by Nadia Raffif
In every world region, men who have sex with men (MSM) face significantly higher rates of HIV than the general population. Young people are also at increased risk for HIV, comprising over 40% of new HIV infections worldwide. Young MSM (YMSM) face the heightened risks of both populations, as well as a number of vulnerabilities that are unique to YMSM. While data on HIV among YMSM are extremely limited, existing studies show high HIV prevalence among YMSM around the world: Russia (9%), Malawi (22%), Namibia (17%), Botswana (21%), United States (19%), Peru (13%), China (6%).
Despite the clear need for intervention, YMSM are often left out of research, policy, and programs designed for general MSM, general youth, and the general population. This has led to funding gaps, inappropriate programming, lack of surveillance data, access problems, and an absence of youth-specific services targeting the unique needs of young gay men.
In order to elevate and address the needs of YMSM in the response to HIV at the local-, national-, and global-level, the Global Forum on MSM & HIV (MSMGF) established the MSMGF Youth Reference Group (MSMGF YRG). First convened in 2010, the MSMGF YRG is composed of 18 YMSM advocates working for the health and human rights of YMSM in their respective regions around the world. The YRG advises and coordinates the work of the MSMGF on YMSM issues, advocating for the empowerment of YMSM within the global HIV response through skills building, cross networking, and meaningful participation in the decision-making processes that affect YMSM.
Since its inception in 2010, the MSMGF YRG has primarily focused on: A) elevating YMSM issues at major international forums; and B) generating data on YMSM health and human rights through research initiatives.
MSMGF YRG members have convened panel discussions at the most recent International AIDS Conference (“Putting the Pieces Together: Responding to the Needs of Young Men Who Have Sex with Men and the HIV Epidemic”) and the AIDS 2012 MSM Pre-Conference (“Targeting YMSM: An International Look at Programs and Funding for Young MSM”). The MSMGF YRG’s efforts thus far have been effective in raising awareness of the unique issues faced by YMSM globally and the urgent need to address them. Both panel discussions at the 2012 International AIDS Conference were delivered to full houses and received very positive reviews.
MSMGF YRG members also collaborated with the MSMGF Secretariat to produce a policy brief using data on YMSM from the MSMGF’s 2012 Global Men’s Health and Rights (GMHR) survey. Entitled “Young Men Who Have Sex with Men: Health, Access, & HIV,” the publication featured a secondary analysis of GMHR data from more than 2400 YMSM, indicating that YMSM around the world experience higher levels of homophobia, unstable housing, violence, and other factors that hinder access to HIV services, compared to older MSM.
YMSM reported significantly less access to medical care, less access to HIV prevention services, lower HIV treatment outcomes, higher prevalence of homophobia and violence, less community engagement, and less comfort with providers, when compared with MSM older than 30. Many of these factors act syndemically,fueling each other and leading to poor health outcomes for YMSM.
The publication concluded with a set of recommendations for supporting YMSM health and human rights that were developed collaboratively by members of the MSMGF YRG.
The YMSM policy brief was particularly successful in this regard, generating news stories in multiple outlets across three continents. The data and analysis presented in the policy brief was showcased at the first-ever LGBT panel at the World Bank’s 2013 Spring Civil Society, used to inform debate in Scottish Parliament, and helped guide the development of a national youth strategy to address HIV in Lebanon.
Targeted efforts are needed to reduce disparities in HIV risk and service access among YMSM. It is incumbent upon national governments, multilateral agencies like UNAIDS, and major global funders like PEPFAR and the Global Fund to recognize that the needs of YMSM must be addressed explicitly and directly. As the world reevaluates goals for the post-2015 development agenda, there are several concrete steps that can be taken to provide crucial support for YMSM health and human rights.