Monday, August 25, 2008

Helping the Hidden Community of HIV

[via TIME]

These men never show up at gay bars, afraid to be found out. Many are married with children but still occasionally sleep with other men. They refuse to be labeled "gay" or "bisexual," insisting that their gay male partners may as well be women. With their layered identities and secretive, high-risk sexual practices, this group of "men who have sex with men" — an epidemiological term commonly used by HIV/AIDS workers — has become one of the toughest groups for health-care authorities around the world to target.

They make up a "hidden community," AIDS experts say, usually prevalent in cultures where the social stigma attached to homosexuality is severe. In some cultures, sex between men is prohibited outright; in the Islamic Republic of Mauritania in Africa, for example, gay sex is cause for execution, which drives many men underground and increases their likelihood of engaging in risky sex. Robert Gray, regional representative of Population Services International (PSI) Asia, an international NGO, predicts that this high-risk group will become a major driving force of the HIV/AIDS epidemic in Asia, Eastern Europe and other places over the next decade.

To stem the trend, activists on the front lines have been attempting to promote safe sex — even in countries where it is not allowed — rather than prevent sex altogether. In the African nation of Burundi, homosexuality is not recognized. "My government said gays and homosexuals don't exist — they are only found in Europe or America," says Burundian Georges Kanuma, 36, an openly gay activist.

Frustrated with the lack of health services for gay patients, who are routinely shunned by Burundian physicians, Kanuma founded a nonprofit AIDS organization, Association National de Soutien Aux Seropositif et Aux Malades du SIDA (ANSS), eight months ago. ANSS's first task has been to provide gel lubricants to gay men in Burundi, where in 2004, the government banned NGOs from sending the taboo lubricant there, leaving many men to use unsafe substitutes during sex — Vaseline, for instance, which weakens latex condoms, compromising protection against HIV transmission. Kanuma has arranged to receive shipments of lubricants from NGOs in France, with a monthly supply of 2,000 packets to hand out to about 40 men who have come forward, a small proportion of the roughly 250 gay men in the capital city of Bujumbura. (Kanuma says an attempt last March to take a census of gay men throughout the rest of the country got him arrested.)

"I always get anonymous calls from men asking for lube," says Kanuma. "They tell me not to ask any questions and just put the lube inside a magazine and leave it in the cafés or streets."

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