Young Men Who Have Sex with Men: Health, Access, and HIV

"In every world region, men who have sex with men (MSM) face significantly higher rates of HIV than the general population."

This policy brief examines HIV risk factors and access to services among young MSM (YMSM), using data from the Global Forum on MSM & HIV (MSMGF)’s 2012 Global Men’s Health and Rights survey (2012 GMHR). The brief includes a set of recommendations for addressing the global HIV epidemic among YMSM.

"In March 2012, the MSMGF formed a multidisciplinary research team to develop and implement the 2012 GMHR, a multilingual survey designed to identify and explore barriers and facilitators affecting access to HIV services for MSM at the structural level, community level, and individual level. The survey was conducted online in Chinese, English, French, Georgian, Russian, and Spanish between April 23 and August 20, 2012. A convenience sample of 5779 MSM from 165 countries was recruited through web-based banner ads and direct email outreach to the MSMGF’s global networks. For this policy brief, the 2012 GMHR dataset was used to evaluate HIV risk factors and access to services among YMSM represented in the sample (n=2491), comparing levels of risk and access between YMSM and older MSM. Differences between YMSM and older MSM were calculated using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables and psychosocial scales. More information on the 2012 GMHR’s methods, measures, and overall findings is available in the MSMGF’s 2012 report, 'Access to HIV Prevention and Treatment for Men Who Have Sex with Men.' [PDF format]"

The document reviews data, including the following communication-related information:

• Access to MSM-Focused Education and Programmes (Figure 10) - A subsection of data on levels of access to a variety of HIV prevention services, including condoms, lubricants, HIV testing, HIV treatment, MSM-focused sex education, HIV education materials for MSM, and HIV risk reduction programmes for MSM, shows that 7% of YMSM have access to sex education, while 13% of MSM have this access. 9% YMSM vs. 19% MSM have access to education materials, and 7% vs. 15% have access to HIV risk reduction programmes.
• 24% (YMSM) vs. 40% (MSM) have access to low-cost sexually transmitted infection (STI) testing, and 14% vs. 30% have access to low-cost STI treatment.
• The per cent of treatment-eligible MSM not on antiretroviral therapy (ART) is 44% YMSM vs. 17% MSM.

"Data from the entire 2012 GMHR survey sample revealed several barriers (factors associated with lower access) and facilitators (factors associated with higher access) that impact the ability of MSM of all ages to obtain...” the following: treatment, testing, condoms, lubricants, and services. "Age-stratified analyses of the barriers and facilitators revealed by the original analysis on 2012 GMHR survey data indicated that YMSM experienced significantly higher levels of homophobia (p<0.001) and violence (p<0.001) compared to older MSM. YMSM also reported significantly lower levels of community engagement (p<0.001), comfort with service providers (p<0.001), and connection to the gay community (p<0.001) compared to older MSM."

Recommendations include the following:

1. "Address Housing Stability and Economic Dependence
2. Provide Comprehensive HIV Prevention Tailored to YMSM - This analysis indicated that less than 10% of YMSM could easily access MSM-focused sexual education or HIV education materials for MSM. EDUCAIDS recommends that HIV education begin before the onset of sexual activity. However, comparatively few countries offer school-based sexual education and inclusion of issues concerning YMSM is virtually absent. Without access to information tailored to the needs of YMSM, many YMSM misunderstand their own level of risk, how to prevent HIV effectively, and what services may be of help. YMSM must have access to sexual education that explicitly addresses sexual practices and sexual health issues relevant to YMSM, including anal sex, substance use, and mental health. Comprehensive sexual education must be accompanied by efforts to ensure YMSM can access the HIV prevention resources they need....
3. Improve Treatment and Care for YMSM Living with HIV - ....Efforts are needed to engage YMSM in low-cost medical care and mental health services, where they can learn more about their sexual health needs and HIV risk factors. HIV testing and treatment must be offered in safe spaces free from homophobia, and all services must be promoted directly to YMSM, taking into account existing levels of knowledge, access to services, and confounding factors like unstable housing, limited income, and discrimination.
4. Address Barriers and Facilitators that Impact Access to HIV Services - For MSM of all ages, homophobia is associated with reduced access to essential HIV services. Not only do YMSM experience higher levels of homophobia, but they may also be uniquely vulnerable to its negative effects due to their dependence on family, educational institutions, and other potentially hostile structures for housing and resources.  Large-scale efforts are needed to reduce homophobia at the societal level, with a special focus on families, educational institutions, healthcare systems, and HIV service providers.... Conversely, community engagement and comfort with health service providers are associated with increased access to HIV services for MSM of all ages. Just as efforts are needed to reduce barriers to service access, it is equally important to support initiatives that bolster facilitators. Organizations focused on MSM and organizations focused on youth should undertake efforts to actively and sensitively engage YMSM in their programs and services, providing a safe space for YMSM to be themselves and interact with other YMSM in their communities. These organizations must recognize the unique needs of YMSM and involve YMSM in efforts to develop, design, and deliver programs that address them. 
5. Support YMSM Leadership and Involvement - YMSM are best equipped to define their own needs and should be supported in developing responses to those needs. The global AIDS infrastructure must work to foster leadership among YMSM and support greater involvement of YMSM in the decision-making processes that affect their health and human rights. Deliberate efforts must be undertaken to ensure YMSM leaders and organizations are aware of opportunities to impact policy at regional and global levels, and YMSM leaders and organizations must be given appropriate amounts of time and information to engage in these processes in a meaningful way. Finally, multilateral organizations and global funders should support initiatives developed and delivered by YMSM themselves, increasing availability of and access to effective and appropriate interventions for YMSM globally."