here - NFI

Transcription

here - NFI

Pukaar
Issue 75
the journal of
Naz Foundation International
October 2011
an international HIV and sexual health journal focusing on south asian masculinities and sexualities
Pukaar October 2011 Issue 75
Naz Foundation International (NFI) is a development agency
specialising in providing technical, institutional and financial
support for the promotion of sexual health, welfare and human
rights of males who have sex with males in South Asia. NFI
believes in a world where all people can live with dignity, social
justice and well-being. With a primary focus on marginalised
males who have sex with males, NFI's mission is to empower
socially excluded and disadvantaged males to secure for
themselves social justice, equity, health and well-being by
providing technical, financial and institutional support. NFI
believes in the innate capacity of local people to develop their
own appropriate services, where the beneficiaries of a service
are also the providers of that service. NFI will always support
such initiatives.
This publication has been produced with the assistance of the
European Union. The contents
of this publication are the sole
responsibility of the Naz Foundation International and can in
no way be taken to reflect the
position of the European Union.
Pukaar
Pukaar is the quarterly journal published
by Naz Foundation International.
It provides a forum for discussion,
information, and advice, as well as general
interest, regarding HIV and sexual health,
focusing on South Asian masculinities
and sexualities.
The opinions expressed in Pukaar
reflect the writer’s views only and do
not necessarily reflect the views of
Naz Foundation International unless
specifically mentioned.
We will always try to ensure that what we
report is relevant to our readers, and we
ask you, the reader, to keep us informed
as to what is happening in your corner of
the world. Send us your questions, letters,
articles, stories (fact or fiction), poetry,
drawings, photographs. Tell us about what
you think and feel, whether it concerns
HIV, your sexuality, or whatever.
Names will be changed and addresses
will be withheld if required.
Send all material to Pukaar, Naz
Foundation International, 9 Gulzar
Colony, New Berry Lane, Lucknow
226001, India
visit our website
www.nfi.net
2
Naz Foundation International’s Ethical Policy
Naz Foundation International is a development agency focusing on male
to male sexualities and sexual health concerns in South Asia. In its work,
Naz Foundation International will fully consider the implications of males
who have sex with males, for themselves, for any male or female sexual
partners such males may have, and for any clients of those males who do
sex work. In this work Naz Foundation International will be guided by
the following principles:
1. Promoting the reproductive, sexual health, and well-being of males
who have sex with males by encouraging sexual responsibility and
safer sexual practices.
2. Encouraging males who have sex with males to access sexually
transmitted infections treatment whenever necessary.
3. Respecting confidentiality in the relationship between males and
their sexual partners and/or clients.
4. Promoting the protection of children and non-consenting adults from
abusive sexual relationships.
5. Promoting the reproductive and sexual health of any female partners
of males who have sex with males, by encouraging sexual
responsibility of their male partners.
6. Encouraging communication of sexual health information between
sexual partners and promoting partner notification of sexually
transmitted infections and HIV infection, irrespective of the
gender of the partner.
7. Working with female reproductive and sexual health services,
in order to facilitate appropriate access to services for infected
female partners of males who have sex with males.
Pukaar is produced and published for
private circulation and not for sale by:
1.3 Quay House, 2 Admirals Way
London E14 9XG, UK
Distributed by:
NFI Regional Office
9 Gulzar Colony, New Berry Lane,
Lucknow, 226001, India
Naz Foundation International is a Charity and company limited by guarantee
in England and Wales
Registration No. 3236205
Registered Charity No. 1057778
Registered office:
London E14 9XG UK
Secretariat
London E14 9XG, UK
Tel: +44 (0)20 7868 1519
Fax: +44 (0)20 7671 7062
Email: info@nfi.net
Regional Programme
9 Gulzar Colony, New Berry Lane,
Lucknow, 226 001, India
Tel: +91 (0)522 2205781/2205782
Fax: +91 (0)522 2205783
Email:regional@nfi.net
Chief Executive's Office
Email: shiv@nfi.net
Contents
p3
p10
p18
p21
p22
p23
p24
p25
p26
p27
p28
p29
p31
p32
In the beginning - 1988 and all
that
A model of technical support to
MSM, transgender and hijra
populations explicated
At the 10th ICAAP, Busan
APCOM Busan Declaration
Homonormativity - the hegemony
of 'LGBT'
Gay sex is an unnatural disease
Non-hijra transgenders struggle for
identity
The Gulf's gender anxiety
US embassy's Pride celebrations
in Islamabad more damage than
support
Building the momentum to prevent
HIV in MSM
Homosexuality in Islam
Who takes risks?
Gonorrhoea strain found 'resistant
to antibiotics'
'Explosion' of sex-spread hepatitis
C in HIV-positive men
Pukaar online
www.nfi.net/pukaar.htm
In the beginning - 1988 and all that
It started in a meeting organised by Shivananda Khan on June 11th, 1988 in a pub called The Angel in North
London. A small group of six South Asian lesbian and gay men got together to discuss the need for some sort
of social support group for people like us. Out of this discussion, Shakti was born, and we began to meet regularly once a month at a LGBT drop in centre . In October that year, Shakti organised its first income-generation disco, introducing bhangra to the LGBT disco crowd. By 1989, this disco was drawing some 500 people
on a regular basis, and Shakti had grown to host several social services for its South Asia member, including
counselling, emergency housing, HIV, as well as participating in gay pride marches, advocacy and challenging
racism in the LGBT community.
Shivananda in 1988
Celebrations and pride
First seminar on HIV and South Asians
in London, 1990
The Naz Project is born
October 1991, with a small grant, The Naz Project was established in a corner
office on the first floor of this building.
The first services provided were a hotline staffed by volunteers, and training
programmes for local authorities in London on South Asian issues with a focus
on male-to-male sex, risks and vulnerabilities.
The name Naz was the shortened form of the name of the first South Asian
person that the founder personally knew living with AIDS – Nazir. Disgusted
with the services he was receiving from both government and non-government
agencies, the Naz Project was born – to fill the gaps in regard to prevention, care
and support.
In 1992, organised the first European consultation for South
Asian and Muslim communities
on HIV/AIDS. Brought together
140 participants from 12 European countries.
During our first engagement with HIV in South Asia by attending the 2nd International Congress on AIDS in Asia and the Pacific in 1992, we as sexual minorities were told that there was no room to have a meeting specifically on "alternate
sexualities" at the conference venue, so we all met at a park opposite.
In 1993, with support from Ford Foundation, and in alliance with Sakhi, a
lesbian organisation in Delhi, we organised the first seminar on alternate sexualities. It was here that Naz Foundation India Trust was first thought of with Anjali
Gopalan, which was born in 1994 as an independent Indian organisation.
3
Strengthening our engagement in South Asia
In December 1994, Humsafar Trust, along with support from The Naz Project, organised the first conference for gay men and other MSM and HIV in India, with funding support from The Mercury Phoenix
Trust and The Naz Project, with NP further providing technical support and assistance.
Over 90 participants from across India, with several overseas participants as observers. Sherman De
Rose was also attending this meeting, and was inspired to establish Companions on a Journey as an
LGBT and sexual health organisation in Sri Lanka in 1995. This conference also was able to empower
several other individuals in India to develop their own MSM and HIV organisations over the next few
years.
In October 1995, the first consultation of representatives from NGOs working on HIV prevention and care issues within Muslim communities
was held in Karachi, Pakistan with funding support from the UN Global Programme on AIDS
(which eventually morphed into UNAIDS). The
focus was on what eventually has become known
as Most At Risk Populations, with some 80 participants from 17 countries, including MSM, female sex workers, and injecting drug users. The
meeting was organised by The Naz Project and
the Pakistan AIDS Prevention Society.
1996 - Beginnings
Since 1991, the Naz Project had been working in London for the South Asia communities in the UK, as well as initiating activities in India
and Pakistan. However, for Shivananda, the issues of males who have sex with males in the South Asia region, their enormous risks and
vulnerability, along with the stigma, discrimination and violence so many faced, along with the very few appropriate services for their
sexual health needs that were available, were increasingly becoming more and more important to him. At the same time, London donors
were also expressing concern with the amount of work and involvement in South Asia of The Naz Project.
Discussions with the Board of Trustees eventually led to the decision to break the The Naz Project into two separate and independent
HIV organisations, one specifically focusing on MSM and HIV in Asia, and one continuing to focus on South Asia populations in the UK,
along with other ethnic minority communities.
In August 1996, The Naz Foundation International was born.
This process of devolution was supported by its first grant from Ford Foundation to conduct a risk and needs assessment among MSM
in Dhaka, Bangladesh
Out of this study conducted in 1997, where 400 kothi-identified males were
accessed for interviews, Bandhu Social Welfare Society was born. With
initial funding from NORAD through the Norwegian Embassy, Bandhu
began with a drop-in centre in central Dhaka providing an outreach programme,, counselling, STI referrals, advocacy, and social support groups.
UI has rapidly grown over the years to become the leading MSM and hijra
support organisation addressing sexual health needs in Bangladesh working in 22 cities, along with strong links with the government, media, and
legal support. A remarkable achievement in a traditional Muslim country.
Also in 1997, with funding support from the UK Foreign and Commonwealth Office and the Mercury Phoenix Trust, a capacity development
workshop was conducted in Baku, Azerbaijan with male sex workers and
other MSM on knowledge and skills building to develop their own HIV
programme. Linguistic and logistic support was provided by the Azerbaijan AIDS Society.
As a part of this project, this was immediately followed by a consultation meeting held in Almaty, Kazakhstan, for representatives from
governmental organisations working on HIV prevention issues from the Central Asian Republics (Kazakhstan, Kyrgyzstan, Tajikistan,
Turkmenistan, and Uzbekistan), where the focus was on MSM and HIV issues, needs and concerns. Local assistance was provided by the
UNAIDS Inter-Country Team for
the region. Twenty-two participants
from the government AIDS programme participated in this meeting
In Baku
4
In Almaty
With funding support from the Foreign and
Commonwealth Office, a study on MSM risks
and needs in Lucknow, India was also conducted in 1997, accessing some 400 kothi identified men for interviews. From this study, Bharosa was established with seed funds provided
by this grant. Since then Bharosa has grown
to becoming the lead MSM and sexual health
agency in Uttar Pradesh, and is classified as a
learning centre for UP.
This was when we first meet Arif, who ran
the assessment project, and became Bharosa's
Project Director, eventually moving on to join
Naz Foundation International in 2000. But
more of that later.
In 1998, NFI, with support from the Department of International Development, UK, NFI
developed Sahodaran, an MSM and HIV sexual health organisation in Chennai, India, and
also conducted training and capacity development for a group of MSM in Cochin, Kerala.
Workshop in Chennai, Tamil Nadu
Working group in workshop
Arif Jafar
as workshop
facilitator
Workshop in Cochin, Kerala
In 1999, hosted the 1st Regional MSM Consultation meeting in partnership with Praajak and Sahodaran in Kolkata. Participating countries
were Bangladesh, India, Pakistan and Sri Lanka, with observers from China, Indonesia, Malaysia, Thailand and Vietnam. Donors were
Family Health International, UNAIDS, and USAID. Support was also given by NACO.
A model of technical assistance from NFI was emerging from all
this work, as NFI began to expand its assistance programme to support the development of local community based organising and mobilising to address the sexual health needs of MSM in South Asia.
While this work was being funded by a range of donors, there
was no core funding for NFI itself, so the work was being implemented by one person. Designing resource materials and tools,
working with local networks to identify key resource persons, advocating nationally, regionally and globally for the needs of MSM
in response to the growing HIV crises among them, this represented
a major challenge in developing a strategic response, where so far
NFI had been a reactive process depending on small project funds
to be able to conduct this work.
Out of this a range of policy papers, essays and articles had also
been produced that articulated the issues, needs and concerns of
MSM in South Asia, highlighting the differences in male-male sexualities in South Asia when compared with Western understandings
of male sexualities and its binary approach. It was becoming very
clear that in South Asia, gender performance was more relevant to
sexual practices between males than sexual orientation, that stigma,
discrimination and social exclusion was based on this gender performance as much as on same-sex behaviour.
5
In 2000, with support from FHI/USAID, four MSM situational assessments were conducted in Bangalore, Hyderabad, and Pondicherry in
India, and Syhlet, Bangladesh. Out of these assessments, and with seed funding provided by the project, local MSM and HIV communitybased services were developed: Gelaya (Bangalore), Mithrudu (Hyderabad), Sneghidhan (Pondicherry), Bandhu-Syhlet.
2000 - A leap into the future
Finally in late 2000, with support from the Department of International Development, UK, NFI was able to implement its strategic
vision of responding to the sexual health needs of MSM in South
Asia and was able to open a Regional Programme Liaison Office
in Lucknow, India providing such technical and institutional assistance, along with staffing. This office hosted a Resource Centre and
Library, along with a regional training centre. NFI's Secretariat remained in London, UK.
In December 2000, NFI hosted its 2nd South Asia Regional
MSM and HIV consultation meeting in partnership with the newly
formed Mithrudu in Hyderabad, India. Over 140 participants from
10 countries and 17 NFI partners were engaged, with funding support from UNAIDS and FHI/USAID.
It was at this meeting that Mithrudu received its first project
funding from the Andhra Pradesh State AIDS Control Society.
In 2001, NFI Regional Office conducted its first training of trainers programme.
6
2001 - the big bang - behind bars
On July 7th, local police in Lucknow decided to raid the NFI Regional Office and arrested three NFI staff including the Executive
Director Arif Jafar, along with the programme manager of Bharosa, the local MSM HIV organisation.
The accusation was that the regional office was really a male
brothel, and that NFI and Bharosa were promoting homosexuality.
Initially bail was refused, and the four (eventually labelled as
the Lucknow Four internationally) eventually spent 47 days in
the Lucknow Jail, before being released on bail on 22nd August
2001.
NFI was able to mobilise an enormous response to this vicious
indictment and human rights abuse against itself and one of its
partner agencies, including the government of Great Britain, Human Rights Watch, Amnesty International, UNAIDS, and others.
Across India, human rights organisations, lesbian and gay groups,
women’s organisations, along with a range of individuals and institutions protested, held marches, and sent letters to the appropriate Union
and State government officials and bureaucrats.
While the key charge of promoting homosexuality and aiding and abetting a criminal act (i.e. Section 377) has been dismissed, to this
date monthly court appearances are still required.
However, despite the horror of this experience, it stimulated the Naz Foundation India Trust petition to the Delhi High Court for the
reading down of Section 377 of the India Penal Code which criminalises same sex behaviour, which eventually led to this being achieved
in 2009.
Did this stop us?
No! We continued technical assistance to NFI partners, international
NGOs working with MSM and HIV, as well as a range of non-government organisations, national AIDS programmes and other institutions. And ever more training and skills building programmes.
Technical support provided to Blue Diamond Society, Nepal and to
Bandhu Social Welfare Society, Bangladesh for their first national
MSM and HIV consultation meetings in 2001 and 2002
In 2003, along with conducting a range of capacity strengthening
programmes for MSM CBOs in India and Bangladesh, we also
organised our third South Asia Regional Consultation meeting in
New Delhi, India.
Over 200 participants from 14 countries in the South and SouthEast regions, representing 40 MSM sexual health projects, of which
24 receive technical support from NFI.
Funders were FHI Asia/India/Bangladesh, UNAIDS and NFI
Between 2004-2005, NFI provided technical assistance to national
partners in Bangladesh and Nepal, as well as supporting some 25
MSM CBOs in India, having held three more regional training of
trainers programmes where 85 trainers were developed, and 15 local training programmes for 324 people had been organised.
At the same time, a range of BCC materials and tool kits were
developed in six different languages to support these local MSM
sexual health interventions.
7
As a part of NFI's advocacy and policy support for MSM and HIV
programming, in 2004 it organised and cohosted the 8th National
Convention of the Indian Network of NGOs working on HIV and
AIDS. This network consists of over 500 HIV and AIDS NGOs
across India.
Also at the 2004 XV International AIDS Conference, Bangkok
Thailand, NFI was the key focus agency to develop the UNAIDS
sponsored MSM Leadership Statement – a call for social justice and
equity. NFI's Social Charter for Justice evolved from this work.
2006 -2007 - Scaling up coverage and advocacy in India
With DFID funding support, a major pilot project was conducted in
four states in India (Andhra Pradesh, Karnataka, Tamil Nadu and
Uttar Pradesh, to validate the emerging model of technical support
and assistance that NFI had evolved over the years since its beginning. This entailed developing 36 new MSM CBOs, conducting 36
MSM risk and needs assessment, testing out the new CBO capacity development tool-kit, and hosting four state level consultation
meetings, all by project end in 2007.
Participants from the Karnataka MSM state consultation meeting
NFI developed a six volume tool-kit for the development of MSM
and transgender community-based organisations that can provide
HIV prevention, care and support services for their constituents in
their locality.
8
Also, with the support of the DFID Social Marketing Fund, NFI
field tested a new, low cost water-based lubricant formula based
on aloe vera, and manufactured and distributed some 2.5 million
sachets to these 36 new CBOs.
During the same period NFI also was engaged in enhancing the
capacity of the National MSM and AIDS Human rights, policy and
advocacy Task Force to enable it to train, establish, monitor and
coordinate the activities of 13 Local Policy and Advocacy Units
in MSM Projects in 13 cities of India over the one year project
period.
At the 2006 XVIth International AIDS Conference in Toronto
Canada, NFI was also one of the primary founders of the Global
Forum on MSM and HIV that is engaged in advocacting for the
sexual health rights of gay men and other MSM across the world.
Currently Shivananda is on its Steering Committee. Being a part of
this enables NFI to upstream its advocacy and policy development
work.
Size can matter
A major milestone in the Asia Pacific Region, the Risks and Responsibilities consultation meeting, held in Septrmber 2006 in New Delhi
and cohosted by NFI and the National AIDS Control Organisation, India, brought together some 380 delegates governments, policy-makers, donors, researchers, grassroots and community based organisations from 22 countries across the Asia-Pacific region and eight other
countries from outside the region. The consultation was funded by many international donor agencies such as Department for International
Development, UK, the World Bank, Canadian International Development Agency, Swedish International Development Agency, Australian
Agency for International Development, HIVOS, Netherlands, International HIV/AIDS Alliance UK, and TREAT Asia/amfAR It was supported by many community organisations and networks from the region. UNAIDS, Naz Foundation International and the Resource Centre
for Sexual Health and AIDS (RCSHA), India, provided technical support to the consultation.
Key outcomes from this significant event were:
1) A Declaration of Collaboration by policy makers, civil society, and donors; 2) An agreed set of Principles of Good practices; 3) An
agreement to develop a pan Asia-Pacific regional tripartite coalition of community sector representatives, along with the UN system and
government sectors to provide a coordinated regional advocacy strategy for policy change, social justice, rights, and an equitable allocation
of public resources for HIV interventions, care, treatment and other services for MSM and transgender
What emerged from this agreement was the Asia Pacific Coalition on Male Sexual Health (APCOM),
which was launched at the 8th International Congress on AIDS in Asia and the Pacific, held in June
2007, Colombo, Sri Lanka. NFI provides technical assistance and fiscal management for APCOM.
Since then, APCOM has grown from strength to strength, and is rapidly becoming the leading advocacy voice for MSM and transgender populations and their sexual health needs in the Asia Pacific
region. NFI sees this as a means to upstream its own advocacy work.
In 2009, APCOM organised its first pre-conference satellite meeting at the 9th ICAAP in Bali,
Indonesia, and at the 10th ICAAP in Busan, Korea, along with significant engagement during the
conferences themselves through hosting satellitte sessions and caucus meetings.
Funding support for APCOM and NFI's fiscal management has come from Hivos, the Dutch funding and support agency which has a strong focus on sexual minorities and health.
2007-2011
With the DFID Asia Regional Poverty Fund closing its doors in 2006, and the DFID India Community Fund and Social Marketing Fund
ending in 2007, the next two years for NFI were a considerable struggle for survival.
As a part of its emerging strategy for the provision of technical support to country partners in South Asia, NFI Regional Office devolved,
and separated out all its India work to form (India) Naz Foundation International as a national and independent India registered, MSM
community led technical support agency. All regional office staff engaged with India work were shifted to this new organisation.
In 2007, with the support of the World Bank through its Institutional Development Fund, India NFI was able to continue its technical
support programme, while NFI's secretariat continued programme management through a range of small grants and contracts.
In January 2009, with a major input from the European Union,
a three-year project on supporting the scale-up of HIV services for
males-who-have-sex-with-males (MSM) in India, by strengthening
the capacity of community-based organisations of MSM, and others to address MSM and HIV issues was implemented. This required INFI to provide
technical assistance and support to 36
current MSM CBOs, and develop 14
new CBOs by the end of the project
and ensure that all these projects were
funded for their service delivery. NFI
provided technical assistance and support to INFI through its Secretariat in
the UK and the Regional Programme
In 2010, India Naz Foundation International changed its name
Office in India. This project ends in
to Maan AIDS Foundation, joining NFI's other country partners:
December 2011. (See "A model expliBandhu Social Welfare Society (Bangladesh), Blue Diamond Socated" page 10)
ciety (Nepal), Companions on a Journey (Sri Lanka), Naz Male
Health Alliance (Pakistan).
9
2011 and beyond
A Round 9 Global Fund South Asia Regional Project for MSM and transgender populations
Community systems strengthening
In 2006, NFI submitted a South Asia regional proposal for the
Round 6 Global Fund to Fight AIDS, Tuberculosis and Malaria
(GFATM). This was rejected because of inadequate engagement
with Country Coordinating Mechanisms.
In 2007, PSI Nepal approached NFI for a joint application for
the Round 7 GFATM. In this application only three countries out
of the eight in South Asia were included in the proposal, This was
given a category three by GFATM which meant "please improve
and re-submit" to paraphrase.
At the beginning of 2008, NFI called a meeting with PSI Nepal,
and all its country partners, bringing in Companions on a Journey
in Sri Lanka to discuss the GFATM Technical Review Panel (TRP)
comments on our Round 7 bid, and decide how to respond.
It was agreed that we should totally revamp the proposal, and
bring in the other countries of the region. NFI mobilised resources
to be able to do this, with funds from Open Society Institute and the
Technical Support Facility, South-East Asia, along with in-kind donations from PSI Nepal and NFI itself. Because of a range of issues,
the final proposal was submitted as a Round 9 one, and following
our responses to the GFATM Technical Review Panel comments,
GFATM announced that they had approved the five year, $44million South Asia MSM and transgender proposal at the end of 2009.
This project is a partnership of 10 agencies, with PSI Nepal as
a principle recipient, and NFI as the key sub-recipient, along with
UNDP as a technical partner. Seven country partners are also a part
of this project. Afghanistan, Bangladesh, Bhutan. India, Nepal, Pakistan and Sri Lanka. Maldives was to be a part of the Coalition, but
withdrew because of their sensitivity around the issues of MSM and
transgenders,
Principally the project builds on the strength and experience that
NFI has developed over the years in providing technical assistance
and support to its country partners, and scales this support substantively, bringing in additional country partners. PSI Nepal would
provide overall grant management, and UNDP would provide regional and in-country advocacy and policy development support
towards strengthening an enabling environment.
2010 saw a year of intense negotiations with the GFATM and PSI
Nepal regarding programmatic and budget issues. As a efficiency
savings exercise, GFATM required to cut the budget by at least 13%
and a range of assessments on all partners needed to be conducted
and approved.
NFI finally signed its contract with PSI Nepal/GFATM in April
2011. Project DIVA is the name given to this project by all partners.
A model of technical support to MSM, transgender and
hijra populations explicated
The mapping of the NFI technical assistance programme (page 11)
illustrates the knowledge and capacity flow from NFI, which supports its country partners, which then is downstreamed to MSM/
hijra community-based and local organisations to strengthen their
capacity to deliver quality HIV and sexual health services. Along
with this, is NFI's relationship with a range of key national and
international stakeholders, such as UNAIDS, UNDP, the International HIV/AIDS Alliance, MSMGF and APCOM which enables
more upstream advocacy and policy development in regard to social justice and equity and access to health.
However, this process took several years to evolve as the history of NFI demonstrates in the previous pages that outlined key
achievements since it began.
In 1992, The Naz Project hosted its first major multi-country consultation meeting on HIV and marginalised populations for South
Asia and Muslim communities in Europe. The consultation model
developed for this meeting was replicated for the 1994 Humsafar
Trust/Naz Project Mumbai conference in 1994, and further tested at
the First South Asian Regional MSM and HIV consultation meeting
in 1999 in Kolkata. This has evolved as a basic template for organising our regional consultation meetings.
Between 1996-1997, Naz Foundation International developed a
range of study tools and training resources which were used to conduct the risks and needs assessment study in Dhaka, Bangladesh.
These tools and study instruments were refined and replicated in
each and every risk and needs assessment conducted by NFI over
the years, including the 36 assessments conducted as a part of the
DFID India Community Fund (2006-2007) project Increasing the
coverage of sexual health services for MSM in Andhra Pradesh,
Karnataka, Tamil Nadu and Uttar Pradesh, India – a pilot project.
The six-volume training tool-kit to support the development of
10
Bandhu Social Welfare Society staff during workshop
new CBOs arose from the many capacity strengthening workshops
conducted by NFI over the years in regard to the community systems strengthening programmes it has held addressing institutional
and programmatic issues for MSM community-based organisations.
It had always been recognised from its beginnings that, by its
very nature, NFI would not be implementing direct sexual health
services to MSM and hijra communities and networks, but rather
support the development of self-help groups and organisations to
provide such services. NFI saw itself then as a development agency
working across South Asia. However, its initial approach was often ad-hoc, responding to what funds were available, and without a
clear strategic vision.
Initially NFI worked at the local level, helping networks to become MSM and sexual health organisations, and then providing ongoing technical assistance to those organisations to strengthen their
systems and capacity to deliver sexual programming. Thus, NFI assisted in the development of MSM HIV programming in Dhaka and
Syhlet in Bangladesh, and services in Bangalore, Chennai, Hyderabad, Kolkata, Lucknow, New Delhi, Pondicherry and many other
cities.
By 2003, Bandhu Social Welfare Society in Bangladesh had
grown from a small service project in central Dhaka to one covering some nine project sites, three in Dhaka alone and in six other
cities.
NFI was not working with individual MSM projects, but rather
supporting emerging national partners, i.e. BSWS, which now developing as a national MSM and sexual health agency with service
points in a range of cities in Bangladesh. In Nepal, initial technical
assistance was developed with Blue Diamond Society which was
also a national partner. Only in India was this emerging model problematic.
In 2005, the World Bank Institutional Development Fund required an India registered organisation to transfer funds for the
project, so NFI took the opportunity to realign its work in India and
established an India partner, initially called (India) Naz Foundation
International, which took over the responsibility of all work in India
that had previously been done by NFI Regional Office.
The World Bank IDF allowed (India) NFI to develop itself as an
independent agency and to begin to replicate the NFI CBO development process in India.
In 2009, the three-year European Union supported project for
technical assistance to MSM CBOs in India, enabled to continue
to build its capacity and scale up its technical support capacity to
locally based MSM community organisations providing HIV services. The GFATM regional project enables Maan (INFI) to continue
this process.
However, as can be expected, the initial name of our India
partner caused a great deal of confusion, and so in 2010, (India)
NFI changed its name to Maan AIDS Foundation. India was now
aligned with NFI in the same framework as the other countries in
South Asia that NFI had developed technical support partnerships
with.
In October 2010, following technical assistance support to a
group of MSM in Pakistan, Naz Male Health Alliance was formed
as the country partner of NFI, as an initial step to implement the
Round 9 South Asian GFATM regional project. And discussions began with an organisation in Afghanistan providing health services
for men who have sex with men, Youth Health and Development
Organisation (YHDO) to take this on board as our Afghanistan
country partner.
In Bhutan, with no appropriate MSM agency in the country,
we will be working with the Bhutan National AIDS Control Programme to develop such a country partner as a part of the GFATM
project.
The GFATM South Asia regional project enables NFI to strengthen its Secretariat based in London, UK charged with the responsibility of overall programme oversight and management, where the
Chief Executive's office is based at the Regional Programme Office
in Lucknow.
It also enables NFI to strengthen the Regional Programme Office
by additional and dedicated staff to manage the technical support
unit, along with developing a monitoring and evaluation.
11
A model explicated
continued from page 11, col. 2
Reducing the risk of transmission of HIV and other sexually transmitted infections amongst males who have sex with males and their
partners in South Asia
Asia Regional Poverty Fund
2000 - 2006
Naz Foundation International was formed in August 1996 with a
specific objective to provide technical, financial and institutional
support to local MSM networks in South Asia, so as to empower
them to develop their own STI/HIV/AIDS prevention and support
programmes. Between 1996 and 2000, eleven such MSM sexual
health projects were developed in the region. Experience gained
during this period enabled NFI to develop a replicable strategy for
project development, and a standardised model of service delivery.
This increased the number of MSM sexual health projects in South
Asia substantially over a five-year period.
A three-year project proposal for increasing coverage of reproductive and sexual health programmes for MSM in South Asia
through providing technical assistance to local MSM networks to
develop their own sexual health services was submitted to the Asia
Regional Poverty Fund of DFID. The proposal involved developing
a Regional Office to be based in India to continue to develop MSM
community based organisations addressing HIV and AIDS, the development of a regional MSM trainers’ network, enhanced advocacy and technical support, as well as the development of some 30
MSM community-based projects across the region. Funding was
secured (ALA/779/551/001) and implementation began in October
2000. This project was extended a further three years - 2004-2006.
During this period, the NFI South Asia regional office was developed that housed NFI’s Advocacy, Knowledge Management and
Training Units, a regional network of 30 MSM trainers developed,
25 MSM HIV projects supported and an additional ten new MSM
community-based HIV service providers developed, along with a
number of training programmes, BCC materials, and training toolkits.
Towards the end of the funding period, DFID conducted an evaluation of our work, which recommended continued support. To this
end, DFID supported NFI in the development of a 5-year strategic
development plan, which included:
• Strengthening operations in India
• Strengthening operations in South Asia
• Institutionalising replicable, scalable and cost effective models
• Enhance knowledge and research capacity
• Strengthen resource mobilising
• Upstream advocacy and policy development
• Enhance NFI’s monitoring and evaluation capacity
• Restructure NFI to achieve the above
It was this process of development that NFI was able to evolve its
fundamental structure of a small Secretariat office charged with the
responsibility of over all programme management, with its Chief
Executive's office based at the NFI Regional Programme Office in
India in order to have a more effective oversight role close to programme activities,
During this period, other resources were mobilised, including
the UK Foreign and Commonwealth Office, DFID India, the World
Bank, and various donors that enabled NFI to organise the Risks
and Responsibilities meeting held in New Delhi, India, in September 2006.
Outputs achieved under this project include:
• Enhancing the Technical Support Unit for India
• Developing four state MSM Technical Support Facilities
• Developing four state level MSM and HIV Forums
• Developing 36 MSM grass-roots organisations
• Developing the NFI CBO development tool-kit into four vernacular languages
• Conducting 16 training programmes
• Advocacy work with State AIDS Control Societies and other donors for on-going support for the CBOs and State Technical Support Facilities
A key outcome of this project was the piloting and full-scale testing of the NFI MSM CBO development tool-kit in a number of
different environments.
This also led to the development of an India country partner of
NFI, Maan AIDS Foundation (formerly INFI) to join with BSWS in
Bangladesh and BDS in Nepal.
With the core support provided by the ARPF, and the mobilising
of additional resources, other activities were implemented.
DFID India
Enhance the capacity of the National MSM and AIDS Human
rights, policy and advocacy Task Force to enable it to train, establish, monitor and coordinate the activities of up to six Local Policy
and Advocacy Units in MSM Projects in six cities of India over a
period of one year
Outputs included:
• Supported the development of the National MSM and AIDS Task
Force
• Developed eight new MSM and human rights policy units within
existing NFI partners
• 12 training programmes conducted
• A study conducted on MSM and human rights issues in these
localities
• Continued support provided to the existing five advocacy cells
developed with funds from Foreign and Commonwealth Office Human Rights Programme
• Four stakeholder workshops conducted with police, media, judi-
DFID India: Community Fund
2006 - 2007
Increasing the coverage of sexual health services for MSM in Andhra Pradesh, Karnataka, Tamil Nadu and Uttar Pradesh, India – a
pilot project.
12
A poster developed by the Knowledge Unit and produced in 11 languages
ciary, lawyers and policy-makers
• Advocacy meetings and seminars held with local stakeholders
(total participants 1540)
• Eleven workshops conducted in local cities where advocacy cells
established for MSM on legal literacy and rights
• Documentation on human rights violations, abuse and discrimination against MSM recorded in all 13 cities
• Participation and technical support for the planning of National
AIDS Control Programme's Phase III five-year HIV prevention
programme in India, along with the development of recommendations for scaling up coverage of MSM and HIV services – adopted
by NACO
A key outcome was the upstreaming of advocacy work in India
on MSM and HIV services and the inclusion of MSM and human
rights issues into NACP’s Phase III plan.
DFID India - Social Marketing Fund
Development and field-testing of low-cost water based lubricant sachets to reduce the transmission of sexually transmitted infections
(STIs) amongst males who have sex with males (MSM) in India.
Outputs included
• Manufacture and packaging of 2.5 million sachets of lubricant
with an aloe-vera base
• Distribution to 66 partner organizations for onward field distribution and testing for user friendliness and acceptability
• Business plan for large-scale manufacture and distribution
A key outcome was up-streaming advocacy work in regard to ensuring access to appropriate sexual health products for MSM within
NACO’s Phase III plans, as well as demonstrating income-generating frameworks for MSM CBOs, along with enabling access to
water-based lubricant by MSM.
In addition, two other projects implemented through this period
contributed significantly to development of the NFI achievements.
Action to address legal, judicial, and social impediments to sexual
health promotion amongst men who have sex with men in India and
Bangladesh – funded by the British Foreign and Commonwealth
Office; July 2003 – June 2006
Achievements included:
• Study on the impact of social, legal and judicial impediments to
sexual health promotion and HIV and AIDS related care and support for MSM in Bangladesh and India conducted and report disseminated (see From the Frontline, www.nfi.net)
• Five advocacy cells developed in India and supported for project
period (continued support beyond project period provided by DFID
India – see above)
• National MSM and AIDS Task Force in India developed and supported – continued development and support beyond project period
by DFID India
• Advocacy cell developed within Bandhu Social Welfare Society,
Bangladesh, evolved into the National MSM and Human Rights
Task Force, with continued support provided by DFID Bangladesh
beyond project period
A key outcome was the up-streaming of advocacy to address the
impediments to national and state levels, along with down-streaming advocacy through the development of the advocacy cells, which
was continued with the DFID India and Bangladesh support.
Risks and Responsibilities: Male Sexual Health and HIV in Asia
and the Pacific International Consultation, 23-26 September 2006.
Development initiated in May 2005:
• Co-hosted by NFI and the National AIDS Control Organisation,
India with technical support from UNAIDS.
• Brought together 380 delegates from 30 countries in Asia and
the Pacific representing government national AIDS programmes,
donors and other funding support agencies, as well as MSM and
transgender organisations
• Raised half-a-million GBP for the meeting
Key outputs achieved
• The Delhi Declaration of Collaboration between government,
A working group at the RR meeting
donors and community-based organisations to work together towards increasing investment and scaling up coverage.
• Principles of Good Practice for implementing MSM/transgender
HIV services developed and adopted by delegates
• Development of a tripartite Asia Pacific Coalition on Male Sexual Health (APCOM) to support and advocate for increasing investment for scaling up coverage of MSM/transgender HIV services
across the region
In addition, as a part of the consultation development process,
21 countries in the Asia-Pacific region conducted an MSM needs
assessment, the majority hosting their first national MSM consultation meetings, incorporating many of these issues into their national AIDS Programmes (an example of this was the five regional
consultations in India developing the needs assessments and recommendations for NACO Phase III plan, which also involved the
advocacy cells and the National MSM and AIDS Task Force – see
above).
Along with this has been significant developments in China, Malaysia, Japan, Indonesia and PNG since the consultation meeting,
where governments are recognising the importance of addressing
MSM and HIV concerns.
Further, a range of key background papers were also developed
with UNAIDS and USAID support for the Consultation Meeting,
including an epidemiological review, a spending assessment, rights
and MSM, socio-cultural frameworks, and good practice.
A key outcome has been the upstreaming of advocacy in regard
to MSM/transgender HIV and sexual health concerns involving
governments and donors directly, along with the development of
APCOM.
The ARPF core support also enabled NFI to begin engagement
in Pakistan, and test out its tools and development processes in this
country.
Developing MSM and transgender HIV services in Pakistan
In May 2005, NFI was asked to be part of a UNAIDS Mission to
Pakistan to review the World Bank supported Pakistan’s National
Enhanced Programme on AIDS men who have sex with men service package projects. This was followed by a short-term contract
with the World Bank to provide immediate technical support to the
current MSM interventions funded by the Enhanced Programme
on AIDS.
A key outcome was the considerable advocacy work that was
conducted with the National AIDS Control Programme, the Provincial AIDS Control Programmes, country donors, and civil society
organisations regarding MSM and transgender sexual health issues,
as well as skilling-up current NGOs who were implementing MSM
HIV services.
Continued on page 14, col.1
13
A model explicated
However, we were not able to fully replicate the work we were
doing in Bangladesh or India, because there were no MSM/hijra
community based organisations in the country, where what services did exist were being provided by non-MSM NGOs. Nor could
we attract any funding or support for such an initiative. It has only
been with the South Asia regional GFATM project that this is being
achieved.
In summary then, with the DFID ARP fund as core support and
along with additional resources:
• Upstreaming advocacy work on MSM and a rights-based approach to HIV prevention, care and support towards Universal Access in Bangladesh, India, Nepal and Pakistan
• Studies conducted on the impact of social, legal, and judicial impediments to sexual health promotion and HIV and AIDS related
care and support for males who have sex with males in Bangladesh
and India
• Development of a National MSM and HIV Task Force in India,
along with eight state level Advocacy Cells in partnership with
MSM CBOs
• Development of a MSM and HIV Advocacy Cell in Bandhu Social Welfare Society, Bangladesh
• Working closely with the National AIDS Control Organisation,
India in developing its Phase III plan where it involves MSM
• Capacity building programmes for NGOs and CBOs working
with MSM in Bangladesh, India, Nepal and Pakistan (total of 45
workshops)
• Developed 36 new MSM CBOs working with HIV issues and
concerns in India
• Developed four state level MSM and AIDS Forums in India
• Conducted 40 situational assessments of MSM in India and
Bangladesh
• Developed tool-kits for MSM CBO development and HIV programming in six South Asian languages
• Developed a range of IEC templates specific to the needs of
MSM in several South Asia languages
• Conducted the Asia-Pacific consultation meeting on male sexual
health (MSM) in New Delhi, India
• Initiated the development of the Asia-Pacific Coalition on Male
Sexual Health (APCOM)
• Partnered a range of MSM and HIV organisations to develop the
Global Forum on MSM and HIV
• Produced a range of reports, papers and presentations
• Upgraded the NFI website
• Provided technical assistance and support to two national MSM
CBOs (BDS, Nepal and BSWS Bangladesh who between them are
working in 15 districts in these two countries
• Provided on-going technical assistance and support to 58 MSM
CBOs working in India
• Provided technical assistance and support to 7 NGOs working
with MSM in Pakistan
• Provided technical assistance and support to PSI Myanmar for
their national MSM and HIV prevention, care and support programme
• Seed funding provided to 45 MSM CBOs in India
Consolidation and reflection - a challenging period
The model of technical and institutional support for community
systems strengthening had proved to be cost-effective process of
both strengthening our country partners, as well as downstreaming
such institutional and technical assistance to locally based MSM
community organistations.
However, with the end of the Asia Regional Poverty Fund grant
in March 2007, and with all the expansion of the work of NFI across
the region, we were placed in the peculiar position of having increasing demands placed upon NFI to support its country partners,
along with the newly emerged INFI (to become Maan in 2010), but
with no resources to respond to these expressed needs..
A dramatic scaling down of technical assistance to our country
The World Bank
Institutional Development Grant for fighting HIV and AIDS and promoting sexual
health amongst males who have sex with
males in the South Asia Region
Providing technical support to MSM networks, groups and organisations towards enabling them to develop as community-based HIV
service providers promoting sexual health amongst their constituencies, Naz Foundation International (NFI) has primarily worked in
Bangladesh, India, Nepal, and Pakistan, with increasing request for
such support from these countries, as well as from Afghanistan, Sri
Lanka, and Myanmar.
The World Bank agreed to provide NFI with a 2 year Institutional
Development Fund grant beginning July 1st 2007 to achieve the
following:
• Strengthened technical support capacity
14
partners resulted between 2007-2009, because of this lack of resources. The Secretariat staff was reduced, along with the regional
office staff where small contracts were developed to keep key work
going.
This also had a dramatic impact on INFI, which also had to reduce their staffing and programming activities, with some core
funding being provided by the World Bank Institutional Development Fund.
There were even demands to close NFI down, but Shivananda
agreed to work on a voluntary basis until such time as funds became
available again.
• Developing knowledge management capacity
• Developing advocacy capacity
• Strengthening financing and management capacity
Funding was channelled through NFI’s India partner, India NFI
to primarily support the above activities in India and the activities
of the regional programme office which implemented the NFI regional work.
Through the strengthening of the Technical Support Unit with
staffing and equipment, has enabled INFI to continue its downstreaming of its technical assistance more effectively along with
scaling up of this support. During the period of this grant, INFI has
conducted two India state level training programmes on capacity
building for 20 MSM CBOs (80 participants), 321 days of site visits in six states providing on-site technical assistance and addressing capacity needs with 43 MSM CBOs provided such assistance,
agreements reached with these six State AIDS Control Societies to
support such technical assistance, and sensitisation programmes
conducted for 420 professionals engaged in HIV work (doctors,
media persons and NGO staff). INFI has also responded to some
5373 requests for assistance.
Further NFI, in collaboration with INFI, conducted two regional
(South Asia) training of trainers programmes, a total of 18 days and
54 participants.
The support provided by the World Bank IDF grant also enabled NFI to provided technical assistance and institutional support
for the development of the Asia Pacific Coalition on Male Sexual
Health (APCOM) by NFI and the engagement of NFI through its
Chief Executive as the Chair of this institution, NFI has been enabled to significantly strengthen and upstream its advocacy work,
with governments, donors, INGOs, national NGOs, and MSM and
HIV groups and organisations, not only in South Asia, but also
across Asia and the Pacific. This has been possible because both
NFI and APCOM share the same advocacy objectives.
It further led to the deepening engagement of the Regional Office
of UNDP in supporting NFI’s country activities, including the first
national MSM and HIV meeting in Sri Lanka, developing an MSM
technical resource team for Pakistan, hosting the India and South
Asia meetings in Lucknow, as well as financial resources, input and
proposal partner, in the NFI GFATM regional proposal.
NFI’s engagement with the Global Forum on MSM and HIV is
also having a similar impact in strengthening its advocacy and technical assistance role, providing opportunities to disseminate NFI’s
work and develop links with MSM and HIV agencies who wish to
replicate NFI’s model of regional technical assistance in their parts
of the world, including sub-Saharan Africa and Latin America.
NFI’s support for INFI has also assisted in the development of
consensus building among the various state and national MSM networks that in the past has been somewhat acrimonious. This has
seen a greater engagement of all these networks in working together
to achieve common goals.
European Union Development Assistance Programme, India
Supporting the scale-up of HIV services for male-who-have-sex-with-males (MSM) in India, by strengthening the capacity of community-based organisations of MSM, and others to address MSM and HIV
issues.
2009-2011
Implementing this project enabled NFI to once again strengthen
its Secretariat functions and activities to some extent, along with
continuing to strengthen INFI's capacity as a technical assistance
agency for MSM and hijra populations in India, implementing the
model of community systems strengthening process.
Results anticipated as a part of this project are:
• India NFI’s technical support and knowledge units strengthened
and office expanded and equipped to provide assistance to MSM
CBOs on an on-going basis.
• By the end of project, 50 MSM CBOs at state and district levels
have been strengthened and are working with India NFI, receiving
regular technical assistance and support in 16 states, a Union Territory, and the National Capital Territory of Delhi
• By the end of the project, the National MSM and HIV Policy,
Advocacy and Human Rights Network and the Network of India
People of Alternate Sexualities Living with HIV are receiving technical assistance and support, and are linked to and working with all
50 MSM CBOs.
• By the end of project, technical support and assistance, along
with knowledge support have been provided to state AIDS control
societies and district AIDS control units, to map MSM sexual networks, and to enable them to access MSM HIV prevention, treatment, care and support service providers in 16 states, a Union Territory, and the National Capital Territory of Delhi
• Appropriate policies developed and implemented by governmental, and private and non-governmental organisations, which deliver
HIV prevention, treatment, care and support services, to address
stigma, discrimination and social exclusion against MSM
• A range of appropriate BCC materials (posters, leaflets and
booklets etc.), training and capacity building toolkits and manuals
developed for, and available to MSM CBOs.
• Effective monitoring and evaluation, including financial auditing
has been undertaken, and the lessons learned from the project have
been distilled and disseminated.
In regard to the process of strengthening existing 36 CBOs and
supporting the development of 14 new CBOs, this has been particularly challenging. This is because of the intense negotiations
that were required with Alliance India, NACO and SACS to get a
consensus on where such support and development should focus to
ensure that no duplication occurred in respect to different funding
streams, arising from the Round 9 GFATM India country project.
Apart from validating the institutional and technical support
process, a key output required by the project was to ensure that all
these 50 MSM CBOs were being funded, hopefully by individual
SACS.
As of the end of December 2010 (2nd year of project), the following results have been achieved:
1. Maan AIDS Foundation strengthened
The INFI project has been strengthened with additional staff and
resources, and provided with eight capacity strengthening workshops conducted by NFI., and scroring above target in a capacity
assessment.
2. Supporting 36 MSM CBOs and developing 14 MSM CBOs to
respond to HIV issues impacting on MSM and transgenders
36 CBOs provided with technical assistance, and 9 new CBOs developed with 39 training sessions for 932 participants in 16 states;
7,205 emails and 11,425 phone calls from these partners. 26 out of
36 existing CBOs score above target in their capacity assessment.
3. Supporting organisations addressing MSM/TG HIV related human rights needs and MSM/TG living with HIV
Support provided to 11 CBOs in the National MSM and HIV policy
, advocacy and human rights Task Force and to six CBOs in the
Network of Indian People with Alternate Sexualities Living with
HIV/AIDS.
4. Supporting state and district governmental AIDS management
organisations
17 CBOs are/will be receiving funds from SACS, 30 CBOs will
receive funding from the GFATM India project. This leaves 6 CBOs
to identify funding sources out of the anticipated total of 35 old
CBOs and 18 new CBOs. In regard to District AIDS Pevention and
Control Units (DAPCU), the anticipated result has not as yet been
achieved as currently DAPCUs are only engaged in data collection
and programming updating. Discussions still on-going in regard to
the relative merits of composite programming, and community-led
interventions.
5. Policy work with mainstream stakeholders working with Integrated Counselling and Testing Centres (ICTC) and Anti-Retroviral
Treatment Centres (ARTC)
This result is not being achieved. NACO policy dictates that the
ICTCs must collect personal information which clients are not
willing to give. A consequence has been a significant drop of in
MSM/TG service users. Maan/NFI working with India Network
For Sexual Minorities (INFOSEM) to request NACO to change its
Continued on page 16, col. 1
15
European Union Development Assistance Programme, India
policy on this.
6. Production and distribution of behaviour change communication
materials
Over the two year period
• Eight editions of Pukaar produced
• NFI website maintained and regularly uploaded with new documents with 917,274 hits alone in year two
• New BCC resources developed and disseminated (posters, booklets, leaflets)
• 156 products developed with 60 other resources uploaded on
website
7. Undertaking effective monitoring and evaluation
• 26 out of 35 of the original CBOs trained to use the NFI MIS
system. This is included in the training programmes for the new
CBOs.
• Maan’s M&E system strengthened with regular reporting from
CBOs.
• NFI’s MIS system now in line with NACO requirements
Challenges being faced
1. Clarifying the role of Maan AIDS Foundation and its
engagement across India as a technical support agency for
MSM/hijra service providers in the light of the state territorial division between the different SRs for the GFATM India project and Integrating this division and the India component of the GFATM regional project into an operational
plan in terms of the inclusion of the Maan engagement in the
GFATM round 9 country project and the upcoming PATH/
CIDA project;
2. NACO’s insistence on collection of personal information
on MSM/hijra clients attending the ICTC and ARTCs leading to a drop-off of service users;
3. Policy engagement in advocacy development of the two
national partners because of a lack of funding support for the
networks themselves.
Posters developed by the knowledge unit for downstream dissemination by Maan AIDS Foundation and other country partners. The
Unit also produces booklets, leaflets and a range of institutional
development tools available on the NFI website.
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Reducing the impact of HIV on men who have sex with men and transgender populations in South Asia
2011-2015
NFI was finally successful in its third attempt to secure funding from the GFATM for a scaled up response to the community systems strengthening needs of its country partners
across South Asia, and the downstream capacity needs of local community based organisations they work with.
The project explicates the full implications of what NFI
has been discussing over the years, and wanting to implement on a regional level, where this grant is the first MSM
and transgender regional project that the GFATM was willing to fund. It is a five year project worth some $44 million
USD.
The project will be implemented in seven South Asian
countries: Bangladesh, India, Nepal, and Sri Lanka (where
there are currently active community-led partner organizations), as well as Afghanistan and Pakistan (where partners
will be developed), and Bhutan (where we will work with the
government).
The main focus of the project activities will be supporting and building the capacity of in-country organizations to
16
deliver high quality services, engage in policy development
and advocacy initiatives, and take part in research on HIVrelated issues affecting MSM and transgender populations.
The project aims to strengthen the community systems to
support and sustain this work. In order for the interventions
carried out by CBOs to be both effective and sustainable, it
is necessary to build their capacity, create stronger linkages
and networks between community organizations and community-led interventions, and provide longer-term support to
these groups.
In the case where MSM and HIV country partners have
their own local MSM and HIV organisation networks, the
project will strengthen their capacity to enhance and share
skills, capacity and knowledge downstream to their partners.
Where such country partners do not exist, the project will
develop the necessary capacity to strengthen national AIDS
programmes to respond effectively and appropriately to the
sexual health needs of MSM in their countries, whilst establishing new country partners. Such organizations will be
developed and supported to undertake necessary policy and
advocacy work, generate knowledge, and strengthen service
provision so that MSM and TG can access and use appropriate HIV-related services. In addition, these organizations
will further support the development and operation of local
MSM and TG organizations providing HIV-related services
to MSM and TG populations at a local level.
Along with national level CBO strengthening, regionally,
the project will enable sharing of knowledge, good practice,
advocacy and skills across the various countries, and address cross-country issues through regional coordination and
supporting regional initiatives. Cross-country learning will
provide added value to country-level research, advocacy and
capacity development, and improve the ability to address regional issues in a strategic way. In the development of the
proposal to the Global Fund, a detailed analysis of what incountry work is currently being funded, will be funded, and
will not otherwise be funded, on MSM and HIV issues was
undertaken; this programme will not duplicate in-country
work. It will add-value to national work by supporting it and
facilitating regional learning and co-ordination.
A multi-country approach has been adopted for the three
main reasons:
1. It is more effective because of the many similarities across
the countries in the region that affect the risks and vulnerability of MSM and TG to HIV—including sexual and gender identities, social norms, stigma and discrimination, and
restrictive legislation and law enforcement—will enable the
knowledge, skills and resources developed in one country to
improve the outcome of activities in other countries in the
region. For advocacy and policy development targeting sensitive issues, utilising regional platforms can help overcome
barriers that would exist if these issues were just addressed
at a country level, and which can create more effective dialogues, and encourage necessary change. Finally, the creation
of a regional body of strategic knowledge covering a range
of issues, including behaviour and other HIV risk factors for
MSM and TG, community-led “good practice” models, and
policy and advocacy initiatives addressing MSM, TG, and
HIV-related issues, will be invaluable to help and improve
community-led efforts to address these issues across the region.
2. It is a more efficient because human, financial and other
resources will be shared across a number of countries, and
the learning, skills and resources required in each country
can be more easily accessed from these shared resources,
without having to duplicate the effort of producing these
from scratch. For example, training to support country-level
MSM and TG CBOs, to support them developing, and scaling-up of HIV services for MSM and TG in their countries,
will be done by holding joint multi-country trainings, BCC
resource templates will be developed that can be adapted to
each locale, and the knowledge and expertise gained in one
locale, will be used and adapted to inform work in another.
3. It is more economic because of the need for fewer resources, as resources will be shared across countries, rather than
having to have them duplicated, and from the economies of
scale gained from the regional procurement of commodities
(condoms, lubricants, HIV-testing kits, and STI drug treatments), that will be used to develop MSM, TG, and HIV-re-
lated community based services in Afghanistan and Pakistan.
Service Delivery Areas
1. Improve the delivery of HIV prevention, care and treatment services for MSM and transgenders in South Asia;
2. Improve the policy environment with regards MSM, transgenders, and HIV-related issues in South Asia; and,
3. Improve strategic knowledge about the impact of HIV on
MSM and transgender populations in South Asia.
With PSI Nepal as the principal recipient, and UNDP as a
technical partner focusing on advocacy and policy development, NFI is the sub-recipient that is implementing the community systems strengthening programme.
As a part of systems strengthening, Technical Advisors
trained by NFI will be seconded to each of the country partners to provide on-going institutional support and development.
In the case of Bangladesh, India, Nepal and Sri Lanka,
funds are available to conduct a range of capacity strengthening programmes for downstream partners, as well as similar programmes for the national partner. In addition to this,
for Bangladesh and Nepal, funds are available to develop
their resource and training centres.
For Afghanistan and Pakistan, beyond working to develop
a national partner in these countries, funds are available to
pilot the concept of MSM CBO development, and then work
with the respective country's NACP to submit a GFATM
country proposal for scaling up CBO development and engagement.
For Bhutan, NFI will work directly with the Bhutran
NACP to develop an MSM CBO partner in the country.
Further NFI is now able to strengthen its Regional Programme office in regard to its technical, monitoring and
evaluation, finance, and knowledge management departments with additional staffing and resources.
In Pakistan, the development process has already begun
and a new national
MSM and HIV partner has been developed - Naz Male
Health
Alliance,
where the word Naz
means "pride". This
new organisation will
be implementing the
Pakistan component
of this project.
For the Regional Of-
You can access this and previous editions
of Pukaar online at:
www.nfi.net/pukaar.htm
Other documents on related issues are
available on the NFI website:
www.nfi.net/publications.htm
17
At the 10th ICAAP, Busan, Korea
25th - 30th August, 2011
www.apcom.org
The Asia Pacific Coalition on Male Sexual Health (APCOM) was significantly engaged at the 10th International Congress on AIDS in Asia and the Pacific (ICAAP)
at Busan, Korea. Apart from hosting the pre-conference satellite on the 25th August
(Beyond Numbers), it also hosted four satellite sessions on Emerging HIV and social
research issues among MSM and transgender people, Engaging the health sector for
scaling up services for MSM and transgender people, I am what I am: Transgender
health and challenges, Sex, Drugs & Technology: Findings from Asia’s largest multicountry Internet survey, along with presenting at the first plenary session dedicated to
MSM and transgender issues at an ICAAP.
Activism, research and a concrete plan of action
APCOM’s “Beyond Numbers” Forum proves a dynamic curtain-raiser to the 10th ICAAP
Coalition and key stakeholders chart a roadmap to stemming the
HIV epidemic among men who have sex with men and transgender
people in Asia and the Pacific
A call for activism to combat stigma and discrimination, the sharing
of new research on HIV, and a blueprint for renewed action to address
the epidemic in the most vulnerable populations in the world’s most
populous region. These led the agenda at “Beyond Numbers”, the
day-long forum organized by the Asia-Pacific Coalition on Male
Sexual Health (APCOM) as a curtain-raiser to the 10th International
Congress on AIDS in Asia and the Pacific.
The meeting was subtitled “Getting to Zero: The forces driving HIV
among men who have sex with men and transgender people in Asia
Pacific” reflecting the theme of one of the day’s major presentations
in which the various concurrent epidemics, or “syndemics”, that
contribute to the challenges of these vulnerable populations were
examined in terms of their impact on individuals and the epidemic
itself.
“We cannot view HIV in isolation,” explained Shivananda Khan,
APCOM Chairperson and Chief Executive of Naz Foundation
International. “There are so many factors at play -- self-stigma and
depression, alcohol and drug abuse, sexual exploitation. All of these
contribute to an individual’s risk to HIV infection, and must be taken
into account when designing effective outreach and intervention
strategies.”
That point was driven home in an extensive presentation of
research carried out by Dr. Frits Van Griensven of the U.S. Centers
for Disease Control’s office within the Ministry of Public Health of
Thailand. “Syndemics are quite simply a set of multiple epidemics
acting synergistically or together, producing an extra burden of
morbidity and mortality in a population,” Dr. Griensven said. “Our
research focuses on the nexus of these epidemics, where they meet
to interact with and reinforce each other. A study carried out among
MSM in Bangkok clearly shows a direct correlation between these
factors and increased risk of HIV infection. It may sound obvious,
but you’ve got to provide solid data to substantiate what’s long
been suspected. MSM and transgendered persons are vulnerable
on so many fronts, right from childhood through sexual maturity.
We’re only at the beginning of what is already proving to be a vital
approach in understanding what really drives the HIV epidemic in
these populations who for so long have been denied health as a human
right.”
The emphasis on understanding syndemic issues in a rights-based
context was supported by senior United Nations officials present. “In
order to prevent and control the spread of HIV, we must protect and
promote the human rights of those most vulnerable, typically also
the most marginalized parts of our societies,” noted Clifton Cortez,
Regional Practice Leader, HIV/AIDS Health and Development for
the United Nations Development Programme. “It’s encouraging
18
that key UN resolutions have called for promoting social and
legal environments that are supportive of and safe for vulnerable
communities, including this year’s UN General Assembly resolution
that for the first time specifically included MSM but unfortunately
ended up excluding transgender persons. While progress is being
made, we clearly have a lot of work left to do.”
A lot of work remains to be done in South Korea as well, where the
10th ICAAP is being held, when it comes to ensuring the rights of MSM
and other sexual minorities. Earlier this year, the government of South
Korea withdrew official support for the conference, and community
organizations and other stakeholders eventually helped organize the
event, which is expected to draw some 2,000 delegates from the region
and around the world. “South Korea is part of APCOM’s Developed
Asia sub-region,” observed Dr. Stuart Koe, APCOM co-chairperson,
who is from Singapore. “But merely because a country is developed
from an economic perspective doesn’t necessarily mean that it offers
its LGBT citizens equal rights in an enabling environment.”
That view was expanded by Jeong Yol, one of the leaders of the
coalition Solidarity for LGBT Human Rights of Korea and Co-chair
of the LGBT sub-committee, that played a key role in rescuing the
10th ICAAP. “For us, making ICAAP happen is just the beginning,”
he said. “There has been frustration, there has been sorrow, and for
the LGBT community in my country there are many obstacles to be
overcome. But the very fact that we’re here today with all of you at
ICAAP, with APCOM, makes it all worthwhile.”
The Korean organizers joined APCOM forum delegates in six
important breakout sessions that discussed ways forward in addressing
syndemic issues, MSM and transgender rights, and universal access
to HIV prevention, treatment and care services.
One session focused on faith and religion, and their impact on how
MSM and transgender persons view their sexuality and their access
to health. Participants recommended that communities find ways to
gain support among faith-based organizations and religious leaders,
drawing upon successful examples that are already occurring in India
and other places where faith leaders are helping reduce stigma and
discrimination by working together with vulnerable populations and
persons living with HIV.
Another session discussed how stigma and discrimination in the
health care sector, a long-running challenge in Asia and the Pacific
region, could be addressed successfully. Participants recommended
that APCOM, whose membership includes the Western Pacific
Regional Office of the World Health Organization, push member
states to include sensitization towards marginalized populations in
the curricula of medical schools and colleges, with the support of
community leaders who could better inform the process.
A particularly lively session focused on how social media and
the Internet, which have strengthened MSM networks but also
impacted the spread of HIV, could be used innovatively within a
behaviour change model aimed at safer sex practices and community
empowerment. Such work is already underway in various parts of
the world, and participants called upon the APCOM membership to
help lead the way for such approaches and research in the region.
The transgender health breakout session focused on the particular
needs of the community. “For far too long we’ve been clumped
together with MSM, but that needs to change, otherwise HIV and
health interventions for our people will remain less than optimal,”
emphasized Laxmi Narayan Tripathi of India, an APCOM Governing
Board member representing the Asia-Pacific Transgender Network.
“It should be so obvious that we are very different from MSM, but
governments, funders and even civil society organizations alike
have ignored this, to the detriment of my people. We appreciate the
support APCOM has given us by including us and strengthening our
capacity to grow and advocate for our rights, but we need to truly
stand on our own and be recognized for the unique community that
we are.”
One of the largest breakout sessions was Living with HIV whose
participants recommended the inclusion of HIV positive MSM in
prevention messages, from conceptualisation to implementation,
and called for the messaging to be more upbeat, in terms of an
individual’s ability to live a healthier and better life given access to
treatment which in turn helps protect oneself and one’s partners. The
social research breakout session recommended significantly scaling
up research into the factors that contribute positively to the lives
and well-being of MSM in the region and not just negative factors,
along with the promotion of evidence-based programming and health
outcomes informed by research findings. Conducting robust social
research to generate evidence to help advocate for better services
was the conclusion.
“Men who have sex with men, transgender persons, people living
with HIV, government representatives, United Nations organisations
– there’s truly unity in diversity,” said Shivananda Khan, while
unveiling the APCOM Busan Declaration (see page 21) that reiterates
APCOM’s commitment to working on all the fronts explored during
the “Beyond Numbers” forum. “The APCOM rank and file may not
always be in agreement on every issue, but we engage in honest and
transparent debate with one common goal – the eventual eradication of
HIV and AIDS in our region, and our world. Today’s forum is proof
that we’re doing all we can to get to zero – the UNAIDS vision of
zero HIV infection, zero stigma and discrimination and zero AIDSrelated deaths. It’s a lofty goal, but we don’t believe it’s impossible.
The very fact we’re all here together today is proof of that.”
Satellite sessions organised at the 10th ICAAP by APCOM
Moving from sheer quantity to queer quality:
Emerging HIV and social research issues among MSM and transgender people
Co-sponsors: APCOM, ARCSHS, UNESCO
Co-chairs: Gary Dowsett, Australian Research Centre in Sex,
Health and Society, La Trobe University, Melbourne, Australia, and
Pimpawun Boonmongkhon, Center for Health Policy Studies, Mahidol University, Thailand
Speakers: Jeffrey Grierson, Australian Research Centre in Sex,
Health and Society, La Trobe University, Melbourne, Australia; Jan
Willem De Lind Van Wijngaarden, Pakistan, UNAIDS/UNICEF,
Pakistan; Hoang Tu Anh, Centre for Creative Initiatives in Health
and Population, Hanoi, Vietnam; Thomas Guadamuz, Center for
Health Policy Studies, Mahidol University, Bangkok, Thailand.
Number of participants: 140
The goal was to bring together a wide range of actors involved
in social research on men who have sex with men and transgender
people, along with HIV prevention, care and support practitioners,
to highlight the importance of social research in informing and improving the quality and effectiveness of HIV responses in Asia Pacific countries. Four social research studies related to sexual health,
HIV and human rights were presented and discussed. A report from
the presentations is to be developed as a possible blueprint for a
best practice document on social research and HIV in the region.
Engaging the health sector for scaling up
services for MSM and transgender people
Co-sponsors: APCOM, WHO, UNDP and UNAIDS
Co-Chairs: Dr Zhao Pengfei, WHO Western Pacific Regional Office (WPRO), Manila, Philippines, and Laxmi Narayan Tripathi,
Founder and Chairperson, Astitva Trust, Mumbai, India
Speakers: Dr Ying-ru Lo, HIV Department, WHO Headquarters,
Geneva, Switzerland; Addy Chen, MSM Working Group, Asia Pacific Network of People Living with HIV/AIDS (APN+), Thailand;
Dr Maninder Singh Setia, Karanam Consultancy, Mumbai, India
Experts from the Asia Pacific region describe the reasons behind
the current exclusion of men who have sex with men (MSM) and
transgender people from mainstream health services (both public
and private), give best/good practice examples from the field, and
develop effective ways forward with the ICAAP delegates who are
present. The goal is to provide up-to-date evidence on the health
sector HIV response at the global and regional levels, to share experiences on providing sexually-transmitted infections (STI) and
other health services, to address stigma and discrimination concerns related to health care providers, and to discover ways forward. Particular attention will be given the recent WHO, UNAIDS
and UNDP global guidance entitled “Prevention and treatment of
continued on page 20, col. 1
19
APCOM satellites at Busan
HIV and other STI among MSM and transgender people in low and
middle-income countries: Recommendations for a public health approach”. Delegates will understand how to foster effective and evidence-based responses to meet the needs for HIV/STI related health
services and address challenges and barriers to access to services
by men who have sex with men and transgender people in the community.
I am what I am: Transgender health and challenges
Co-sponsors: APTN, APCOM, TSF South Asia, Alliance TS Hub,
UNDP, UNAIDS
Co-chairs: Khartini Slamah, Core Group, Asia Pacific Transgender
Network (APTN), Malaysia and Laxmi Narayan Tripathi, Founder
and Chairperson, Astitva Trust, Mumbai, India
Speakers: Prempreeda Pramoj Na Ayutthaya, Core Group, Asia
Pacific Transgender Network (APTN), Thailand; Manisha Suben
Dhakal, Programmes, Blue Diamond Society, Nepal
Little effort has been made to create a new demographic category
for the purpose of epidemiology (that is, for tracking health conditions, including HIV, in different populations). Male-to-female
transgender women have often been categorized as “men who have
sex with men” in data collection and service design; that label may
not accurately reflect gender identity or sexual orientation. Since
population-based studies and global health surveys rarely include
gender-variance variables, the data remain extremely patchy for
the trans community and this leads to an inability to identify and
meet the health needs for this community. This satellite helped develop good practices and supportive policies worldwide that promote health, research, education, respect, dignity, and equality for
transgender community and gender-variant people in all cultural
settings. Delegates understood the need for - and how to develop
- strategic partnerships and alliances between Trans communities,
the legal profession, human rights bodies, parliamentarians and
governments, policy makers and the media.
Sex, Drugs & Technology: Findings from Asia’s
largest multi-country Internet survey
Co-sponsors: APCOM with DAN, M.A.C. Fund, UNDP and
UNAIDS
Technology break-out session at the preconference
Chair: Stuart Koe, Co-chair of APCOM; Co-Chair of DAN (Developed Asia Network for HIV in MSM & TG)
Speakers: Laurindo Garcia, AIMSS and Positivevoices.net, Philippines; Sin Howie Lim, Epidemiology and Public Health, National
University of Singapore, Singapore; Thomas Guadamuz, Center for
Health Policy Studies, Mahidol University, Thailand; Chongyi Wei,
Department of Epidemiology, University of Pittsburg, USA
AIMSS, the 2010 Asia Internet MSM Sex Survey, was a voluntary online survey conducted simultaneously in nine languages
and dialects, with over 26,000 respondents mostly from 9 countries in Asia. The survey provides an enormous set of data with
rich insights and unprecedented opportunities to understand the
sexual risk behaviours of MSM in Asia and elsewhere who use the
Internet. The session demonstrated the potential for the use of Information and Communications Technology (ICT) for communitydriven research, while discussing the forces driving HIV and risk
behaviour amongst MSM using the Internet for sexual networking.
Topics covered included factors associated with extreme high-risk
behaviour, use of drug and recreational substances, young people,
HIV status disclosure, and living as a positive MSM. Researchers
from the project reviewed procedures and analysis of AIMSS data
for socio-behavioural factors related to HIV transmission among
MSM internet users including how study implementation leveraged
innovative technology and community networks.
Delegates were given fresh insights into the forces
driving HIV among tech-savvy MSM in Asia, better
understood the use of ICT in the design and execution of community-driven research intended to gain
new evidence for policy, advocacy and programmatic design to reach hidden populations.
APCOM is a coalition of MSM/TG community representatives, donors, government sector, UN agencies,
and technical experts. Community sector representatives are nominated from across Asia and the Pacific
through sub-regional network: Australasia, China, Developed Asia, India, Insular South-East Asia, Pacific
South Asia, and also from the Asia Pacific Transgender Network, and the Asia Network of Positive People
(MSM Working Group).
Its Secretariat consists of an Interim Secretariat Coordinator Midnight), Administratve Assistant (Vaness),
Executive Management Consultant (Paul Causey) and
a Communications Advisor (Roy Wadia)
20
APCOM Busan declaration
APCOM
25th August 2011
Notable progress has been made in the global response to the HIV
epidemic, but with regard to men who have sex with men and
transgender persons in Asia and the Pacific there remains a real and
ever-expanding gap between the rhetoric of focused responses and
the reality of the increasing HIV prevalence among these populations
in the region.
The September 2006 “Delhi Declaration,” urgently called for a
scaled-up response to HIV prevention and care for men who have sex
with men and transgender people. The Declaration was developed at
the first Asia and Pacific consultation on male sexual health, which
brought together over 400 people in a tripartite coalition of MSM
and transgender community-based HIV organisations, along with
representatives from government, donors and international and incountry agencies.
Since then, a range of political actions have been taken to which
governments in the region have signed up to, including:
• The Economic and Social Commission for Asia and the Pacific
(ESCAP) Resolution 66/10 (May 2010) and 67/9 (May 2011)
• The UN Human Rights Council 17th Session Resolution on
human rights, sexual orientation and gender identity (June 2011);
and
• The UN General Assembly Political Declaration on HIV and
AIDS 65/277 (June 2011).
These have all called for a more focused response to HIV, taking
into account the extent of stigma, discrimination and social exclusion
of men who have sex with men, and transgender persons that is
impeding the development and delivery of appropriate HIV and
sexual health services for these populations.
The 2008 Independent Commission on AIDS report “Redefining
AIDS in Asia – Crafting an effective response” highlighted the
negative health impact that low investment and service coverage
has, and will continue to have, on men who have sex with men, and
transgender persons. This continues to be true.
In 2010, UNDP issued two reports: “An agenda for action on legal
environments, human rights and HIV responses among men who have
sex with men and transgender people in Asia and the Pacific” and
the World Health Organization – Western Pacific Regional Office,
along with UNAIDS and UNDP, issued a document on “Priority
HIV and sexual health interventions in the health sector for men
who have sex with men and transgender people in the Asia-Pacific
region.” Both these reports urged governments in Asia and the
Pacific to abide by their commitments, and international donors and
multilateral institutions to support these commitments.
The Asia Pacific Coalition on Male Sexual Health (APCOM) and
the delegates attending the APCOM pre-conference meeting at the
“10th International Congress on AIDS in Asia and the Pacific,” in
Busan, Republic of Korea, on the 25th August 2011,
Noted the continued worsening of the HIV epidemic and the spread
of other sexually transmitted infections (STI) among men who have
sex with men, and transgender persons in the Asian and Pacific
countries;
Reminding all of the many agreements made by governments to
abide by a range of international human rights commitments, and
United Nations declarations, policies and guidelines, addressing
those affected, infected and vulnerable to HIV, including men who
have sex with men, and transgender people;
Urged by the immediate need for coordinated and sustained responses
to the HIV epidemic in Asia and the Pacific, for men who have sex
with, men and transgender people;
for international donors, multilateral institutions and civil society
throughout Asia and the Pacific, to strengthen the spirit of partnership
and collaboration to work together to:
• Significantly expand financial investments for the provision
of appropriate HIV and sexual health services for men who have
sex with men, and transgender persons - within the framework of
universal access for all;
• Increase the scope, scale, intensity and quality of prevention,
treatment, care and support services for men who have sex with
men, and transgender persons across the region;
• Maintain momentum and escalate investment in the development
and assessment of new prevention technologies, and ensure that these
are made accessible to men who have sex with men and transgender
persons across Asia and the Pacific quickly and equitably;
• Acknowledge men who have sex with men, and transgender
persons in Asia and the Pacific, as key partners in country and
regional responses to HIV and other STI, and actively provide
institutional, financial and technical support to enhance the
capacity of men who have sex with men, and transgender people to
be meaningfully involved in decision making, policy development,
programme planning and implementation;
• Address the legal, judicial, and policy impediments to effective
and appropriate HIV and sexual health services for men who have
sex with men, and transgender persons in Asia and the Pacific, and
completely eradicate stigmatizing and discriminatory punitive laws
and practices - whether by governments, bilateral or multilateral
agencies, or service providers;
• Collectively step up efforts to combat stigma, discrimination,
violence and abuse faced by men who have sex with men including
gay men, transgender people, and those living with HIV.
Only then can we, by working together, reach Zero stigma and
discrimination, Zero new infections and Zero AIDS-related
At the APCOM pre-conference: Clifton Cortezt, Practice Leader,
HIV, Health and Development, UNDP Asia-Pacific Regional Centre on the dias along with Stuart Koe, Co-Chair of APCOM.
We, the Governing Board of APCOM, specifically call upon
governments to honour their political commitments on HIV, and
21
Homonormativity - the hegemony of ‘LGBT’
The mainstream Western LGBT movement has become a
commercialized monolith in the years since 1960s “gay liberation,”
and its impact is in no way limited to the US and Europe.
This mainstream movement not only embraces a “with us or
against us” mentality that demands queer people come out (as L,
G, B, or T only) or be left behind, but it also creates a very narrow
definition of acceptable genders and sexualities. The movement
then punishes those who don’t fit into that definition by stigmatizing
non-mainstream identities and refusing to allow these stigmatized
gender and sexuality minorities to have a voice on legal and policy
priorities.
There are countless examples of how the mainstream
LGBT movement uses stigma to limit access to legal and
policy agenda-setting to those who meet its narrow identity
criteria. In this post I’d like to focus on two places in particular:
the example of third-gender kathoeys in Thailand and the
example of alternative queer genders and sexualities in the US.
In Thailand, as Sonia Katyal describes in her piece “Exporting
Identity” (14 Yale Journal of Law and Feminism 97-176), there was
an understanding before the Western mainstream LGBT movement
showed up of three genders: male, female, and kathoey. If the word
“gay” did come up, it would probably refer to a kathoey, but what
Westerners would term “homosexual behaviour” was generally
private. When the Western LGBT movement arrived in the 1980s
on the heels of globalization and the spreading AIDS crisis, a new
masculine-identified image of the gay man showed up in Thai culture.
“Gay” became public, seeking legitimacy through masculinity.
The word “gay,” Katyal posits, may have come into common use
in Thailand specifically to distinguish these masculine-identified
gay men who aligned themselves with the Western movement
from kathoeys. Whereas gender identity had not previously been
regulated by the state, the adoption of the Western LGBT model in
Thailand made private public. Thai gay men turned social stigma
on kathoeys, alienating both kathoey identity and effeminate gender
expression. They began to define themselves in opposition to the
newly-stigmatized kathoeys, who were then socially and legally
sanctioned due to their public visibility. Ironically, they also became
an easy target for state actors who objected to the arrival of the LGBT
movement in Thailand.
This shift in understandings of gender and sexuality also affects
access to legal and policy priorities in Thailand. As Katyal explains,
kathoey identity is not a public sexuality, so rights such as protection
from sexual orientation-based discrimination and the freedom to
identify as gay without being harassed are far less important to this
population than rights such as privacy, the legality of private sexual
acts, the right to education, and the ability to legally identify as a
third gender.
The Western LGBT model is also harmful in that it tries to address all
gender identity issues by using a Western understanding of transgender
identity. Non-binary genders are either stigmatized or simply erased.
For example, a 2008 TIME Magazine article conflates kathoey identity
with transgender female identity and puts most of the spotlight on ID
cards and bathrooms. Though some Thai people who would fit into
the definition of the English term “transgender” are now lumped in
with kathoeys in Thailand, the original definition is closer to “third
gender,” and many kathoeys do not want to transition from male to
female, but rather consider themselves a separate gender that should
be legally recognized as such.
This is not only a problem in Thailand. My own experience in
the United States is that queer minorities are often pushed aside and
stigmatized, encouraged to feel shame for not slotting neatly into
the mainstream LGBT movement. Those who practice alternative
sexualities–for example, polyamorous or kinky queer Americans–are
particularly stigmatized as the LGBT movement tries to focus on
family, assimilation, and marriage. Anyone who deviates into gender
22
fluidity or alternate sexual values risks being avoided, ignored, or
actively shunned by big players in the LGBT movement, whose
priorities include marriage, adoption, and gays in the military.
In the media, mainstream LGBT leaders meet conservative fears of
leathermen in parades, drag queens teaching their children, and a slippery
slope into polygamy with the language of assimilation. “We’re just
like you,” these spokespeople are quick to reassure. “We have normal
families, our kids go to school, and our identities are not about sex.”
As someone who writes and talks about sex, is pro-kink, and
is openly polyamorous, I am discouraged from being too vocal in
mainstream spaces. I don’t feel comfortable attending many activist
workshops or social gatherings because I do not fall into the LGBT
acronym as a queer, gender queer activist. Online, I have found some
support at the margins, but am discouraged by threads such as this
one on Queerty, where gay and lesbian commenters take the attitude
that trans people, lacking money and power, simply must live with
the fact that only LG(B) priorities will be achieved. The numbers
of gender fluid, gender queer, and non-binary people are of course
even smaller.
Even as the acronym expands (QUILTBAG is the largest I’ve
seen so far), the use of an acronym itself alienates those who can’t
claim one or more letters and the movement still tends in reality to
focus on the L and the G, and much more infrequently, the B and T.
Other groups may get a letter, but that’s pretty much all we get. For
example, I’ve frequently seen issues that are mostly of relevance to
non-binary genders, like the problem of “Male or Female” checkboxes
on forms, described as a “transgender issue,” meaning that many
non-binary people might not be able to find the discussions that are
relevant to us. We are encouraged to push ourselves into the T as
much as possible, and if not, resources and support may simply be
unavailable. While trans identities are stigmatized on the one hand
by many gays and lesbians, fluidity is stigmatized on the other. Even
when “queer” is part of the acronym, this means little in practice.
In my experience, stigma operates as a silent force to keep our
priorities on the back burner. It’s not only vitriol in comment threads
that makes me think twice before coming out as polyamorous, standing
up for the legal right to practice BDSM, or loudly criticizing the
same-sex marriage movement. It is a fear that I live with after years
of hearing “innocuous” comments about gender and sexuality, the
kind of fear that piles up when a marginalized community is subjected
to stigma and shame. It is a fear that comes from not hearing many
loud voices like mine and thus allowing stigma some power over
me, the possibility that I may really just be weird and my priorities
unreasonable.
This fear is very powerful, because it doesn’t require a constant
voice to keep us down. I don’t have to ask my boss whether she’d
fire me if I talked openly about my gender and sexuality. I don’t
have to poll the organizations I might like to work with one day to
ask how they’d feel if they Googled my name and found an article
on alternative sexualities. I know that the loss of opportunity and
livelihood is a real danger if I am open about my marginalized
gender and sexuality. I also know from the above examples that the
mainstream LGBT community is unlikely to support me and that it
is a huge uphill battle to amass enough funding to achieve my policy
priorities.
However, I would like to end on a hopeful note. If you feel
marginalized by the LGBT movement, wherever you live, there is
hope for change. If we can find each other, start building our own
movements, and figure out creative ways to be sustainable, then we
can start to change the conversation. From a place of stigma, we
can say “enough is enough” and build pride around our identities
without requiring anyone in our community to feel a certain narrow
way about his/her gender or sexuality.
http://www.genderacrossborders.com/2011/09/20/the-hegemony-of%E2%80%981lgbt%E2%80%99?
Gay sex is an unnatural disease
For the Indian Union health minister Ghulam Nabi Azad, men having
sex with men (MSMs) is not only “unnatural” but also a “disease.”
According to Azad, “this disease has come to India from
foreign shores”, and Indian society needs to be prepared to face it.
Unfortunately, he said, the number of “such people” is increasing
by the day.
In statements made while addressing zilla parishad chairpersons
and mayors on HIV/AIDS, Azad said, “The disease of MSM is
unnatural and not good for Indian society. It’s a challenge to identify
such people. In case of female sex workers, we can identify the
community and reach out to them since they live in clusters. But in
case of MSMs, it isn’t always possible.”
These comments have not only caused uproar among civil society,
but also in the National AIDS Control Organization (NACO), which
incidentally reports to Azad.
“How can this be a disease? It is just a form of sexual orientation.
It’s definitely not unnatural,” a NACO official told TOI
. NACO has been working towards identifying MSMs and
giving them a rightful place in society. A large number of targeted
interventions (TI) have been put in place by NACO to specifically
cater to the needs of the MSM community.
According to NACO’s latest surveillance data, India is home
to an estimated 4.12 lakh* MSMs of whom 2.74 lakhs have been
identified.
Around 4.2% of all sexually-active males in India are believed to
have sex with other men, with Chennai, Andhra Pradesh, Gujarat,
Tamil Nadu and Orissa reporting the highest number of such cases.
Of the total number of 1,511 TIs, 168 exclusively cater to MSMs.
Each TI, catering to 1,000 MSMs, cost Rs 15 lakh.
The 2010 UNAIDS report on the global AIDS epidemic found that
among the high-risk group that got HIV infection in India last year
— 9.2% were intravenous drug users, MSMs (7.3%) and female sex
workers (4.9%).
“MSMs are those who are involved in very high risk sexual
behaviour. They usually have multiple partners. Some are also
involved in commercial sex activities,” the report said.
Till now, a single TI would cater to MSMs and transgenders. Now,
NACO has decided to have separate interventions for transgenders
and MSMs.
Experts say that after Article 377 or homosexuality in India was
decriminalized by the Delhi high court, virtually legalizing consensual
sexual relation among adults of same gender, more MSMs started
visiting TI sites.
“India has for long ignored the MSM community. India, like other
Asian countries, had been addressing HIV/AIDS in high-risk groups
such as female sex workers and injecting drug users, with the MSM
population being left out because many men are married and do not
identify themselves as gay or bisexual. That caused an alarming rise
in HIV infections in the MSM community,” explained an expert.
Dr Charles Golks, head of UNAIDS in India, told TOI that MSMs
are a key population, who are at higher risk of acquiring HIV and
the Indian government’s initiatives is helping reduce the threat.
“India was the first country in Asia to recognize the vulnerability
of the MSM population and put in place interventions required.
NACO was also instrumental in putting down Section 377 that
criminalized homosexuality as it was proving to be an impediment
to effective public health intervention. In the next five years, under
India’s National Aids Control Programme IV, stronger interventions
with higher community involvement will be put in place to reach out
to the MSM community.”
Data from 78 countries revealed that condom use among MSMs
was more than 50% in 54 countries, including India.
Treat Asia’s report, “MSM and HIV/Aids: Risk in Asia”, which
compiled studies conducted in 19 countries, said access to information
and condoms is limited, with prevention programmes available to
only 2% of MSMs in 16 Asia-Pacific countries. What’s worse, sex
between men is illegal in 11 of the countries surveyed.
The Times of India, 5/7/2011
* 1 lakh is 100,000
UNAIDS rejects prejudice and misconceptions about men
who have sex with men and transgender people
UNAIDS welcomes the call by the Prime Minister of India, Dr
Manmohan Singh, to have an “HIV sensitive” policy and programmes
so that the marginalized populations affected by HIV are not denied
the benefits of health and development programmes. “We should
work to assure for them a life of dignity and wellbeing. We have to
ensure that there is no stigma and discrimination towards HIV infected
and affected persons,” said Dr Singh. During the inauguration of the
National Convention, Dr Singh reiterated his government’s strategy
to provide HIV services to groups at higher risk of HIV infection.
“There is no place for stigma and discrimination on the basis of
sexual orientation,” said Mr Sidibé. “I welcome the bipartisan call
by Mrs Sonia Gandhi and Mrs Sushma Swaraj to end all forms of
stigma and discrimination against people at increased risk of HIV
infection.”
“Consistent with WHO’s disease classification, UNAIDS does not
regard homosexuality as a disease,” said Mr Sidibé. According to the
recently released UNAIDS and WHO guidelines on prevention and
treatment of HIV and other sexually transmitted infections among
men who have sex with men and transgender people, legislators and
other government authorities should establish anti-discrimination
and protective laws in order to eliminate discrimination and violence
faced by men who have sex with men and transgender people.
UNAIDS is committed to providing support to India’s successful
AIDS response, which has seen new HIV infections drop by more
than 50% in the last decade. India currently produces more than
85% of high-quality generic antiretroviral drugs for the majority of
low- and middle income countries.India’s courts have progressively
protected the human rights of people living with HIV and men who
have sex with men by striking down discriminatory laws.
UNAIDS will work with the Government of India, civil society and
community groups in realizing the vision of zero new HIV infections,
zero discrimination and zero AIDS-related deaths in India.
Why we must work with male-to-male sex and
HIV prevention, care and support
Because:
• It is the right thing to do on humanitarian
grounds
• It is the right thing to do epidemiologically
• It is the right thing to do from a public health
perspective
Males who have sex with males (MSM) whether
their self-identity is linked to their same sex
behaviour or not, have:
• The right to be free from violence and
harassment
• The right to be treated with dignity and respect
• The right to be treated as full citizens in their
countries
• The right to be free from HIV/AIDS
MSM who are already infected with HIV have the
right to access appropriate care and treatment
equally with everyone else, regardless of how the
virus was transmitted to them.
23
Non-hijra transgenders struggle for identity
Hijra isn’t the only transgender identity. There are others, such
attention to themselves, and struggle to find recognition as anything
but a ‘deviant’ community, writes Gee Ameena Suleiman.There are
several transgender identities that exist in South India. There are
the female to male transgender identities of Thirunambigal in Tamil
Nadu, Magaraidu in Andhra Pradesh and Gandabasaka in Karnataka.
Then there are male to female identities such as the kothi, hijra (also
called Aravanis and Thirunangaigal in Tamil Nadu), Jogappa in
Northern Karnataka, Jogatha in Andhra Pradesh and Shiva Shakti
in Maharashtra and Andhra Pradesh.
Not all of these various identities are as well known as the hijra
identity which has become societally synonymous with transgender
identity. This is mainly because of the historic visibility of this
community which has self-organised a cultural and social space
through a Guru-Chela system. This acts as a support to a lot of young
hijras/kothis who leave their homes and join one of the seven Gharanas
as ‘daughters’ or ‘chelas’ under their gurus. The hijra/kothi can often
be seen at traffic lights carrying out their “basti collections” — one
of the few occupations this community has struggled to provide for
itself in a hostile and discriminatory society.
The HIV/AIDS funding that India receives has resulted in the
setting up of many NGOs across the subcontinent which “target” the
kothi as a primary carrier of the infection. But the gender identity
of the kothi is glossed over by the easy conflation of the NGO term
MSM (men who have sex with men) with kothi. Kothis are not men.
They are male-bodied but identify as female.
Jogappas are young male children usually from dalit or other
‘backward’ castes, sometimes even from Muslim families in northern
Karnataka, who are dedicated to the Goddess of Yellamma. They
wear female clothes and act as mediators between devotees and the
Goddess. They are forbidden to marry.
The Jogappa is not a category exclusively for transgenders but is a
traditional space that permits cross-gender expression. This provides
a lot of transgender women with a legitimate space to express their
non-normative identities in society.
I identify as a Thirunambi. Female to male transgender. Long
before I knew what I was, I knew I was gender non-conforming. Only
recently did I find the terms that best describe what I am and found
people who are similarly gendered. A person born as female but with
the gender expression that is male. I struggled for several years of
my life trying to articulate what I am. To tell my family, friends and
lovers that I am not a woman who is boyish. But a man.
There are diverse ways to be a transgender man. Some of us want
sex change surgeries, some don’t, some of us identify as heterosexual,
some as lesbian or gay, yet others as multi-sexual. Some of us are
more fluid with our genders than others. Some of us have been forced
into marriages with men by our families, while others managed to
leave our biological families to find limited freedom by migrating
to other cities.
But the oppression that we have faced due to our “deviant” gender
expression cuts across the variety of gender expression within the
community. The levels of oppression of course vary according to
the caste and class positions that we occupy. I write as a Nair-born,
English-speaking, middle-class FTM. I write for my working class,
dalit, non-English-speaking FTM brothers. I write because our voices
are never heard.
We are silenced before we can speak. We face the double oppression
of being female-born on top of our non-conforming gender expression.
We don’t have a system like the hijras. We don’t have Gurus who will
mother us when we leave our biological families. We are invisible
because we are conditioned to “pass” in public as men, to say that
our bodies don’t matter because we feel disconnected with them.
Is that body that bleeds every month, the body with breasts, that is
seen as female mine? This is a question that all of us have grappled
with.
It is difficult for us to transition with respect to our bodies because
of the lack of awareness about our genders in society. The medical
establishment is largely ignorant of our needs and don’t offer
affordable sex reassignment surgeries for working-class femaleborn transgenders. Some of us have been in lesbian relationships,
not knowing how to articulate that we are men. Trapped as butch
lesbians.
Very few funders are interested in our struggle for recognition.
Even queer/ feminist groups exclude us as ‘anti-feminist’ for joining
the oppressive side by identifying as male. A reductive feminism that
ignores the female-bodied experiences that we have. A feminism that
does not recognise how difficult it was for us to leave our homes and
express our gender in spite of being born female.
We don’t clap our hands drawing attention to ourselves, we slide
past the crowd, knowing that transphobic violence will follow if we
are outed as female bodied. We are directed to urinals where biological
men stand and pee. We are beaten up if we step into women’s toilets
by women who think we are voyeuristic, male harassers. Most of
our public spaces are gendered spaces — buses, toilets, queues at
the cinema hall, etc.
Our struggle is to find a space where gender non-conformity is
not condemned as abnormal. To push from the margins to claim a
place in the centre, fearlessly and unapologetically. This is a call to
recognise the existence of non-hijra transgender persons. This is a
call for support from those of you who are straight, gay, lesbian,
feminist, bent, non-labelled, gender queers, multi-sexual. A call for
the annihilation of gender as we know it.
Gee Ameena Suleiman is a transgender man who works with LesBiT,
an organisation working with Lesbian, Bisexual and Transgender
men
DNA, 18/9/2011
Monks teach maleness to Thai
‘ladyboys’
ladyboys, have their controversial work cut out.
“Sometimes we give them money to buy snacks but he saved it
up to buy mascara,” headteacher Phra Pitsanu Witcharato said of
Pipop.
Novice monks’ days pass as in any other temple -- waking before
dawn, collecting alms and studying Buddhism -- but every Friday
attention turns to the katoeys at the attached school.
“Were you born as a man or a woman or can you not specify
your gender - not man or woman?” asked Phra Pitsanu at a recent
assembly. “You cannot be anything else but your true gender, which
is a man. As a novice you can only be a man.”
The temple has a stricter interpretation than others of rules governing behaviour during Buddhist training that is a key childhood
The 15-year-old aspiring “ladyboy” delicately applied a puff of talcum powder to his nose -- an act of rebellion at the Thai Buddhist
temple where he is learning to “be a man”.
“They have rules here that novice monks cannot use powder,
make-up, or perfume, cannot run around and be girlish,” said Pipop Thanajindawong, who was sent to Wat Kreung Tai Wittaya, in
Chiang Khong on the Thai-Laos border, to tame his more feminine
traits.
But the monks running the temple’s programme to teach masculinity to boys who are “katoeys”, the Thai term for transsexuals or
24
Thai 'ladyboys'
experience for many Thai boys.
Pupils are banned from using perfume and make-up and prohibited from singing, playing music and running.
“We cannot change all of them but what we can do is to control
their behavior to make them understand that they were born as a
man... and cannot act like a woman,” said Phra Pitsanu.
The Kreung Tai temple has run the course for boys aged between
11 and 18 since 2008, after former principle Phra Maha Vuthichai
Vachiramethi devised the programme because he thought reports of
katoeys in the monkhood had “affected the stability of Thai Buddhism”.
He told AFP that he hopes the teaching methods will be rolled
out to other temple schools to “solve the deviant behavior in novices”.
It is an attitude that enrages gay rights and diversity campaigner
Natee Teerarojanapong, who said trying to alter the boys’ sense of
gender and sexuality was “extremely dangerous”.
“These kids will become self-hating because they have been
taught by respected monks that being gay is bad. That is terrible for
them. They will never live happily,” he told AFP.
Gay and katoey culture is visible and widely tolerated in Thailand, which has one of the largest transsexual populations in the
The Gulf’s gender anxiety
Moral panic over transgender men and women is symptomatic of
the Gulf’s problem with shifting gender roles.
As women in the Gulf become more visible, both socially and
politically, and as migrants bring with them different ways of living,
the region’s governments are stepping up their gender policing. To
allay fears among conservative elements, they are regulating more
tightly what is deemed acceptable behaviour for men and women.
The direct targets of this backlash are those who visibly challenge
gender norms – in particular, boyat (an Arabisation of the English word
“boy”, generally referring to women with a masculine appearance)
together with transgender men and women.
In the past few years, dozens of articles and talkshows in the
mainstream media have decried the spread of boyat and “the third
sex” – a term used disparagingly to describe effeminate men and
transgender women. This media frenzy has propelled a moral panic
that manifests itself in discriminatory legislation across the region,
in police crackdowns and in campaigns to “set them straight”.
In 2007, Kuwait criminalised “imitating members of the opposite
sex”, leading to the arbitrary arrest and detention of hundreds of
transgender women. In research in Kuwait this year, Human Rights
Watch found that most of those targeted by the police had suffered
abuse, torture, sexual assault and harassment at their hands.
In 2009, Dubai began a public awareness campaign, “Excuse Me, I
am a Girl”, warning Emirati women of the dangers of masculinisation
and attempting to set them on the path to “femininity”.
The National daily newspaper reported recently that police and
the community development authority would collaborate to combat
the spread of boyat. Plainclothes policewomen have been deployed
in shopping malls and popular hangouts to catch women violating
arbitrary codes of female dress and behaviour, although it remains to
be seen what this campaign actually entails and whether any boyat
have been arrested.
The anxiety over the perceived erosion of cultural norms may
be seen as a reaction to the emirate’s rapid opening up and swift
demographic changes. The regulation of public morality has always
been a means for the state to reinforce its sovereignty, particularly
in rapidly changing societies.
There are many ways to understand this panic beyond facile
world, and Natee said the temple’s programme is “very out of
date”.
But Phra Atcha Apiwanno, 28, disputed the idea that society accepted ladyboys and said he joined the monkhood because of social
stigma about his sexual identity.
“The reason I became a monk is to train my habits, to control my
expression... I didn’t want to be like this,” he told AFP.
Monks have had limited success in their project -- three of the
six ladyboys to have graduated from the school are said to have
embraced their masculinity, but the remaining three went on to have
sex changes.
Pipop said he has struggled with his sexuality at the temple.
At home in Bangkok he dressed like a girl, putting on make-up
and taking hormones until he developed breasts, but he has since
stopped the treatment and wears only a surreptitious dab of powder
at the temple.
He does not believe he will live up to his family’s hopes that he
will become more manly.
“I can make them proud even I’m not a man,” the teenager said,
adding he had given up his ambition to be an airhostess and now
aspires to work in a bank.
He thinks he will have a sex change after graduation.
“Once I leave the monkhood the first thing I want to do is to shout, to
scream out loud saying: ‘I can go back to being the same again!’”
Aptransnet elits, 18/7/2011
explanations of “transphobia” and “homophobia”. In several of the
more liberal Gulf states such as Kuwait and the UAE, there is a relative
margin of state tolerance for both male and female homosexuality
among their citizenry as long as it is discreet and doesn’t visibly
challenge norms of acceptable male and female behaviour and
dress.
In fact, most arrests have been for “gay weddings” and boisterous
parties. Other arrests took place when behaviour became too public,
such as the case of the Saudi man who appeared in a YouTube video
behaving suggestively and gender-inappropriately in 2010. This
indicates that the greater fear is the perceived challenge to orthodox
practices and gender roles, family structures and “cultural values”
rather than homosexual behaviour per se.
The visibility of both boyat and transgender women as identifiable
markers of gender transgression has led to a disturbing public
vilification of both. In various media reports, the homosexual
component, while present, is not necessarily the most important
aspect of their behaviour; rather, attraction to women is seen as a
natural outcome of masculinity and vice versa.
The crossing of gender norms is far more salient in public discourse
about boyat and other gender-transgressive individuals. For example,
an Emirati psychologist publicly advocated treatment for female
masculinity early on, so that it does not lead to homosexuality.
Psychologists, social scientists and social commentators treat what
they understand as a rejection of women’s natural place as a pathology
that needs to be contained.
This is a symptom of a deeper anxiety about the erosion of traditional
gender norms and roles. In Kuwait, for example, the parliament
has been a battlefield over the role and behaviour of women in the
public sphere since 1996, with liberals making gains such as securing
women’s right to vote and run for public office while conservatives
succeeded in maintaining the sex-segregation law in universities.
The backlash is far from over, however, as more conservative MPs
try to ban “revealing” women’s swimwear and “regulate” plastic
surgery by banning any form of sex reassignment surgery and gender
correction.
In Dubai, where only about 12.5% of the residents are Emirati
while the rest are western, Asian and Arab expatriates and migrant
workers, tensions over a perceived loss of the city to foreigners and
continued on page 26, col.1
25
US embassy’s Pride celebrations in Islamabad more damage
than support
In accordance with the US President Barack Obama’s May 31,
2011 GLBT Pride Proclamation that, “we rededicate ourselves to
the pursuit of equal rights for all, regardless of sexual orientation or
gender identity,” US Ambassador for Pakistan, Richard Hoagland
and members of Gays and Lesbians in Foreign Affairs Agencies
(GLIFAA) hosted an event declared as ‘Islamabad’s first ever Gay,
Lesbian, Bisexual, and Transgender (GLBT) Pride Celebration’ on
June 26, 2011in the Federal Capital of Islamic Republic of Pakistan.
This high profile event was reportedly attended by 75 people including
Mission Officers, U.S. military representatives, foreign diplomats,
and leaders of Pakistani LGBT advocacy groups who showed their
“support for human rights, including LGBT rights in Pakistan at a
time when those rights are increasingly under attack from extremist
elements throughout Pakistani society”.
Unthankfully, all the sensational and flowery claptrap peddled
around this event turned out to be a disaster for the budding
underground Pakistani LGBT movement as the US Embassy
conveniently oversaw the repercussions this event would have brought
in an already critical country which is fighting against terrorism and
radicalization while sacrificing its peace, its liberty, its sovereignty
and countless lives of its law enforcement agencies and civilians
alike.
Within a few days, the streets of major urban cities of Pakistan
namely Islamabad, Karachi and Lahore were hailed with the students
and political workers of Jamaat-e-Islami, a religious political party,
chanting slogans at their highest pitches against homosexuals and
America. For them it was a golden opportunity to kill both ‘the evils
with a single stone’. Banners were displayed in major cities, especially
in the federal capital, within a few days demanding persecution
of gays and accusing Americans of propagating and imposing
this ‘westernized’ idea. The lash back didn’t remain limited to the
Jamaat-e-Islami only but sooner most of the political parties joined
this bandwagon to form a coalition against the government for their
menial political interests.
On the other hand, the Pakistani media, especially the local
Urdu newspapers and channels dealt with the issue with their usual
approach i.e. lacking all the required sensitivity and knowledge
to handle this crucial issue. Their sole concern was to raise their
circulations and that’s all. Although a few liberal and sensible voices
were raised through articles by Nuwas Manto, Hashim bin Rasheed,
The Gulf’s gender anxiety
the subsequent erosion of morals has led to a similar backlash. In
2008, two Britons were arrested and deported for allegedly having
sex on a beach. Newspaper commentators were quick to decry the
invasion of “foreign values” and the local press subsequently reported
that the government had detained dozens of tourists for a variety of
“indecent acts”.
In times of social strain, gender and sexuality often become the
focal point of broader anxieties, a phenomenon evident in media
frenzies, new proposed legislation, and the brutality of the police
and the impunity with which they act against an already vulnerable
population.
These actions violate the most basic human rights of these
individuals: the right to be free from violence and torture, to adequate
healthcare (which precludes “reparative therapy”) and the right to
self-expression and privacy. Within this logic, the bodily autonomy
of women and those who transgress gender norms will unfortunately
continue to be eroded and subject to politically sanctioned containment
and violence.
26
Marvi Sirmed and Mohsin Sayeed but most of these were published
in English dailies or in their online o-peds and blog sections while
leaving a huge void for majority Urdu readers. There was a dire need
to represent a sensitive and sensible portrayal of the issue in the Urdu
media to counter the venomous articles and hate speeches by Orya
Maqbool Jaan, Aamir Liaquat and Ibtisam Elahi Zaheer, who not
only openly condemned homosexuals but also denounced them as
sinful, non-Muslims, lesser than human beings and demanded capital
punishment for them with full zeal.
Meanwhile, our media circulated and aired all this hate speech while
completely overlooking its ethical and social responsibilities. I guess
it’s high time that our mushrooming news channels and newspapers
start differentiating between free speech and hate speech because
without it, they are only damaging the fabric of an already complex
and fragile society.
This unnecessary brouhaha by our sensational media started not
only an untimely debate in our society but also in our households. I
had never heard my mother, an ardent Urdu daily follower, having any
strong stance against anyone, say it a murder, a rapist or a dacoit but
one day she said, “All homosexuals should be stoned to death.”
Being a gay, living in Pakistan, from a traditional Muslim family
background, it was already an ordeal to be myself but after this US
Embassy triggered media frenzy things have turned even worse. The
people I am out to, are now looking at me with a different perspective.
They either consider me an undercover CIA agent with hidden agenda
to ‘westernize’ the cultural values of Pakistan or look as if declaring
that when the rogue mullahs will come and deliver me from my deadly
sins, they will religiously mind their own business. This isn’t solely
my own story but of several completely out or partially out queers in
Pakistan. On the other hand one can imagine the suffering and tension
of all those unheard, closeted voices, which were already afraid of
coming out and pretending to be ‘normal’. The level of concern and
uneasiness resulted from this highly inefficient and implausible event
has made them even more vulnerable at the hands of the society,
which is always ready to prosecute anyone different.
Surprisingly, it has also been reported that US embassy which
claimed to “support LGBT rights in Pakistan” isn’t going to entertain
LGBT Pakistanis for asylum. It’s as if that after starting a storm in
the cocktail, they are also having an easy way out.
After talking to several local LGBT activists I have gathered two
main stances regarding this whole fiasco and the future of Pakistani
LGBT movement. A very small number of activists suggested that
this event should be considered as a golden opportunity to come out
formally and launch a full blown LGBT movement in Pakistan, after
we had missed a similar opportunity in 2007 at the time of ShazinaShumile case. On the other hand, the majority of the activists opined
that it’s very sensitive and crucial time to come out and it’s better to
remain underground for the survival of this movement. Change can
be brought slowly and gradually, in safe and calculated ways. The
recent incident where a young LGBT activist Falak Ali of Neegar
Society was severely beaten up by the mullahs in the streets of Multan,
a southern Punjab city, in the presence of police is just an example
of the reaction of the public about this whole issue.
Still, Pakistani LGBT activists are hopeful and determined about
the future of LGBT movement in Pakistan and they strongly believe
that whenever there’s going to be any LGBT movement in Pakistan,
it will be most definitely by Pakistani people for Pakistani people. No
one else can decide or force the time for what and when we need to
emancipate ourselves from the restrictions of the heterosexist society.
We can have allies and support from other international organizations
but the primary stakeholders will be ourselves.
http://www.galaxymag/com/blog/index.php/2011/08/us-embassypride-celebations-in-islamabdad-more-damage-than-support/
Building the momentum to prevent HIV in MSM
The Global HIV Epidemics among Men Who Have Sex with Men
Chris Beyrer, Andrea L Wirtz, Damian Walker, Benjamin Johns, Frangiscos Sifakis, Stefan D Baral
World Bank, 2011
The Lancet, Vol 378, July16 2011
Larry Kramer, on accepting the Tony Award last month from the
Theatre Guild-American Theatrical Society for The Normal Heart
as Best Revival of a Play said: “To gay people everywhere, whom I
love so dearly…we are a very special people, an exceptional people,
and…our day will come.” My day came in 1982 when I secured
an Assistant Professorship in the Department of Medicine at the
University of California, San Francisco. I set about establishing a
behavioural medicine clinic fully integrated into general medicine
practices, researching chronic disease prevention, and teaching
interns and residents about psychological issues. One guest speaker,
a social worker, led a discussion with the residents about the special
medical needs of gay men. He was dead a month later from what
later became known as AIDS.
The “special and exceptional people” cited by Kramer had lived
through the 1970s and fought for human rights in the USA. That was
followed in 1981 with the scourge of AIDS that could have knocked
the wind out of the gay community. Instead, the community rallied
and used its skills and talents to advocate for resources to develop
community-based systems of care and prevention, and to ensure that
human rights were not trampled.
Unleashing that energy and skill to build a global movement to
improve HIV prevention and care services for men who have sex
with men (MSM) is long overdue. Momentum is building and Chris
Beyrer and co-authors make an important contribution. The Global
HIV Epidemics among Men Who Have Sex with Men documents
the extent of the HIV epidemic and outlines what needs to happen
to ensure that everything possible is being done to prevent and treat
HIV infection in MSM worldwide.
This volume documents the need in terms of the numbers, but also
addresses the scenarios in which HIV epidemics among MSM exist
in low-income and middle-income countries. The first scenario they
describe, characterising the HIV epidemic in most of Latin America,
is one in which MSM are the predominant exposure mode for HIV
infection in the population. In these countries MSM are ten to over
100 times more likely to have HIV than the general population. By
contrast, eastern Europe and central Asia have the highest rates of
HIV among injection drug users (IDUs), but MSM are still several
times more likely to have HIV than the general population. A different
scenario is found in sub-Saharan Africa where HIV is widespread
among heterosexuals, but even in these contexts MSM can have two
to 20 times higher prevalence of HIV than the general population
estimates. South, southeast, and northeast Asia are characterised
by epidemics that have equal contributions from MSM, IDUs, and
heterosexuals, although MSM are still at least ten times more likely
to have HIV than the general population.
The needs come not only from the numbers. Beyrer and his co-authors
document well the lack of prevention technologies focused on maleto-male transmission. They note that much effort has been expended
on encouraging voluntary HIV counselling, testing, and behavioural
interventions to decrease rates of unprotected anal intercourse by
encouraging less risky sexual behaviours. Although important, such
strategies are probably insufficient to produce immediate or lasting
change in HIV transmission. Male circumcision may be effective
for reducing acquisition of HIV through anal intercourse but we will
never know for sure because of the challenges of conducting a trial to
prove efficacy. Antiretroviral-based prophylactic approaches provide
the best opportunity for managing HIV among MSM. In the wake
of the IPREX, CAPRISA 004, and HPTN 052 trials, it is now time
to accelerate efforts to determine if similar benefits can be obtained
with rectal use of these or similar compounds. In some countries,
like Peru where the epidemic is concentrated in MSM, providing
universal access to care with MSM-sensitive services could actually
change the overall trajectory of disease spread.
Kramer’s use of the term “exceptional people” referred to the
gay community’s creativity, resilience, and energy to ensure that the
response to HIV was all that it could be in resource-rich countries
of the world. But not everyone views homosexual exceptionality in
a positive light. Many parts of the world view same-sex relations as
abnormal, deviant, sinful, and illegal. At best, most governments and
donor agencies have ignored HIV among MSM. At worst, MSM are
stigmatised and prosecuted. Homosexuality is criminalised in just
less than half of the UN member states with punishment ranging
from jail time to the death penalty.
Beyrer and his colleagues show us that MSM are everywhere in
the world and disproportionately affected by the HIV epidemic. They
highlight how MSM are underserved nearly everywhere and that the
global response to HIV will stall without access to treatment and
prevention services in the context of protection of fundamental human
rights. The HIV global epidemic among MSM is only beginning to
be addressed. Beyrer’s book is a key part of the momentum that will
continue to propel us in the right direction.
Part of the Faith, MSM and stigma and discrimination posters series produced by NFI Knowledge Unit in regard to Chritianity, Hinduism,
Islam and BUddhism, available on our website www.nfi.net
27
Homosexuality in Islam
Critical reflections on gay, lesbian and transgender Muslims
Scott Siraj al-Haqq Kugle
Published by Oneworld Publications 2010
From the back cover
Many Islamic authorities claim that homosexuality is categorically forbidden, but the
reality is much less clear-cut. There are no verses in the Qur’an that unambiguously
condemn homosexuals, and there are even some that suggest they can be tolerated
in Muslim communities. In addition, reports from Hadith that denounce homosexual
and transgender persons are of dubious authenticity.
This pioneering work is the first to tackle this complex and controversial issue
from a religious perspective. Scott Kugle [as a practicing Muslim] critically engages
with scripture, law and tradition to examine the foundations for prevailing attitudes
towards homosexuality in Islam. Arguing that Muslims can reconcile themselves with
the inevitable diversity in society without compromising their principles, Kugle makes
a forceful case for a renewed Islam that accepts all followers, regardless of sexual
orientation or gender identity.
From the Preface
Bismillah al-rahman al-rahim … In the name of God, the compassionate One, the
One who cares.
All praise belongs to God, the singular and subtle One, who created the universe
and made humankind reflect its diversity. All thanks be to God, who made from one
human being two, and from two made many and declared, we created you all from
a male and female and made you into different communities and different tribes.
Glory be to God who made a multitude in which each is unique and urged them to
reflect upon their differences, overcome their egoistic judgment of others, and find
the good in each reflected in others – so that you should come to know one another,
acknowledging that the most noble among you is the one most aware of God (Qur’an
[Q.] 49:13). Then to God they are called and all return. So let us each revere that God,
the forbearing One, the One who is just.
book does not convince them, it may encourage them to see the issues
Muslim communities, like all other religious groups, face the
in a new light, and in that sense it will have succeeded.
challenge of confronting diversity. Like other groups, Muslims
Why talk about gay, lesbian and transgender Muslims now? We
hesitate and stumble – sometimes inflicting violence along the way
must talk about them because they exist and are suffering – are
– before dealing justly with people in their diverse ranks who are
increasingly refusing to bear suppression in silence. Some turn to
different in appearance, language, ethnicity, creed, or bodily ability.
their religious tradition with faith-filled criticism, seeing it as not
Among the diverse ranks of people are some who are different in
merely part of the problem but as essential to possible solutions.
gender identity or sexual orientation. Such people are always a small
This book is based upon the experiences and hopes of those who are
minority yet they appear in every culture and religious community.
not content to wait for their Muslim sisters and brothers gradually to
This book is about the challenge before contemporary Muslims to
come to tolerate them. It offers theological reflections and insights
acknowledge, understand, and accept the diversity in their midst,
arising from lesbian, transgender and gay Muslims’ efforts to build
especially with respect to sexual orientation and gender identity. It
support groups to help them reconcile their sexual orientation and
contributes to the ongoing process of meeting that challenge and
gender identity with Islamic faith. Their struggle beckons Muslims to
urges Muslim actively to reconsider prejudgments they may hold
pay attention to this minority community’s experiences and insights
about gay, lesbian, or transgender members of their communities.
before dismissing them or opposing them.
Muslims have profound resources for dealing with theologically and
In that spirit and hope, I offer this book to the public. In the end,
ethically with diversity, but often ignore them when facing difference
only God knows best. I seek protection with God, the One who opens
and conflict. In their long history, Muslims have intensively dealt
possibilities (al-fattah). The loving One (al-wadud), the One with
with sectarian differences. Through this debate, the classical Islamic
sciences developed one of their best characteristics – the tolerance
subtle grace (al-latif).
1
for diversity of interpretation of sacred texts; this is expressed in the
Abou El Fadl, Speaking in God’s Name, p.10 note 8
words of Abu Hanifa, the renowned jurist, who is reported to have
said, “We know this [position] is one opinion, and it is the best we
Editors comment:
can arrive at, [but if] someone arrives at a different view, then he
This is an excellent book, despite acknowledged weaknesses, that
adopts what he believes [is best] and we adopt what we believe [is
begins to address the issue of faith and sexual diversity. The author
best].”1 This book invokes that long tradition of tolerance within
acknowledges that it does not look at same-sex behaviour and
the faith – which is often ignored or lost in contemporary Muslim
gendering amongst Muslims, but rather seeks to look at the essentialist
communities – in searching for faith-based response to gay, lesbian
approach to sexual diversity. That he admits is for another book.
and transgender Muslims.
Similar work is arising within the Christian faith, as well as in
For many Muslims, dealing with homosexuality or transgender
others, such as Hinduism and Buddhism, a growing critique of how
issues is a matter of sin and heresy, not difference and diversity.
organized faiths often evolve in systems of social policing of sexual
But when pressed, such Muslims often have no clear idea of what
and gender diversity , different from the original teachings.
homosexuality means, or simply deny that there are any homosexual
If we are to ensure that faith-based gay men, lesbians, transgenders,
people in Muslim families and communities. But there are Muslims
and others in the broad spectrum of sexual and consensual behavioural
who face issues squarely with open minds and humble hearts; they
diversity, to ensure access to citizenship, well-being and social justice,
may read this book and grapple with the issues it raises. Even if this
then this book helps us understand the issues.
28
New report shows major AIDS funders fail to track investments
for gay men and transgender people
Country-level data indicates severe underfunding for these highly vulnerable populations
A new report indicates that most major bilateral, multilateral and
private philanthropic funders that focus on HIV do not consistently
track their investments targeting men who have sex with men (MSM)
and transgender people. Produced by the Global Forum on MSM
& HIV (MSMGF), the report also examines tracking of domestic
government funding dedicated to these populations in all UN Member
States, revealing that only 25% these countries recorded levels of
HIV prevention spending for MSM in 2010 and no country tracked
spending for transgender people.
“With overwhelming evidence for the need to prioritize MSM and
transgender people in the global fight against AIDS, it is shocking that
so few funders actually know how much money they are spending on
these populations,” said Dr. George Ayala, Executive Officer of the
MSMGF. “Funders often talk about the importance of investing in
key affected populations, but budgets offer a clear reflection of what
their priorities actually are. HIV investments must be accounted for
in order to ensure that MSM and transgender people are getting the
support they need.”
In the few countries that did track HIV prevention spending for
MSM, expenditures fell far below the amount required to achieve
universal access. According to country reports made to the United
Nations in 2010, an average of 2% of national HIV prevention
budgets was dedicated to MSM in the 42 low- and middle-income
countries that tracked spending for this population – $15.8 million in
total. Nearly 75% of that sum came exclusively from international
sources, highlighting the role of bilateral, multilateral and large
private philanthropic funding in service provision for MSM in lowand middle-income countries.
The report follows a number of recent publications arguing in
favour of targeted investments for most-at-risk populations like
MSM and transgender people. In June of this year, the World
Bank issued a report demonstrating that increased access to HIV
prevention and treatment for MSM can change the trajectory of a
national epidemic. That same month, the Lancet published a new
global HIV investment framework that emphasizes the importance
of targeted investments for key affected populations.
“After 30 years of diffused investment, the world is realizing that
a focused approach is the only one that will work,” said Dr. Ayala.
“It is time for funders to reflect that in their budgets and track their
investments by population. Donor agencies must communicate and
coordinate to ensure adequate coverage without duplication, and we
must all aim for a higher level of accountability to the people we
serve.”
The full report, “An analysis of major HIV donor investments targeting
men who have sex with men and transgender people in low- and
middle-income countries,” can be accessed online at
http://www.msmgf.org/files/msmgf/Publications/Global_Financing_
Analysis.pdf
Who takes risks?
and children. The difference between the lab and the real world,
Figner says, is partly the extent to which they involve emotion. In
an experiment where adolescents’ emotions got triggered strongly
(with a gambling task in which they made stepwise decisions of
increasing risk and got immediate feedback on how good or bad
they were doing, a situation much closer to real-world incremental
or dynamic risk decisions), they looked very different from children
and adults and took bigger risks, just as observed in real world settings.
Emotion can affect decisions about risk-taking in all age groups,
not just adolescents, Figner says. And the emotion doesn’t necessarily have to be triggered from the decision situation itself even,
for example. if you’re angry about an argument, you might later
drive too fast on the highway.
Science Daily (July 27, 2011)
It’s a common belief that women take fewer risks than men, and
that adolescents always plunge in headlong without considering the
consequences. But the reality of who takes risks when is actually
a bit more complicated, according to the authors of a new paper
which will be published in the August issue of Current Directions in
Psychological Science, a journal of the Association for Psychological Science. Adolescents can be as cool-headed as anyone, and in
some realms, women take more risks than men.
A lot of what psychologists know about risk-taking comes from
lab studies where people are asked to choose between a guaranteed
amount of money or a gamble for a larger amount. But that kind of
decision isn’t the same as deciding whether you’re going to speed
on the way home from work, wear a condom, or go bungee jumping. Research in the last 10 years or so has found that the way people choose to take risks in one domain doesn’t necessarily hold in
other domains.
“The typical view is that women take less risks than men, that
it starts early in childhood, in all cultures, and so on,” says Bernd
Figner of Columbia University and the University of Amsterdam,
who cowrote the paper with Elke Weber of Columbia University. The truth is more complicated. Men are willing to take more
risks in finances. But women take more social risks -- a category
that includes things like starting a new career in your mid-thirties
or speaking your mind about an unpopular issue in a meeting at
work.
It seems that this difference is because men and women perceive
risks differently. That difference in perception may be partly because of how familiar they are with different situations, Figner says.
“If you have more experience with a risky situation, you may perceive it as less risky.” Differences in how boys and girls encounter
the world as they’re growing up may make them more comfortable
with different kinds of risks.
Adolescents are known for risky behavior. But in lab tests, when
they’re called on to think coolly about a situation, psychological
scientists have found that adolescents are just as cautious as adults
Sexual Health
Sexual health is a state of physical, emotional,
mental and social well-being related to sexuality; it
is not merely the absence of disease, dysfunction or
infirmity. Sexual health requires a positive approach
to sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and
violence. For sexual health to be attained and
maintained, the sexual rights of all persons must be
respected, protected and fulfilled.
WHO Definition
Sexual rights embrace human rights that are
already recognized in national laws, international
human rights documents and other consensus
documents. These include the right of all persons,
free of coercion, discrimination and violence.
29
MSM can effectively self-test for chlamydia, gonorrhea
Men who have sex with men can self-test for chlamydia and gonorrhea
as effectively as health care providers can, according to findings from
a study involving 286 adult men.
Data from previous studies show that the risk of HIV infection
increases in men who have sex with men (MSM) who have other
sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia
University, New York. Therefore, regular STD testing for MSM is
important, however “less than 14% of physicians routinely screen
male patients for chlamydia and gonorrhea,” Dr. Sexton said at
a congress of the International Society for Sexually Transmitted
Diseases Research. Lack of time, lack of staff, and lack of knowledge
were the reasons most often given for not screening.
In this study, Dr. Sexton and colleagues in Washington, D.C.
compared the results of nucleic acid amplification testing (NAAT)
for chlamydia and gonorrhea when MSM administered the tests
themselves and when a health care provider administered the tests.
Patients were recruited from the Whitman-Walker Clinic in
Washington, and they were eligible for the study if they reported
having intercourse with a man within the past 6 months and if they
wanted to be screened for rectal and pharyngeal chlamydia and
gonorrhea.
The screening tests were performed twice on each patient, and
the patients were randomized to initially perform self-tests or to be
tested by a health care provider. For the self-test, patients were given
instructional cards, and a health care provider was present, but offered
no additional assistance.
Overall, both providers and patients had positive test results for
12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25
cases of rectal chlamydia, and three cases of pharyngeal chlamydia.
Both providers and patients had negative results for rectal gonorrhea,
pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia
in 193, 256, 183, and 277 tests, respectively.
The only time a provider’s test was positive and a patient’s test
was negative was a single case of pharyngeal gonorrhea. However,
patients’ tests were positive when providers’ tests were negative in six
cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three
cases of rectal chlamydia, and two cases of pharyngeal chlamydia.
The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal
chlamydia, and pharyngeal chlamydia using only the provider’s
positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using
both the patients’ and providers’ positive results was 8.5%, 8.9%,
13.3%, and 1.8%, respectively.
There were no significant differences in the detection of gonorrhea
between the patients and providers, Dr. Sexton said. Patients appeared
to identify significantly more cases of gonorrhea, which might be
due to false positives, cross-contamination, or more rigorous testing
on the part of the patient, she noted.
Test results were no different based on whether the patient or the
health care provider collected samples first.
Self-administered STD tests could reduce the time burden on
health care providers and expand the number of MSM who are
tested, said Dr. Sexton. In addition, informal feedback from patients
suggested that, for the most part, the tests were easy to perform and
more acceptable than allowing a health care provider to collect the
samples.
“I talked to a lot of the patients, and many of them said they would
prefer to do the testing on their own,” Dr. Sexton said.
The results suggest that self-testing is a feasible option. However,
some modifications need to be made to the testing instructions, and
more research is needed to determine the best way to incorporate
self-testing into a clinical setting, she noted.
Dr. Sexton had no financial conflicts to disclose. Test kits used in
the study were provided by Gen-Probe.
MSM Asia, 23/7/2011
New city-based HIV strategy in China to address HIV infection
among men who have sex with men
Government officials in Chengdu, China, hosted a workshop today
to address the city’s rapidly-growing HIV epidemic among men who
have sex with men (MSM). Participants in the workshop discussed
a new five-year strategy that calls for a dramatic scale-up in the
coverage of HIV prevention and treatment for the MSM population
in Chengdu and promotes the participation of community-based
organizations in the city’s response to HIV.
“Cities have a critical role to play in the AIDS response,” said Mr
Yang Xiaoguang, Director of Chengdu Health Bureau, speaking at
the workshop on 9 July. “By working to build a strong, multi-sectoral
response in Chengdu, with meaningful community participation,
we can scale up coverage of prevention, treatment and care services
among MSM and halt the spread of HIV in our city,” he added. Also
joining the workshop were senior officials from China’s Ministry of
Health, government officials from Sichuan Provincial Health Bureau,
representatives from civil society and Michel Sidibé, Executive
Director of the Joint United Nations Programme on HIV/AIDS
(UNAIDS).
According to government figures, approximately 5% of men who
have sex with men in China are living with HIV—88 times higher
than the national HIV prevalence of 0.057%. In the city of Chengdu,
more than 10% of the MSM population is living with HIV. Across
China, HIV prevalence is generally higher in cities and urban areas,
reaching almost 20% in some south-western cities.
“Cities are at the heart of China’s development and progress, and
30
must remain at the forefront of its HIV response,” said Mr Sidibé.
“Through bold action to address HIV among men who have sex
with men, cities can lead the way to achieving the UNAIDS vision
of zero new HIV infections, zero discrimination, zero AIDS-related
deaths. We hope that over the next year, many more Chinese cities
will implement city-based MSM strategies,” he added.
Approximately one in three new HIV infections in China is among
men who have sex with men. However, according to government
figures, less than half of the MSM population has access to HIV
testing services and less than 15% of HIV-positive MSM who need
treatment are receiving it. Chengdu’s new strategy underscores the
critical role that community-based organizations can play in reaching
men who have sex with men and other populations at increased risk
of HIV infection.
Tong Ge, Coordinator of China’s MSM Health Forum and a
participant in the Chengdu workshop, noted the importance of
ensuring strong cooperation between government and civil society.
“By building on the experiences of cities like Chengdu, which already
have well developed AIDS responses, we can help to promote multisectoral collaboration on an equal, orderly basis and strengthen the
response to HIV nationwide,” said Mr Tong. “The next step will be to
implement similar strategies in other cities nationwide,” he added.
World Bank, 09 July 2011
The bottom line
Anal-sex talk still makes people blush. But it’s also increasingly popular in the hetero world.
Every couple of years, another once-scandalous sex taboo starts
making its way toward the commonplace. A decade ago, blow jobs
were what people whispered about; then three-ways became the
naughty bedroom act. Now, it’s anal sex—but according to the Centers
for Disease Control’s National Survey of Family Growth, it’s rapidly
becoming a regular feature of hetero couples’ horizontal activities.
The survey, released last year, showed that 38.2 percent of men
between 20 and 39 and 32.6 percent of women ages 18 to 44 engage
in heterosexual anal sex. Compare that with the CDC’s 1992 National
Health and Social Life survey, which found that only 25.6 percent of
men 18 to 59 and 20.4 percent of women 18 to 59 indulged in it.
Anecdotal research also demonstrates curiosity is on the rise.
Babeland’s anal-sex workshops are now held three or four times
a year, instead of once, and they’re filled with straight couples.
“More and more, people are devoting themselves to learning about
anal pleasure,” says Carolyn Riccardi, education coordinator for
Babeland’s New York retail stores. “Male-to-female anal sex has
been happening since the dawn of time,” she says. “What’s different
now is that women are actively learning how to enjoy it and have
fun with it.”
“I first did it with my husband,” says Lisa, a recently divorced
thirty something from across the Hudson. “It was a regular part of
our married sex life, and I enjoyed it. I think it can feel good for
anyone—except if you’re too uptight about it, meaning, you’re
literally tight-assed.”
Ah, yes, the anal-sex dilemma: If you think it’s going to hurt, it
will. Relaxation isn’t the only requirement for a good experience:
Too much aggression (and no lube) can put a woman off anal sex
permanently.
And not all guys are anal enthusiasts, either. Jim, a 27-year-old
consultant, has been given the opportunity by willing partners but
hasn’t taken the plunge. He agrees that it seems to be on the rise
among his friends but wonders whether it’s “really a cultural shift
or just something we ease into semi-contemporaneously as we age,
like marriage or buying real estate or listening to jazz rap.”
The idea that anal is something couples eventually turn to for sexual
variety seems to be supported by the CDC survey, which shows the
lowest numbers among those who’ve never been married and are
not cohabiting, compared with those who are cohabiting, married,
or divorced.
For me, anal sex is very intimate, much more so than regular sex.
If I care about someone, I’m willing to experiment,” says Irene, a
33-year-old East Village environmentalist who has been doing it with
Lax, a 30-year-old Wall Streeter. But when we press Lex on whether
he likes to receive anal attention from his girlfriends, he responds,
“Call me old-fashioned, but the guy should be the penetrator, not
the penetratee, no?”
It’s an attitude still widely held by many straight men today, and
one that’s reflected in the CDC survey: Though the report is chock-full
of all kinds of straight, gay, and lesbian sex in fairly graphic detail,
there’s absolutely no research on female-to-male anal play. It turns
out that the straight-male fear of reciprocal anal play is a potent mix
of sexism and homophobia; a straight man can do it to someone else,
but having it done to him isn’t okay.
But the newly discovered anti-cancer benefits of prostate
stimulation are giving straight guys—especially the progressive New
York breed—a legitimate excuse to be more, shall we say, open to
exploration. And men’s magazines, which until recently discussed anal
sex only in terms of how to trick a girlfriend into giving it up, now
publish articles on the Aneros—the doctor-created, FDA-approved
prostate stimulator—and the male G-spot, a.k.a. the P-spot, a.k.a.
the He-spot.
“Straight guys come in looking for the Aneros,” says Riccardi,
“but once they get all their questions answered, they’ll walk out
with something more fun and less medical for themselves. Or their
girlfriends will come in looking for ways they can be the penetrator,
too.” When Riccardi first started working at Babeland three years ago,
she would gently ask straight female customers if they’d ever tried
sticking a finger up their boyfriend’s or husband’s bum, and they’d
shoot her looks of horror. “Now when I ask them that question, they
almost all say, ‘Oh, sure.’ ” The store’s strap-on sales have never
been higher.
“My wife is totally turned on by the idea of ‘having’ me, as that’s
just not something women really get to do most of the time, and it’s
not something that guys have usually had done to them. It really is a
reversal in the most primal of ways,” explains newlywed Brooklynite
Anthony. “I think anyone who doesn’t enjoy it or thinks they wouldn’t
is hindered by their own hang-ups. It feels good, period. And breaking
taboos is sexy. Variety is sexy. Being vulnerable is sexy.”
IRMA, 14/7/2011
Gonorrhoea strain found to be ‘resistant to antibiotics’
A new strain of the sexually transmitted disease gonorrhoea has become resistant to antibiotics, international research shows.
Analysis of the bacterium that causes gonorrhoea found a new variant
which is very effective at mutating.
Scientists from the Swedish Reference Laboratory warn that the
infection could now become a global threat to public health.
New drugs to delay the spread of the infection are needed, experts
say.
The first case of antibiotic-resistant gonorrhoea was found in
Japan.
By analysing this new strain of neisseria gonorrhoea, called H041,
researchers identified the genetic mutations responsible for the new
strain’s extreme resistance to all cephalosporin-class antibiotics.
Cephalosporins are used to treat a wide variety of bacterial
infections. They are also closely related to the penicillins.
“A team of researchers will present its findings at a conference
run by the International Society for Sexually Transmitted Disease
Research in Canada.
Dr Magnus Unemo, from the Swedish Research Laboratory
for Pathogenic Neisseria, said it was an alarming and predictable
discovery.
“Since antibiotics became the standard treatment for gonorrhoea in
the 1940s, this bacterium has shown a remarkable capacity to develop
resistance mechanisms to all drugs introduced to control it.
“While it is still too early to assess if this new strain has become
widespread, the history of newly emergent resistance in the bacterium
suggests that it may spread rapidly unless new drugs and effective
treatment programs are developed.”
Prevention not cure
Rebecca Findlay, from the Family Planning Association, said it was
a worrying sign.
“Prevention becomes more important because we know antibiotics
won’t always work. Gonorrhoea can affect people of all ages and
everyone should be now focusing on looking after their sexual
health.”
Dr David Livermore, director of the antibiotic resistance
monitoring laboratory at the Health Protection Agency, said that the
cephalosporin antibiotics used in the UK are still effective for treating
gonorrhoea.
31
'Explosion' of sex-spread hepatitis C in HIV-positive men
There is an ongoing “explosion” of deadly hepatitis C among men
who have sex with men.
It’s spread mainly by anal sex, often enhanced by
methamphetamine, according to a report in the July 21 issue of the
CDC’s Morbidity and Mortality Weekly Report.
“We are having an explosion of sexually transmitted hepatitis
C,” study researcher Daniel S. Fierer, MD, of New York’s Mount
Sinai School of Medicine, tells WebMD. “We have uncovered an
emerging epidemic of sexual transmission of hepatitis C. And the
main reason is men having anal sex without a condom.”
It’s no surprise to experts who treat hepatitis C. Liver cancer and
cirrhosis caused by hepatitis C virus (HCV) already is the leading
cause of death among people with HIV infection who have access
to HIV drugs. Some 30% of Americans with HIV are co-infected
with HCV.
Sexual transmission of HCV among people without HIV is
rare, notes Eugene R. Schiff, MD, director of the Center for Liver
Diseases at the University of Miami, who was not involved in the
Fierer/CDC study. Among heterosexual couples, he says, only 2% of
those with HCV infect their partners after 20 years of monogamous
marriage.
The same may be true for men who have sex with men -- if they
practice safe sex.
“Our data do not support sexual HCV transmission between
HIV-negative men,” Fierer says. “There is reasonable data that
HIV-negative men are not part of this epidemic.”
But that’s not the case for HIV-positive men, notes Lynn E.
Taylor, MD, of Brown University. Taylor was not involved in
resistant gonorrhoea strain
“But our lab tests show that the bacteria are becoming less sensitive
to these cephalosporins, with a few treatment failures reported. This
means that we are having to change the type of cephalosporin that is
used and to increase the dosage.
“The worry is that we will see gonorrhoea becoming a much more
difficult-to-treat infection to treat over the next five years.
“Prevention is better than cure, especially as cure becomes harder,
and the most reliable way to protect against STIs - including resistant
gonorrhoea - is to use a condom with all new and casual partners.”
Gonorrhoea is one of the most common sexually transmitted
diseases in the world.
Some 50% of women infected with gonorrhoea have no symptoms.
The same is true of 2-5% of men.
When symptomatic, gonorrhoea is characterised by a burning
sensation when urinating and can cause discharge from the
genitals.
If left untreated, gonorrhoea can lead to serious and irreversible
health complications in both women and men.
http://www.bbc.co.uk/new/health-14078098
Naz Foundation International has moved its
Secretariat in London to:
1.3 Quay House. 2 Admirals Way
London, E14 9XG, United Kingdom
Phone: +44 (0) 20 7868 1510;
Fax: +44 (0) 20 8741 9841
32
the Fierer study. In a study published last March, Taylor and her
colleagues showed that new HCV infections are relatively common
among HIV-positive men who do not use intravenous drugs -- a
phenomenon previously reported in Europe and Australia.
“We have robust evidence of increasing HCV incidence among
men who have sex with men who do not inject drugs but do engage
in high-risk sexual behaviors,” Taylor, who was not involved in
the Fierer study, tells WebMD. “It is the new sexually transmitted
infection in this population. I am very concerned.”
Schiff notes that when HIV-positive men get HCV, they have
much higher levels of the hepatitis C virus in their blood. Taylor
and Schiff warn that hepatitis C infection progresses quickly in
people with HIV infection.
“These men are sitting ducks for liver cancer,” Taylor says. “If
they don’t get treated and get HCV eradication, they are at risk of
cirrhosis or liver cancer. ... We are seeing tons of gay men newly
diagnosed with HIV, and then with HCV. I could go to a funeral of
an HCV patient every week.”
Anal sex, methamphetamine linked to HCV
Fierer and colleagues gave detailed questionnaires to 34 HIVpositive men with new hepatitis C infections, as well as to 67
closely matched HIV-positive men who tested negative for HCV.
In detailed questioning and interviews, the men denied any form of
intravenous drug use -- even the use of prescription testosterone.
There was “quite a laundry list” of behaviors linked to new HCV
infections. But careful statistical analysis revealed two factors
that independently raised an HIV-positive man’s risk of HCV
infection:
• Receptive anal intercourse with ejaculation of the partner
increased HCV risk 23-fold.
• Having sex while high on methamphetamine increased HCV risk
28.5-fold.
“This is a smoking gun for classic sexual transmission with
semen,” Fierer says.
Fierer warns that while the study implicates semen, it does
not suggest that anal sex without ejaculation is safe. It isn’t.
And a troubling study of outbreaks of HCV among HIV-positive
German men suggested last March that prolonged or traumatic anal
intercourse often exposes both partners to infected blood.
As for methamphetamine, Fierer says the problem is that it
removes sexual inhibitions while prolonging the sex act.
“Crystal meth is an incredibly disinhibiting drug. This is very much
used for sex, and judgment and all kinds of other things go out the
window,” he says. “Patients tell me, ‘Well, now it seems like a very
bad idea to take meth and have unprotected sex with a partner who
ejaculates in you. But at the time it seemed like a great idea.”
Taylor warns that using erectile dysfunction drugs to prolong sex
also appears to be a risk factor for HCV transmission among HIVpositive men.
Sex-spread HCV threatens new HCV treatments
New HCV treatments make it much more likely that a person can be
cured of hepatitis C. But there’s a catch.
Schiff notes that a person can be infected with hepatitis C over
and over again. He’s already seen patients who seem to be getting
better with treatment, and then suddenly are reinfected.
That’s going to be a problem, he says, because powerful new
hepatitis C drugs have an Achilles heel -- the virus quickly becomes
resistant. If a person is reinfected with HCV during treatment with
one of the new drugs, there’s a good chance the virus will acquire
resistance to all similar drugs.
“If people are re-exposed to HCV after treatment with new
antivirals, there will be resistant virus,” he predicts.
CDC Morbidity and Mortality Weekly Report, 21/7/2011

here - NFI

Transcription

Similar documents

PDF | 14.6mb

LI EF ORE - MSM Guide

Facilitators and Challenges to ART Adherence among Men

INDBX NUMBER: SUPERVISOR: INSTITUTIOI{:

Babies born from HIV/AIDS positive mothers

Implementation Letter

For joint pain

Organic Sulfur - MSM

Balancing fear with Efficacy: The case of Intersexions