I'm pretty over being told to put my hands up in the air...
Brandon O'Brien is a writer and poet from Trinidad. This is his other brain.
Caution: May contain intense critical analysis, long rants, and uncomfortable (but necessary) subject matter.
This report shows that the relative risk of contracting HIV is significantly higher among men who have sex with other men (MSM) in Belize than in the general population. This is also true in several other countries for which data are available, including countries that have repealed the law that criminalizes anal sex and countries where the law still applies.
Some Public Health practitioners have hypothesized that decriminalizing the practice of anal intercourse among consenting adults would lead to a reduction in the incidence rate of HIV infections among MSM. To date, published data have not substantiated this hypothesis.
From Chris Beyrer et al’s July 2012 Lancet paper on HIV in the MSM community:
Making an impact in HIV epidemics among MSM will require achieving adequate coverage of packages of prevention interventions. According to our data, it may be necessary to reach more than half of at-risk MSM to have substantial impact. To achieve such coverage, policy reforms, including decriminalization of male-male sex, are needed to create enabling environments in which men can safely access care and prevention services.
From Beyrer’s 2010 Clinical Infectious Diseases supplement ‘Global Prevention of HIV Infection for Neglected Populations: Men Who Have Sex with Men’:
For MSM in developing countries, basic services for prevention of HIV infection have yet to reach the large majority of men. Homophobia and discrimination limit access of MSM to prevention services and markedly increase vulnerability, as does criminalization of same-sex behavior. Decriminalization of same-sex behavior is a structural intervention for prevention of HIV infection and has recently been embraced by a nonbinding statement from the United Nations.
The refusal to acknowledge the medical merit of the decriminalization of same-sex behaviour in curbing the epidemic of HIV/AIDS and other STIs in the developing world is a refusal to curb the epidemic overall.
Organizations committed to HIV prevention and the care of those affected have a mandate to support policies that work. When medical practitioners insist upon not supporting those policies in their capacity as members of those organizations, those organizations are within that mandate to sack them. It would work the exact same way, for example, if a global coalition of pediatricians dedicated to ensuring young children get vaccinated chose to sack a doctor who insisted against the evidence that vaccines cause autism.
Bain is right when he says that MSM, especially in the Caribbean, are at high risk of contracting STIs such as HIV. After all, he got those facts largely from Beyrer.
Bain is wrong when he says that the solution is to continue criminalizing same-sex behaviour. Such a legal position makes it even more difficult for MSM to get or choose to seek treatment in a society that already holds a dangerous social stigma against LGBT persons. Bain is therefore woefully underinformed as to the policies that the majority of public health professionals are in support of - policies that CHART was committed to supporting - or was willing to lie by omission as it pertains to the facts related to the issue, since he was willing to quote Beyrer’s numbers, but not Beyrer’s conclusions.
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