing. His spirit and fierce determination will be with us forever. Rest in peace dear Rob.”
--Ale Trossero, Director of Programmes, East Asia and the Pacific Regional Office

“When I first met Robert Carr in London it was a night that was filled with loads of laughter, brilliant conversation, passionate debate and inclusion – but he called it "field work." I was dazzled. He became my friend and confident and to many people at an event in Toronto last year one phenomenal dance partner. Dance on Mr Carr!”
--Alastair Hudson, Stigma Index Team: United Kingdom

“I remember Robert as a person of the utmost integrity, yet full of laughter and fearless to speak his mind about issues passionate to him.”
--Daniel McCartney, HIV team

“With his sharp wit and incisive perceptiveness, Robert had a way of saying the unexpected and often illuminating the unspoken. I first met Robert at one of his many conference presentations, where he showed a news photograph of two men being ushered away from a shop into a police van, amid a violent onslaught from a small crowd. At first glance, the image appeared to show a prejudiced, destructive and pessimistic scene in Jamaica for gay men. Yet Robert spoke of the picture as a great sign of hope—of progress in Jamaica. The police in the photo were ‘serving and protecting’ gay men, rather than joining in or even initiating the violence. I have learnt mountains from Robert, and although we have many more mountains to go in terms of overcoming the issues he fought so passionately for, each step will be all the stronger, wiser and more determined for having known him.”
--Lucy Stackpool-Moore, HIV team

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

HIV Update: Sex between men

By Kevin Osborne (IPPF)

Since its debut in the early eighties, HIV continues to disproportionately affect men who have sex with men (MSM). Despite some policy gains made over the past years, MSM still experience serious challenges when trying to access HIV prevention, treatment, care and support services. And much of this has to do with the prevailing culture of stigma and discrimination.

In every country in all regions of the world, relationships and consensual sex occurs between men. Yet in over 70 countries criminal penalties currently exist for same-sex acts between consenting adults, including imprisonment and death. Even in countries where consensual sex between men is not illegal, MSM are among the most marginalized and discriminated against in society. Individuals are often targets of exclusion and violence on account of their real or perceived sexual orientation. This reality was underscored earlier this year with the tragic loss of David Kato in Uganda. And despite being at a greater risk of HIV infection, MSM are too often overlooked in national responses with few, if any, targeted resources provided.

The existence of punitive laws also makes it very difficult for MSM to openly access health services, and more needs to be done to effectively serve their sexual and reproductive health (SRH) and HIV needs. In recognition of this need, IPPF has recently entered into a partnership with the Global Forum on MSM & HIV (MSMGF) – a network promoting the health and human rights of MSM worldwide – to scale up our collective efforts. IPPF’s Sexual Rights Declaration clearly stresses that every human being has the right to sexual and reproductive health - including gay men and other MSM - and our lead article by MSMGF calls for this right to be honoured.

Our work with MSM has increased considerably over the last five years. In 2005, 25 per cent of IPPF Member Associations had specific strategies for MSM, and by 2009 this had increased to 45 per cent, with some outstanding examples. While much still remains to be done to meet the SRH and HIV needs of MSM and their partners, IPPF Member Associations are uniquely placed to provide much-needed services – including access to stigma-free clinical services, high-quality condoms and water-based lubricant, specific risk reduction strategies, and appropriate referrals for care and support. Working in partnership with regional and country level MSM organizations and networks will help shape and strengthen both our work and our collective voice to address the sexual and reproductive health and rights of MSM.

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

What do I do if I am living with HIV and…

Ahead of International Women's Day on the 8th of March, IPPF has published a new informative booklet and poster for young women living with HIV. The booklet and poster answers questions raised by young women living with HIV about dating, relationships, sexuality, and parenthood.

It offers information to help young women to have a healthy, happy, and sexually fulfilling life and to decide on issues relating to sexual and reproductive health. The booklet covers the following topics:

What do I do if I’m living with HIV and...

...I want to date or be in a relationship?
...I want to tell my partner or my family that I am living with HIV?
...I want to protect my partner from HIV and other STIs?
...I want to practise safer sex?
...I want to get pregnant?
...I want to protect my baby from HIV?
...I do not want to get pregnant?
...I want to end a pregnancy?
...I want further support?

Like all people, there is a lot of diversity among young women living with HIV. We hope this guide provides information that is useful in helping young women decide how to best look after their sexual and reproductive health.

To download the booklet and poster: http://www.ippf.org/en/Resources/Guides-toolkits/What+do+I+do+if+I+am+living+with+HIV+and.htm

Girls Decide: Nomvelo's journey, Swaziland

On 16 February, IPPF launched Girls Decide at the first screening of the Girls Decide film series. The films and publications are part of a larger initiative that aims to highlight the centrality of girls’ and young women’s sexual and reproductive lives for both individual and global development, and aims to ensure that girls’ and young women’s sexuality and pregnancy-related issues are effectively addressed by adopting policies and practices that work for girls.

The Girls Decide films share the stories of six girls from around the world in their journeys to make informed decisions about sex, pregnancy, abortion and relationships. They show how Member Associations of IPPF fulfil their commitment to young people’s sexual and reproductive rights through the provision of quality youth-friendly services.

The films are all based on true stories and were developed through a participatory process with young women from each of the six countries. The main characters are portrayed by actors. All interviewees are practising health professionals and community leaders.

One film shares the story of a girl in Swaziland. Nomvelo was born with HIV and she is interested in taking her relationship with her boyfriend further, but does not feel confident about how to talk to him about her HIV status. The Family Life Association of Swaziland, an IPPF Member Association, provides support to girls and young women living with HIV to lead positive and healthy lives.

IPPF believes that all girls and young women living with HIV have the right to experience their sexuality in healthy and positive ways. They also have the right to date, to be in relationships, to marry, to access sexual and reproductive health services and information, to have children and to decide if, how and when to disclose their HIV status.

To see the other films and for further information on the Girls Decide initiative: http://www.ippf.org/en/What-we-do/Adolescents/Girls+Decide.htm

I love you. A universal language.

Valentine’s Day is about love, irrespective of gender, sexual orientation or HIV status.

In many countries, laws exist that do not allow people to express love without fear of persecution or violence. Laws that criminalize HIV transmission and exposure, and those that criminalize behaviours and practices associated with HIV transmission, have a profound impact on the lives of people.

Even on Valentine's Day, people living with HIV and people most vulnerable to HIV infection - including women, men who have sex with men, transgender people and sex workers - will experience stigma, discrimination and violence.

Everyone has the right to love – love does not discriminate.

Be conscious this Valentine’s Day.

Criminalize Hate Not HIV is part of a growing campaign to raise awareness about issues relating to the criminalization of HIV transmission. For more information: http://bit.ly/criminalization.

There must be a silver lining

By Lucy Stackpool-Moore

Any day is a sad day for the world when senseless violence takes the life of a kind, compassionate human being. Yesterday was no exception, when David Kato, the litigation and advocacy officer for SMUG (Sexual Minorities Uganda) was killed in his home in Kampala.

David was a friend, and worked closely with IPPF on a number of occasions over the last two years. He spoke about the law and human rights at the Vienna International AIDS Conference.  Just a few months ago, David, representing Africa, provided an important perspective at a meeting of the UK Consortium on AIDS and International Development about barriers to universal access of HIV care & support. He made sure that due attention was given to this issue for all people, including those from sexual minority groups.



David Kato speaking at IPPF satelitte session in Vienna. Placard he created read "AIDS 2010 demands withdraw of the Ugandan Anti-Homosexuality Bill in its entirety now!"



At times like this we must look for inspiration and compassion and hope, and we must find the silver lining hiding in even the darkest of thunderclouds. I was reminded of the great Archbishop Desmond Tutu’s humane and wise comment about homophobia in March 2010—which he called ‘a step backward on human rights’ in Africa:

“Hate has no place in the house of God. No one should be excluded from our love, our compassion or our concern because of race or gender, faith or ethnicity -- or because of their sexual orientation… It is time to stand up against another wrong.

Gay, lesbian, bisexual and transgendered people are part of so many families. They are part of the human family. They are part of God's family. And of course they are part of the African family. But a wave of hate is spreading across my beloved continent. People are again being denied their fundamental rights and freedoms…

These are terrible backward steps for human rights in Africa. Our lesbian and gay brothers and sisters across Africa are living in fear…The wave of hate must stop… Exclusion is never the way forward on our shared paths to freedom and justice.”

IPPF is deeply shocked and saddened by the news of David Kato’s murder. Our thoughts are with David’s family and friends and colleagues at SMUG (Sexual Minorities Uganda). We have lost a friend, a colleague, a committed human rights activist and a generous and compassionate human being.