WHO: Stigma denies HIV care to gay men and transgenders

HOMOSEXUAL men and transgender people should get equal access to HIV/AIDS programmes under the World Health Organisation’s first guidelines aimed at ending the stigma that denies care to many, the UN agency said yesterday.

WHO also reported evidence of HIV infections surging again among men who have sex with men and people who change their gender, particularly in Western countries.

The two groups are already hard hit by the AIDS epidemic that began 30 years ago.

“This is the first time that WHO, as a UN agency together with other partners, is putting this forward,” said Dr Gottfried Hirnschall, director of the HIV/AIDS department at the WHO. “It is sensitive but is right to the point and is really critical for the epidemic.”

The 21 recommendations form “the first global public health guidelines” to focus on homosexual men and transgender people, the WHO said. They are designed to help health care workers and policymakers overcome discrimination and offer them testing, counselling and life-saving treatment.

Homosexual men are 20 times more likely to be infected with the virus than heterosexual males, and rates are even higher in Mexico, Thailand and Zambia, according to the WHO. HIV infection rates among transgender people range from 8% to 68%, depending on the country.

An estimated 2% to 4% of males have reported having sex with another man during their lifetime, Dr Hirnschall said.

“Certainly one thing that we know is that MSM behaviour [men who have sex with men] exists in all cultures,” he added. “Obviously, the level of acceptance and cultural mystification varies from culture to culture.”

More than 75 countries criminalise same-gender sexual activity, according to the WHO. “And transgender people lack legal recognition in most countries,” it said.

This forces many homosexuals and transgender people to risk criminal sanctions if they seek help from a health care worker. Police often have authority to harass support groups, it said.

“Because of the stigma, the discrimination, they will often access services late, they may not access them at all and often, if they do access them, the quality of services provided to them may be inferior,” Dr Hirnschall said.

“If a transgender, in many parts of the world, comes to a health service, she gets chased away at the door,” he said. “If she ever makes it by the guy at the door, the next question is ‘where do we put her, in which ward do we put her?’.”

George Ayala, executive officer of the San Francisco-based Global Forum on MSM and HIV, said healthcare services should offer a “welcoming and safe” environment.

“It is difficult to respond with even the best of interventions that we have available to us if individuals run the risk of violence, of ridicule, of other forms of humiliation on their way to accessing services,” he said.

Hua Boonyapisomparn, a transgender activist from Thailand, said transgender communities have been “invisible” in national and international health care programmes.

“HIV guidelines are an important, historic step which is a hope for transgender community to ensure that their voice will be heard at all levels,” she said.