Stigma within healthcare facilities blocks access to services for MSM and transgender
Decriminalize and engage MSM and transgender populations in HIV responses

Shobha Shukla (CNS) *

10th International Congress on AIDS in Asia and the Pacific (10th ICAAP) in Busan from 26th August to 30th August, 2011

Stigma within healthcare settings blocks access of men who have sex with men (MSM) and transgender populations to existing services to an alarming level. "The Asia Pacific Coalition on Male sexual health (APCOM) has been looking at this issue of stigma within healthcare settings which prevents people from accessing services and in fact kills people if nothing else.

So what NFI and APCOM are doing is engaging more with the UN system, WHO, and other stakeholders to improve quality of education for the health sector, to engage in issues around health sector reforms and to improve services at grassroots level" said Shivananda Khan, Chief Executive of Naz Foundation International (NFI) and Co-Chair of Asia Pacific Coalition on Male sexual health (APCOM) at the 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP) in Busan, South Korea.

Mental health issues arise because of significant levels of stigma and discrimination. Depression, harassment, relationship problems, loneliness, and social isolation, are among the few pressing mental health concerns that challenge MSM and transgender populations in particular. HIV and sexually transmitted infections (STI) counselling is more concerned with sexual and reproductive health, and doesn't adequately address mental health concerns beyond HIV prevention and to some extent care and support issues.

"It is not just looking at mental health at individual basis but society as a whole. What we are trying to do at NFI and APCOM is to look at how we can address stigma and discrimination through government, legal reforms, social change, as well as provide services at local level for individuals who have family issues to deal with, who have marital issues to deal with, and other issues. Yes there are no properly trained counselors that can address them as mental health issues and that requires education at all levels" said Shivananda Khan, who was conferred upon the Order of British Empire (OBE) by the British Queen in recognition of his contribution to HIV prevention among MSM.

Shivananda points out another major game-changing intervention in reducing stigma within healthcare settings: "Medical curricula need to be reevaluated to address the health needs of all marginalized communities including MSM and transgender. If you look at the treatment of STIs there is no training in the curricula that is appropriate to the needs of MSM and transgender populations. If you look at the mental health curricula there is no training around addressing stigma and discrimination as a key element in addressing mental health problem. There is no education for the families arising from having gay sons and [lesbian] daughters."

"Human beings irrespective of their sexual identities should be treated with dignity. Families, medical fraternity, police, bureaucrats, politicians, it is the whole of society you can engage in improving health responses for MSM and transgender populations" said Shivananda Khan.

Decriminalize and engage MSM and transgender populations in HIV responses

(CNS): Policies that criminalize same-sex behaviour and punitive laws continue to impede access to existing healthcare services for those at heightened risk of HIV such as men who have sex with men (MSM) and transgender populations. The 10th International Congress on AIDS in Asia and the Pacific (10th ICAAP) is being organized in South Korea - a country where a lot more needs to be done to provide safe, supportive and dignified access to services for LGBT community.

"South Korea doesn’t have a very good record regarding programming around sexual minorities and HIV. If you look at the data, one of the highest number of people dying among young LGBT people are here. There is a whole issue around shame and culture that impacts upon their lives. The government is not very responsive, and no education system exists on these issues" said Shivanand Khan, Chief Executive of Naz Foundation International and Co-Chair of Asia Pacific Coalition on Male sexual health (APCOM).

According to the Wikipedia, "Lesbian, gay, bisexual, and transgender (LGBT) people in South Korea can face legal challenges not experienced by non-LGBT residents. Male and female same-sex sexual activity is legal in South Korea, but same-sex couples and households headed by same-sex couples are not entitled to the same legal protections available to heterosexuals. As in many countries, however, the climate for gays and lesbians is evolving and becoming more tolerant.Homosexuality in South Korea (Republic of Korea) is not specifically mentioned in either the South Korean Constitution or in the Civil Penal Code. Article 31 of the Korean Human Rights Committee Law states that "no individual is to be discriminated against on the basis of his or her sexual orientation."

However, Article 92 of the Military Penal Code, which is currently under a legal challenge, singles out sexual relations between members of the same sex as "sexual harassment", punishable by a maximum of one year in prison. The Military Penal Code does not make a distinction between consensual and non-consensual crimes and names consensual intercourse between homosexual adults as reciprocal rape."

"What we hope to achieve with discussions with colleagues from LGBT communities in Korea is that these issues have a high visibility and more knowledge management. From Asia Pacific perspective we are hoping to have a better recognition of some of these crucial issues that have an impact upon our lives by increasing our risks and vulnerabilities to HIV" added Shivananda Khan, who was conferred upon the Order of British Empire (OBE) by the British Queen in recognition of his contribution to HIV prevention among MSM.

"My message for the conference is that the key vulnerable communities in Asia and the Pacific to HIV are MSM and transgender populations. Unless we are engaged in designing, developing and providing services, HIV is never going to be resolved as a key issue in our parts of world" said Shivananda Khan.

Shivananda reminds us of one of the landmark developments of 2011 in this context - the UN Political Declaration adapted in June 2011 by member countries including South Korea.

The UN Political Declaration among other very significant points says that: "...many national HIV prevention strategies inadequately focus on populations that epidemiological evidence shows are at higher risk, specifically men who have sex with men, people who inject drugs and sex workers, and further note, however, that each country should define the specific populations that are key to its epidemic and response, based on the epidemiological and national context."

However the UN Political Declaration didn't mention transgender populations as high risk group for HIV. "One of the key successes of 2011 is the new UN General Assembly Political Declaration that was signed up in June 2011 where for the first time MSM are particularly mentioned as a vulnerable community. Okay they didn’t mention transgender populations but it is step on the way. For Asia Pacific, we have had two UN declarations that have mentioned MSM and transgender – these are major steps forward in making the political environment more conducive towards working with MSM and transgender communities" said Shivananda Khan.

Further adds Shivananda: "As always we hope that this congress will push the envelope even further with clear recognition from all governments that unless they engage MSM and transgender people, HIV is not going to be resolved in terms of reducing the level of HIV."