Study finds poor global access to HIV services
A survey with more than 5,000 participants worldwide indicates that the majority of men who have sex with men find it difficult or impossible to access HIV testing, HIV counseling, free condoms and free lubricant.
The findings have been released to coincide with World AIDS Day and authors say it underscores the importance of universal access to HIV prevention and treatment, a central theme of this year’s World AIDS Day observance.
Initial analysis of the survey’s results indicates that fewer than half of MSM worldwide have access to even the most basic HIV prevention and services.
Of all respondents, only 39 percent reported easy access to free condoms and barely one in four reported easy access to free lubricant. A full 25 percent said free lubricant was completely unavailable.
Large percentages of men reported that it was difficult or impossible to access other essential services as well, including HIV testing (57 percent), HIV education materials (66 percent) and HIV treatment (70 percent).
Conducted by the Global Forum on MSM & HIV (MSMGF) in collaboration with Dr Patrick Wilson, Assistant Professor at Columbia University’s Mailman School of Public Health, the survey was carried out online in Chinese, English, French, Russian, and Spanish, with nearly three quarters of all study participants from low or middle income countries.
Executive Officer of the MSMGF Dr. George Ayala says since the beginning of the epidemic, it has been widely recognized that condoms, lubricant, testing and treatment, when combined with community-led behaviour change and support programs, are the most reliable tools available in the fight against HIV among MSM.
"More than 25 years in, it is inexcusable that MSM around the world continue to have such restricted access to these basic lifesaving resources."
"With the excitement surrounding the promise of pre-exposure prophylaxis (PrEP), it can be easy to forget that we already have a rich selection of prevention measures that we know work right now," says Patrick Hebert, Senior Education Associate at the MSMGF. "Today’s findings reinforce the fact that we can’t even get condoms and lube to more than half of MSM around the world. We must look seriously at barriers that prevent MSM in different country contexts from accessing these proven prevention tools."
While reporting on levels of access to currently available HIV prevention tools and services, the survey also explored knowledge about emerging technologies like PrEP, which involves taking antiretroviral drugs before exposure to HIV in order to prevent infection. While men in North America, Western Europe and Australia reported more knowledge about emerging prevention strategies than men in Africa, Asia, the Caribbean, Eastern Europe, and Latin America, large numbers of men in all regions of the world expressed confusion about these technologies.
When asked whether MSM should use PrEP to prevent HIV infection, 40% of respondents said "I don’t know."
Regional differences also emerged regarding experiences of stigma and discrimination. On every measure of stigma related to homophobia, men in Africa, Asia, the Caribbean, Eastern Europe, and Latin America reported higher levels and harsher forms of stigma and discrimination than men in North America, Western Europe and Australia.
"Stigma and discrimination fuel the HIV epidemic among MSM and other high-risk populations," said Othman Mellouk, Co-Chair of the MSMGF and Advocacy Coordinator of the International Treatment Preparedness Coalition (ITPC) for North Africa. "Stigma and discrimination undermine access to prevention and treatment programs by forcing MSM underground and away from services they may need. Without addressing the bigger issue of homophobia, we will have no hope of ending AIDS."
The MSMGF is currently working with Dr Wilson to complete analysis of the full data set and is expecting to release a comprehensive report in early 2011.