It has only been a day since attending an HIV panel discussion on World AIDS Day, and news just came in that the CDC approximates 70% of HIV positive youth were infected via male-to-male sex in the US. Now, I am reflecting on my own reality being HIV positive and a young MSM (YMSM). I am talking about the bittersweet reality of coming out from a humble yet complex background. In my African context, young MSM are overlooked in the whole HIV response. They are disproportionately affected by HIV. Young men having sex with other men living with HIV face stigma and discrimination. There is always a deafening silence and invisibility of this group of young people when it comes to service provision. There is also an evidence-based scientific data gap for young MSM dynamics. This makes evidence-based programing a challenge.
Homosexuality, as an element of normal human variation among adults, finds little acceptance among health professionals in Africa. Non-discriminatory policy treatment and public health for all, regardless of the type of client that shows up for services, must become a norm. Talking about sexuality and same-sexual activities practiced among young people is still controversial and not discussed in local HIV responses, especially in national designs for programs tackling young people’s sexual health, despite evidence that unprotected anal sex is the highest risk to STI and HIV infections.
Homosexuality and same-sex sexual behaviors is still stigmatized, and it is even considered a felony that could lead to incarceration in many places. It is taboo in almost all African countries that often give a generalized humdrum of homosexuality being “un-African,” and that being gay is not masculine. They promote the myth that most gay identified people are cursed and diseased, leaving YMSM to deal with low self- esteem and identity crises. Most African countries view issues like homosexuality as examples of cultural abnormality and a twisting of religion that is sinful. Most of society, academia and community leadership show contempt and an unwillingness to support YMSM despite startling data that show YMSM are in dire need of drastic action to prevent HIV infections which are a public health concern.
“Same-sex experiences are often tolerated as part of a process of experimentation toward the development of normal heterosexual behavior” A psychiatry specialist once said to me.
The perception of such double stigma (i.e. stigma associated with *any* sexual activity, compounded by stigma associated with non-heterosexual sexual activity) can motivate feelings of guilt and low self-esteem among YMSM, some of whom are in the process of developing a gay identity. Guilt can lead to closeted sexual experimentation and heightened sexual risk. In other cases, families learn about their gay children and react with violence, disowning their children or implementing drastic measures like forced and arranged marriages to the opposite sex. Pressure from society forces YMSM to “change” or to get forced psychiatric care. The verbal and physical abuse by peers and family members can lead to high levels of chronic stress among YMSM. As a result, some young MSM are forced out of their homes or run away and become involved in drug use, alcohol binging or sex work. Engagement in survival sex (exchanging sex for food, shelter, alcohol, drugs, safety, etc.) has been found to be fairly common among homeless or street youth.
My experience with the repressive environment of homophobia always reminds me that safe environments for YMSM should be pragmatic, inclusive and conducive. These safe spaces must be able to understand the personal issues linked to sexuality. Programmatic areas targeted at YMSM must be capable of addressing both psycho-social needs and sexual well-being of YMSM and their risk taking decisions. Often, when we talk about young people and HIV, we fail to address both psycho-social needs and sexual well-being of these individuals. We tend to forget that change begins with me as a young person. I need space to organically grow with the response, to learn about new game changers in fields of science focused on HIV prevention. I need safe spaces to articulate my queer identity.
When we design innovative program models for HIV services, much must be included in a holistic and careful way. We need to consider how harmful cultural practices, economical issues, laws and legal environments constitute barriers to provision of and access to HIV and other health services. We must consider the psycho-social and self-esteem issues among these groups of young people.
Anthony Adero is a Kenyan born young LGBT and HIV activist, lobbying for access to Sexual Reproductive Health information, STI and HIV services, and human rights for young MSM. Anthony is also a member of the Youth Reference Group at The Global Forum on MSM and HIV.
Anthony advocates for current and critical issues affecting young LGBT people and wants to further pin point current strategies for effective change; supporting anti-stigma as well as HIV education campaigns that work to ensure we increase and enforce protective laws and strategies that oppose and repeal laws that criminalize HIV non-disclosure, exposure or transmission, homosexuality, and gender variance.