Guyana's UNGASS Country Progress Report is available from Guyana's National AIDS Programme website
The approach to health promotion targeting vulnerable sub-populations of gay, bisexual and other men who have sex with men (MSM) is still based on narrow, technical public-health strategies of outreach and referral to “friendly” services. The programmatic response needs to be holistic by improving the quality of client services across the board through training to mitigate same-gender and HIV-related stigma by addressing homophobia among health care workers. Once services become and are know to be client-friendly, there will be less need to invest in “targeting MSM” as Gay, Lesbian, Bisexual and Transgender (GLBT) communities in Guyana would gain confidence that the public-health system does not house homophobic prejudices and allow discriminatory practices. Training and sensitization of providers is specifically mentioned as a recommendation in the HIV-AIDS Behaviour Change Communication (BCC) Strategy for Guyana 2006-2010 (see pg. 37).
The fourth aim of the 2006 and 2007 campaigns is stated as “reaching high risk groups,” under which the vulnerable sub-populations of gay, bisexual and other MSM are classified. As stated in the BCC Strategy document as well, it is categorically clear that stigma and discrimination drive MSM away from health care seeking behaviour, which includes testing for HIV. To date there have been no BCC campaigns to address what is probably the gravest barrier to universal access among MSM, that is, mitigating stigma and discouraging societal discrimination which often accompanies these homophobic prejudices. The suggestion that “a focused effort on increasing access to condoms by high-risk groups with the strategic placement of condom vending machines at high traffic locations, for example, bars and clubs” (UNGASS Country Progress Report, pg 22) is an effective BCC strategy in a cultural environment in which stigma against same-sex practices, sex work and sex among youth are widespread is unsatisfactory.
Ironically enough, the National Blood Transfusion Service (NBTS) is one of the public-health institutions which promote homophobia by stigmatizing ‘men who have sex with men’ and ‘women who have sex with women(WSW)" as prohibited groups for blood donation. The fact that WSW, who are considered at low risk for HIV infection, is listed provides irrefutable evidence that the NBTS policy is rooted in same-gender stigma which was common early in the epidemic (when AIDS was considered the ‘plague’ for homosexuals).
SASOD and the Guyana Rainbow Association (Guybow) have raised these concerns in official correspondence with the Head of NBTS and the Minister of Health (copied to UNAIDS and PAHO/WHO) to which we have received no reply. For good practices in this area, we need not look further than our fellow CARICOM member state, St. Lucia, where potential blood donors are asked about the number of sexual partners in their sexual history, and are not questioned about the gender of their partners.
It is noted that while programmes aimed at benefiting other vulnerable sub-populations have began to take shape only “some work has been done with MSM.” It is also of concern that narrow, public-health approaches of peer education and outreach seem to be the programmatic response to HIV among MSM. SASOD would like to emphatically state that health-promotion programmes which do not address the political, legal, social, economic and cultural factors of marginalization and exclusion that create vulnerability and thereby put MSM at risk will only have minimal impact as the benefits of increased HIV awareness can only be sustained in socio-cultural environments which facilitate behaviour change by supporting same-sex practicing men. It is also noted that there are plans to fully implement the MSM programme in 2008. SASOD anxiously awaits to see the approach of this programme and how it will involve in design and implementation gay, bisexual and other MSM and those who work with GLBT communities.
Major Challenges and Remedial Actions
Despite the horrendous statistic of 21.2% HIV prevalence among MSM from the BSS (2005) and Guyana’s poor-track record of meaningfully responding to the epidemic among MSM, the UNGASS Country Progress Report limits its challenges to “general discrimination against PLHIV” and does not include the real challenge of same-gender stigma as well. As such the recommend remedial actions are technical responses which will only create more programmatic structures, which need coordination and support, and do not reverse the epidemic. SASOD encourages a more holistic approach to responding to the epidemic which addresses the political, legal, social, cultural and economic conditions that allow the epidemic to flourish in Guyana.
Submitted to the Guyana National AIDS Committee
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