HIV Epidemic and Human Rights Among Men Who Have Sex With Men in Sub-Saharan Africa: Implications for HIV Prevention, Care, and Surveillance
Abara, W.E., and Garba, I. Global Public Health (October 2015): 1–14 [Epub ahead of print], doi:10.1080%2F17441692.2015.1094107.
This article argued that HIV among men who have sex with men (MSM) in sub-Saharan Africa (SSA) is driven by many factors, and advocated for strategies grounded in social determinants and human rights. The authors reviewed available data on HIV among MSM; access to prevention, treatment, and care; and how the legal context affects MSM and contributes to their HIV risk. Data are limited, but indicate very high rates of HIV and multiple risks among MSM in SSA. However, HIV among MSM in SSA is largely unaddressed. Social determinants, including education, socioeconomic status, stigma, discrimination, and sexual and racial identity, shape vulnerability to HIV and access to prevention and care. Laws that criminalize MSM behavior contribute to the HIV epidemic; they promote stigma and discrimination, hinder policies and care to prevent and treat HIV, foster risk taking, and place organizations and providers that work with MSM in legal jeopardy. The authors summarized initiatives addressing the sexual risks and health needs of MSM through national policies and programs in Kenya and South Africa. They also described how human rights frameworks can be used to challenge discriminatory laws; and how international instruments can be used to hold governments accountable for reducing structural barriers and ensuring access to HIV prevention, treatment, and care.