Human Rights Considerations in Addressing HIV among Men who Have Sex with Men

From the Case Study Series from the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1), this technical brief provides a systematic global review and synthesis of practical approaches, programme examples, and resources to support human rights as a core element of HIV programming for men who have sex with men (MSM). The document gives an overview of US policies on and commitments to MSM and human rights and outlines recommended approaches, including programme examples in various countries, for linking health and human rights to address HIV among MSM. It also offers a synthesis of questions for developing and monitoring HIV programmes for MSM, and a list of programme resources.

AIDSTAR-One provides the following context within the report: "In many countries, the HIV risk to MSM is exacerbated by social, cultural, and political factors. These include cultural biases against MSM, limited access to information and services, low national investments in health, and legal, institutional, or social barriers, including negative bias among providers, that make it difficult for MSM to negotiate safe sex or obtain adequate services for preventing and treating HIV and other sexually transmitted infections (STIs). This situation is compounded by adverse human rights environments - for example, in settings where same-gender sexual relationships are illegal - where MSM may fail to seek treatment because doing so may lead to harassment, refusal of services, arrest, or violence."

The following are 3 practical measurable strategies provided in the document that are meant to support the linkage of health and human rights in HIV programming for MSM:

1. Strategy 1. Engage with Those Who Would Benefit - Recommended programme approaches include: encourage peer-to-peer support, dialogue, and leadership among MSM; and encourage and support the involvement of MSM in health and rights programming ("To be meaningfully engaged, those individuals and their networks must be able to inform themselves and to be honest and vocal in their participation.") Practical examples and indicators of success toward meeting the goal are also provided.
2. Strategy 2. Remove Barriers That Limit Access to HIV Programming - recommended programme approaches include (practical examples and indicators of success toward meeting the goal are also provided):
   • Document policies and practices that present barriers to the HIV response.
   • Promote literacy about human rights and supportive policies and practices - "Health programs should integrate locally appropriate 'know your rights' programs to inform key populations about national laws and human rights, build literacy about human rights, and help MSM obtain counseling, protection, and redress for human rights violations. Education should also include police, lawyers, and judges, who may not understand the impact of punitive laws and enforcement on public health and access to health services. Program implementers should work with judiciary and law enforcement agencies to promote policies and practices that support effective health programs for MSM, including education on sexual health, HIV counseling, testing and treatment, distribution of condoms and lubricants, sterile injection equipment, and other health promotion and harm reduction measures."
   • Support reporting of and response to rights violations - "...Some health programs can train peers from MSM communities in paralegal work and hire them to link community members with legal and social services, and to compile evidence for broader human rights action..."
   • Facilitate dialogue between MSM and policymakers - "...When strategic opportunities arise, implementers should use their bridging role to bring clients together with policymakers to discuss problems, find workable solutions, and build the community's informed participation in health policy development...."
3. Strategy 3. Integrate Rights Approaches within Health Programming and Support Universal Rights to Health - Recommended programme approaches include: promote professional and institutional standards in health care settings; fund health programming for MSM at sufficient scale; and support peer-based health services in both community and clinical settings ("Clinicians and other health providers with direct experience in MSM communities, including those who are MSM themselves, can be essential partners, not only providing nondiscriminatory health care but also serving as links to communities of MSM, to ensure that HIV program designs match community needs."). Practical examples and indicators of success toward meeting the goal are provided.