A large-scale study of gay men and other men who have sex with men (MSM), conducted by the Global Forum on MSM & HIV (MSMGF), indicates that only one third of MSM can easily access condoms, lubricant, HIV testing, and HIV treatment. Combining a multi-lingual online survey and focus group discussions, the study suggests that structural barriers like homophobia play a significant role in blocking access to HIV services for MSM, while greater comfort with health service providers and more community engagement are associated with higher levels of service access.
The MSMGF's study aimed to identify factors that affect access to HIV services for MSM. The online survey conducted earlier this year included 5779 men from 165 countries. In addition, the MSMGF collaborated with African Men for Sexual Health and Rights (AMSHeR) to conduct focus group discussions with 71 MSM across five cities in South Africa, Kenya, and Nigeria.
Of men who participated in the online survey, only 35% reported that condoms were easily accessible, 21% reported easy access to lubricant, 36% reported easy access to HIV testing, and 42% reported easy access to HIV treatment. Levels of access differed by country income level, with reduced access to services more commonly reported in lower income countries.
"Such poor levels of access at the global level are unacceptable," said Dr. George Ayala, Executive Director of the MSMGF. "The differences in access by country income are especially important to note as the Global Fund moves into a new funding model where countries are grouped into bands by income level. Even in upper middle income countries, MSM still have extremely low access to services. Without targeted funding to MSM and other key populations, the new funding model may continue to deteriorate levels of access for the groups most affected by HIV."
The MSMGF research team also conducted analyses to identify barriers (factors associated with lower access) and facilitators (factors associated with higher access) that impact the ability of MSM to obtain condoms, lubricant, HIV testing, and HIV treatment.
Adjusting for country income, greater access to condoms, lubricants, and HIV testing were associated with less homophobia, greater comfort with health service providers, and more community engagement. Among participants living with HIV, higher access to HIV treatment was associated with less homophobia and greater comfort with health service providers. Greater access to lubricants and greater access to HIV testing were also associated with less outness (the degree to which others know of one's sexual orientation) and fewer negative consequences as a result of being out, respectively.
"As we collectively forge ahead into the new territory of treatment-based prevention, it is clear that many of the old challenges remain," said Noah Metheny, Director of Policy at the MSMGF. "Addressing structural barriers remains essential to realizing the potential of HIV interventions for MSM, and it becomes more important with each new prevention and treatment option that is made available. Investments in the development of new interventions must be accompanied by efforts to increase access."