Discrimination and homophobia are often more prevalent in rural areas. Outreach workers in Montana know that there are certainly barriers for men to being tested for HIV. One of the most significant is the fear of being harshly judged, labelled and dismissed. It’s one of the reasons some gay/bi men get married to women and start families- they want to be ‘normal’- even though they already are. The sense of shame and guilt can be overpowering- and it’s adding fuel to the fire as far as HIV is concerned.
Rural outreach workers have known this for years- it may be one of the reasons that HIV is spreading so rapidly in the south. It’s almost certainly one of the reasons that HIV is spreading in the African American population. But we haven’t paid much attention- at least scientifically- to this issue. Now it looks as if science is actually catching up to reality. From The Sobering Truth About HIV Among MSM by Gregory Trotter, Chicago AIDS Foundation blog (July 25):
The idea of “turning the tide” against the AIDS epidemic will prove to be no more than a slogan if more is not done to address the growing number of gay/bisexual men infected with HIV worldwide, experts said today.
Speaking at an afternoon press conference today, a panel of experts presented new research – recently published in a series in the medical journal, The Lancet – that confronted the reality of HIV prevalence among MSM (men who have sex with me). The series concluded that, in addition to medical and scientific advances, more must be done to eradicate the cultural and societal impediments of homophobia and discrimination. Until that happens, ending the AIDS epidemic is unlikely, said Chris Beyrer, a professor at Johns Hopkins Bloomberg School of Public Health. (emphasis mine)
We routinely encounter discrimination in dealing with MSM in Montana- some of whom do not openly identify as gay. In fact, some are married- with children- and do not plan on leaving their families. But they’re having sex with other men- and some are not using condoms with their wives. “If I did, she’d know I was having sex with someone else,” one client told me.
The fear of being exposed for these men is great. One man told me, “I can’t afford to be seen as gay. It would kill me- it would kill my wife.” Shame from society, churches and social groups abut being gay have forced men to create false lives. But they haven’t stopped sexual behavior. This type of internalized shame is not uncommon here- and the wives of these men could be put at risk as a result.
Shame, homophobia and discrimination are fueling the epidemic- so are apathy and denial (see my essay Gay Men Are Flunking The Test). Part of me wonders when we’re going to start seeing a rise in HIV infection among rural women- the wives of gay/bi men. Back to Mr Trotter:
On average, MSM are 19 times more likely to be infected with HIV than the general population in low- and middle-class countries, according to Dr. Kevin Fenton, director of the National Center for HIV/AIDS.
Many African countries do not accurately report numbers of MSM and some do not even acknowledge they have MSM among their population, said Paul Semugoma, Uganda physician who serves on the steering committee for the Global Forum on MSM &HIV (MSMGF).
Homophobia is rampant in such countries, he said.
“If we don’t start solving these impediments for MSM, we’re not going to do much about the epidemic,” Semugoma said.
In a recent study in Jamaica, 82% of Jamaicans self-identified as homophobic, largely out of fear of HIV prevalence among gay/bi men, said Maurice Tomlinson, legal advisor on marginalized groups for AIDS-Free World, an international advocacy group.
Such homophobia has engendered a climate where gay men are afraid to buy condoms for themselves, Tomlinson said. Their female friends often buy condoms for them, he said, but refuse to buy lube, as that would imply a female “deficiency.”
And so many gay/bisexual Jamaicans use petroleum jelly, saliva or even hairspray as a lubricant, he said.
“In those cases, it would be better if they used nothing at all,” Tomlinson said.
To learn more about how HIV affects MSM throughout the world and possible solutions to problem, read the full series in The Lancet titled “HIV in Men Who Have Sex with Men.”