A new report in the medical journal The Lancet details the available data about how stigma against homosexuality across the globe is interfering with efforts to slow down the spread of HIV. The article notes that “most global cases of HIV are not due to homosexual transmission,” but anti-gay laws, harassment, intimidation, silence, and invisibility still have a major impact on the effectiveness of HIV advocacy and outreach:
Almost everywhere, rates of HIV infection are higher in men who have sex with men than in the rest of the population. This is partly because of inadequate information, denial of resources for prevention services of all sorts, and because heterosexism and homophobia marginalise people and make them less able to adopt preventive techniques, even if they are available. Although difficult to prove conclusively, good evidence shows that greater stigma and criminalisation helps increase vulnerability to infection.[...]
Homophobia both increases vulnerability and reduces access to services. Prevention programmes directed towards homosexual men are often harassed by police, and official silence means that some men mistakenly believe that homosexual intercourse is safe. In much of the former Union of Soviet Socialist Republics, Africa, and the Middle East, where any recognition of rights or citizenship is denied to homosexuals, programming of services to include MSM is difficult to achieve. Homophobia affects HIV in direct ways by driving discussion about MSM and homosexuality underground, legitimising fear and prejudice, and compromising AIDS service organisations so that they cannot work publicly with LGBT and MSM communities.
This argument jibes with reports that HIV rates in Uganda actually increased as what seems to be a backfire of the abstinence-based advocacy required by President George W. Bush’s AIDS relief plan (PEPFAR). When all gay sex is condemned — or even simply when marriage equality is denied — abstinence messages sound to gay men like sentences to a life of chastity, a life without love. Sexual health can only be addressed when sex is actually acknowledged and discussed, and homophobia continues to be the largest barrier to that education taking place.