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Martin Foreman

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Homosexualities, HAM and HIVOS

Amsterdam, Netherlands, November 2004: It's twenty-five years since doctors in Los Angeles and New York first diagnosed rare strains of pneumonia and skin tumours in a few of their homosexual patients. The diseases resisted treatment and were symptomatic of an immune failure that led to death within weeks or months. It took eighteen months for the news to reach the scientific press - a few paragraphs in the US government-published Morbidity and Mortality Weekly Report in June 1981. By the end of that year it was clear that a new disease was affecting increasing numbers of gay men in the United States. AIDS had arrived.

Epidemiologists suspected that AIDS was caused by a virus and after a period of intensive research, HIV was isolated in 1983. Like any other virus, HIV is transmitted from person to person through clearly identified means - in this case, in semen, vaginal fluids and blood. That means that anyone whose behaviour frequently exposes them to any of these body fluids is at risk of contracting the disease from someone who is already infected, irrespective of the sex of either partner, their age, race or sexual orientation.

That was the reality known to a few virologists and other scientists and to the even fewer lay men and women who were following the research. But to the rest of us, with only some of the facts at our fingertips and unaccustomed to rigorous thought, perception was different. Most of those who were falling ill and dying were gay men, in Western Europe, Australia, Canada and New Zealand, as well as the United States. Sure, a few others were diagnosed with AIDS, including women sex workers, heroin users and Haitians of both sexes and even, it was reported, men and women in a remote corner of Uganda, but these were all at the margins of Western society. To the general public this was a Gay Disease - or in the words of the media and some religious leaders in the United States - a Gay Plague.

The identification of HIV/AIDS as a gay disease discouraged many governments across the world from instigating the kind of measures necessary to educate the general public about the disease and ways of protecting oneself. It also meant that in many countries, the lead in HIV/AIDS education, on a spectrum from counselling to high-profile activism, was taken by gay men rather the government. By 1990, the fruits of their work could be seen. The majority of gay men in the West and increasing numbers in other countries, such as Brazil, were aware that they were vulnerable to HIV and were using condoms, significantly reducing the rate at which the epidemic was spreading.

Leap forward to 2004. Worldwide, twenty million people have died of AIDS and twice that number are living with HIV. The number of women infected has risen dramatically and, globally, represents 45% of those with the virus. This is no longer a gay disease, right? Well, yes and no. It's not a gay disease in that it is clear that anyone can contract HIV, but is a gay disease in that millions of men who have sex with men are at risk of infection. Not only that, but a wide range of psychological, social, political and economic factors increase their vulnerability. These same factors limit the effectiveness and scope of prevention programmes for such men in many countries across the world.

It was to provide an uptodate overview of the challenges to effective HIV/AIDS prevention for men who have sex with men in the developing world that the Dutch organisation HIVOS organised a one day seminar in Amsterdam last month, entitled Homosexualities, HIV/AIDS and HIVOS: Why?. Experts flew in from across the globe, including yours truly, to share their experiences and ideas in front of an audience of three hundred people.

The day began with a minute's silence to honour the memory of Fanny Ann Eddy Viola, an activist and cofounder of the Sierra Leone Lesbian and Gay Association, who was murdered in Freetown at the end of September. She would have been at the meeting, one of almost a dozen African men and women who were present, representing the new wave of activists on that continent who have set out on the long journey to achieve respect and full citizenship in their societies as individuals sexually and emotionally attracted to their own sex.

The first of the day's four presentations was given by Shivananda Khan, who, in his long robe, announced for the first time in public that he was a real man. That was not an innocuous statement. It was both a response to a discussion that Shiv and I have been having over the last year and which I covered in a previous column (click here) and an introduction to his topic, which covered the wide range of male identities in South Asia. More than any other presentation that day, Shiv drew our attention to the key word in the title - homosexualities - by pointing out some of the many cultural constructs in which men who have sex with men identify themselves. 

As one of the two respondents to Shiv's presentation, I focused on two of the issues that had arisen. Use of the word "gay", I said, seems to reflect geographical and conceptual societies (think Western Europe and the Indian middle-class) where social and sexual relationships are mostly egalitarian, while indigenous terms, such as kothi are used in societies where there are often significant social and economic differences between sexual partners. I again asked the question that I had raised in that same column, as to whether it was appropriate to support, rather than challenge, indigenous identities if these identities are misogynistic and possibly counter-productive. (No, the issue wasn't discussed, and no, I don't know what the answer is.) I suspect - although I did not say so at the time - that these identities will wither away relatively quickly and within a generation gay will become the preferred term for most men across the world who have sex with other men.

The second presentation came from Tim Frasca, a USAmerican with long experience in Chile, who discussed the inability of the gay and feminist movements in Latin America to unite to address issues of HIV/AIDS, sexuality and gender. Both Tim and his respondents highlighted the commonalities and diversities between the two groups, and I was once again left with the impression that our intellectual desire to work with each other is defeated by much deeper psychological concerns. As men who have sex with men, we may have strong personal relationships with individual women but for most of us there is little emotional empathy for women in general. That lack of empathy prevents us from fully understanding and fighting for feminist issues. The same is true in reverse - women do not fully understand the needs and concerns of men who have sex with men. 

Gary Dowsett, in his response to Tim's presentation, revealing his dislike of the term men who have sex with men (MSM - an issue covered here), offered his alternative: homosexually active men / males. I like his suggestion, but hope that it never gets contracted to HAM, particularly among English-speakers in the Muslim world where already stigmatised men are unlikely to want to describe themselves as pig meat.

The third presentation was by Edwin Cameron, a South African judge who in the 1990s came out first as gay and later as HIV-positive. He and his respondents pointed out that although the epidemic was overwhelmingly transmitted heterosexually in southern Africa, many gay men in the region had played influential roles in AIDS education and in campaigning for access to antiretroviral drugs. Yet those same gay men had often been reluctant to highlight the risks of transmission among their own communities. Some good points were made, but the platform of three white Africans was not representative of most men on the continent who have sex with men and an opportunity was lost to more fully understand and engage the delegates from Nigeria, Tanzania, Uganda and elsewhere in Africa. 

In the final session, Ruben Mayorga of Guatemala gave a compelling presentation on miserably small amounts of money available for prevention and care for men who have sex with men in Latin America, given that they represent up to 50 percent of recorded HIV/AIDS cases in the region. The day drew to a close with a range of points being made from the floor, including the reminder that gay rights are human rights and that HIV/AIDS prevention for men who have sex with men will only become effective when it is included in mainstream prevention programmes. And, fond of the sound of my own voice, I added the observation that while there was a wide variety of men who have sex with men present, there were no transgenders, who form a highly visible community in many countries in the developing world and who are often more vulnerable than other men who have sex with men to HIV.

The final event of the day was the speech by Manuela Monteiro, HIVOS' General Director, acknowledging and thanking Frans Mom for his 22 years' work with the organisation, at least half of which was spent as a vociferous, politically incorrect and highly effective advocate for gay men and lesbians in the developing world. Frans is the gentleman pictured For more information on HIVOS, click here.

As such conferences go, it was too short, but as such conferences go, it was better than most, with a high standard of presentations and interventions from
both the stage and the audience. Unlike the global AIDS conference in Bangkok in July, I came away from the HIVOS meeting feeling energised and optimistic.

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