Jorge Saavedra's
moment of truth came in the middle of an impassioned
speech to 5,000 people about the paltry amount of money
being spent to stop the spread of AIDS among gay men.
The Mexican
federal official paused, then said publicly for the first
time that he was gay.
As he held up a
photo of himself with his partner, the crowd applauded
wildly. Afterward, men from Africa and India congratulated
him with tears in their eyes.
''They told me
that I was a hero and that they wished they could do the
same in their countries,'' said Saavedra, who is infected
with HIV and also heads the AIDS prevention program in
a country where many gay men live in denial.
Saavedra's
coming-out on Tuesday at the International AIDS Conference
sent a powerful message to the world: Homophobia must be
stamped out if AIDS is to be controlled.
Fewer people are
dying from AIDS, but rates of new HIV infections among
gay and bisexual men in many countries are rising at
alarming rates.
Yet less than 1%
of the $669 million reported in global prevention
spending targets men who have sex with men, according to
UNAIDS figures from 2006, the latest available data.
UNAIDS says these
men receive the lowest coverage of HIV prevention
services of any at-risk population. And experts say
discrimination has driven gay and bisexual men in
developing nations underground -- turning them into
one of the epidemic's hardest groups to reach. From Mexico
to India, a surprising number of men who have sex with
men insist they are not gay, and in many countries,
governments still refuse to admit homosexuality
exists.
''It's very
difficult to provide services to men who have sex with men
in countries that don't acknowledge they exist or
criminalize them if they do exist,'' said Craig
McClure, executive director of International AIDS
Society, which organized the conference.
In 86 nations,
homosexual sex is considered a crime, and in seven
countries it is punishable by death, according to the
Foundation for AIDS Research, known as Amfar.
During the
conference's inauguration, U.N. secretary general Ban
Ki-moon urged nations ''to follow Mexico's bold
example and pass laws against homophobia.''
In 2003, Mexico
banned discrimination based on sexual orientation, and it
has opened what it calls homophobic-free health clinics. The
government has a national campaign that includes radio
spots with mothers accepting their gay sons.
Saavedra's program has earmarked 10% of its $12 million
budget toward prevention among gay and bisexual men.
Worldwide, few
developing nations check the rates of HIV infection among
men who have sex with men, but researchers who have surveyed
some of these countries say they are finding the rates
are nearly twice that of the general adult population.
''This fight
needs to be driven by epidemiologists'' who urge making this
high-risk group a priority, not only for the human rights
argument, but for the public health argument, said
Chris Beyrer, director of the Center for Public Health
and Human Rights at Johns Hopkins University. ''It's a
virus so you need to put the money where the virus is.''
Gay and bisexual
men are 19 times more likely to become infected with HIV
than the general adult population, according to Amfar, which
collected data on these men in 128 countries. In
Mexico, this group is 109 times more likely to acquire
HIV. To date, 57% of the HIV diagnoses in Mexico are
from unprotected sex between men.
Thailand is
seeing ''an emerging epidemic of really unbelievable
proportions'' among its gay and bisexual men after being
held up as an example for its success with a massive
condom campaign that curbed HIV's spread among sex
workers, drug users, and migrants, said Kevin Frost,
Amfar's chief executive officer.
Prevalence of HIV
among gay and bisexual Thai men was more than 15% this
year compared to 1.4% for the general adult population,
according to Amfar. Frost said the country's
prevention programs ignored one of its most vulnerable
groups.
''These men
believed they were not at risk because they were not having
sex with sex workers or women, which is what the campaign
focused on,'' Frost said. ''That scenario is being
played out across the developing world.''
Complicating
matters is that in countries from Latin America to Southeast
Asia, many men who have sex with men insist they are not
gay. More than 30% of Latin American men who reported
having sex with men said they also had unprotected sex
with women, according to UNAIDS. Many are married.
''Everybody knows
somebody like that,'' Saavedra, 48, said. ''Instead of
saying they are gay, it's easier for them to justify their
behavior. They say they were drunk and they were
really sexually excited and willing to have sex with
whomever.''
Some have beaten
up transvestites after having sex with them because they
are ashamed of themselves, experts say.
Even governments
deny these men exist. Last year, Iranian president
Mahmoud Ahmadinejad said at Columbia University in New York,
''In Iran we don't have homosexuals like in your
country.''
In Malawi, that
country's first organization working on behalf of gay men
was created in 2006 with the backing of World Bank officials
and other international agencies.
Called the Centre
for the Development of People, the group surveyed 100
gay men about discrimination to prove to the government that
such men existed in Malawi. Homosexual sex is
punishable up to 14 years in prison in the African
country.
The organization
also found through testing 200 gay men that about 21%
carried HIV compared with 12% for the general adult
population.
''This means that
we are not moving ahead with the fight against AIDS,''
said Gift Trapence, the organization's director, who has
received e-mails threatening hanging.
AIDS activists
say they avoid using words like ''homosexual'' or ''gay''
and instead use the label ''men who have sex with men,'' or
MSM, so their work is not impeded by the stigma.
Ashok Row Kavi
said he has learned the importance of carefully choosing
his words in India, where he started one of the country's
first organizations to work with gay and bisexual men.
The Humsafar
Trust found nearly 14% of the gay and bisexual men it
surveyed in 1999 were infected with HIV. Kavi said when he
told India's AIDS officials they ''totally panicked
because until now they believed these men did not
exist.''
But last year
they added a definition of men who have sex with men to
their health planning program to start prevention campaigns.
The definition includes married men.
Kavi has been
training health workers how to ask men if they have had gay
sex and not scare them away.
''I tell them to
say things like, 'There are many cultures where men are
very close to men. Are you one of these men?''' he said.
''These questions have to be sensitive,'' especially
in India, where sodomy is illegal.
''That's why the
word homosexual is not used,'' he said. ''If
anyone asks a man that, he will slap you.'' (Julie Watson,
AP)
