Wed 4 Dec 2013 In: Health and HIV View at Wayback View at NDHA
PART ONE: SUCCESS VS FAILURE PART TWO: DIVERGING PREVENTION PATHS PART THREE: TREATMENT AS PREVENTION PART FOUR: PREVENTION BY CLINICIAN PART FIVE: HOMOPHOBIA AND CRAZINESS The NZ AIDS Foundation has voiced its public bewilderment that most nations are still struggling with strategies to once again contain or reduce their currently out of control HIV infection rate amongst men who have sex with men. New Zealand and a small handful of other nations have clearly shown by example that it can be done and how to do it. The NZAF has gone further and pointed out that the only major advance in HIV prevention being hailed by international organisations such as UNAIDS, may work for straight populations but has no demonstrable promise for gay and bi men. By trying to now globally graft a 'straight' solution onto a faltering but proven fixable 'condoms for anal sex' ethos these international and national prevention organisations are in fact being homophobic, the NZAF charges. Luiz Loures with gay international celebrity Elton John In part four of this World AIDS Day extended feature series Dr Luiz Loures of UNAIDS, the United Nations' global monitoring and mentoring arm, gives GayNZ.com his reaction to the criticism that the fixation on the new big thing in HIV prevention, treatment as prevention, is a dangerous route for those men immersed in gay and bi HIV epidemics. Now, in the final article of this series, he specifically responds to the "homophobic" charge. (As in the previous article, we note that in conversation Dr Loures exclusively uses the term "msm" to refer to men who have sex with men so we have retained that usage within his comments here. In transcribing his thickly-accented and Portugese language manner of speech we have occasionally inferred or clarified his choice of words.) "If you Google UNAIDS, if you Google me and msm, you will see how much this is a priority for us," Loures says defensively. "Only just this morning I was dealing with the recent case of some msm who were put in jail over the weekend, and we are taking action. In Africa we have taken action in one case after the other. That statement that UNAIDS is a homophobic organisation, to be very frank with you, I take that as an insult. And I hope what I tell you is going to help clarify... if you talk to people that are in this business, if you look at the documentation, if you look at the work, UNAIDS is the only [global] organisation today that is putting up very clearly the msm issue [and which is involved in aspects such as] social transformation." As far back as 1986 the first International Conference on Health Promotion, in Ottawa, established that, to be successful, public health initiatives such as the fight against HIV/AIDS must be firmly based on community participation, partnership, empowerment and equity. Does UNAIDS embrace and promote these fundamentals? Loures focuses on the empowerment element. "There is no question that UNAIDS is strongly, openly against any kind of criminalisation of same-sex relations. We condemn it because it is not morally acceptable and it works against what we have to do to control this epidemic. Criminalising people only drives them underground and can only fuel this epidemic further. Criminalising msm is against public health. The promotion of human rights is our priority today and that is clear." But are the resources and willingness trained on straight epidemics - most of which are showing signs of coming under control - fairly and reasonably balanced by the effort going into the gay and bi epidemics, most of which are clearly once again way out of control? Does Loures believe that the priority he says UNAIDS gives to men who have sex with men is matched by other organisations, including governments and their agencies? He chooses his words carefully, but it is clear Loures believes there are serious problems - though he carefully avoids pointing a finger at specific organisations, governments, NGOs or religions. "If the priority was given the way [advised by] the international response, if it was given as it is supposed to, then we would not be facing the [current] epidemic amongst msm," he says. "But discrimination is a reality. I am not saying that this is valid for international conferences and so on but of course discrimination is so powerful, it goes across every single aspect of life." Having initially tiptoed around the diplomatically delicate part of his response Loures becomes more fired up and direct. "I think the attention given to the msm epidemic is not sufficient. At UNAIDS we constantly monitor and track not only how much money is going into [the fight against HIV/AIDS] but where it is going in terms of the locations. There are major, major discrepancies and contradictions in [the area of] msm and the lack of resources going in this direction. In general we don't deal with this msm epidemic in an open way, in a way that is inclusive." Those discrepancies show up in the reporting of where the money that governments and global funders put into the fight against HIV is actually spent. "In general, what you see across the globe is that there is more money, [but] not necessarily to respond to the epidemics where they [actually] are, especially the epidemics amongst msm. In country after country that we are researching money goes to everywhere but it doesn't go specifically to the epidemics amongst msm. This is a major worry." He is careful to point out that UNAIDS itself is not a financing body; it is instead tasked with monitoring the HIV epidemics and the responses to them, and providing information. "We are not a finance organisation as such, but if you look at the way we operate, for instance we have people in a large number of countries, including all the countries where there is major discrimination and criminalisation of msm, in terms of the use of our own people, the use of our own resources and our own time I can assure you [you will see] that in the majority of these countries the majority of our own time goes into msm issues. It is very [rare] that there is one day [that goes by], even for me here in Geneva, that I don't spend part of my own time dealing with that." "But if you look at [all the global money] that goes into HIV/AIDS only 1.5 per cent is going to msm. It's a very, very strong indication that something is not going in the right direction. We are speaking about the only part of the global epidemic that is increasing." The line to Geneva starts to break up, making direct quotes difficult, but Loures makes it clear that he sees the lack of sufficient funded work being done in some countries, generally due to cultural issues with homosexuality, as completely unacceptable. Of the lack of sufficient funding for work helping men who have sex with men, and the fact that very little of even that small proportion is accounted for in those countries, he exclaims in exasperation: "It's crazy!" (- Author Jay Bennie is the only New Zealand journalist to have regularly and consistently reported on all aspects New Zealand's HIV epidemic amongst men who have sex with men for over twenty years.) Jay Bennie - 4th December 2013