Prepared by Mrs Magda Wills
While the global response to HIV and AIDS has realized several successes in achieving universal access to prevention, care and treatment to date, challenges persist in ensuring equal access to these services for most at risk populations. The epidemiology of HIV reflects a stark disparity in access to prevention and treatment services for neglected most-at risk populations, such as men who have sex with men (MSM). World-wide, MSM often experience higher rates of HIV relative to the total population. The reasons for this dynamic are multi-faceted and include high risk behaviors, and cultural as well as structural barriers. For MSM in developing countries, for example, basic services for prevention and treatment of HIV infection have yet to reach the large majority of men. Homophobia and discrimination limit access of MSM to prevention services and markedly increase vulnerability, as do criminalization of same-sex behavior. Decriminalization of same-sex behavior is a structural intervention for prevention of HIV infection and has recently been embraced by a nonbinding statement from the United Nations (Beyrer C,Clin Infect Dis. 2010 May 15;50 Suppl 3:S108-13)
In the Caribbean, all of the above mentioned barriers exist. In fact, recent evidence demonstrates that there is a correlation between the decriminalization of homosexuality and lower rates of HIV (UNAIDS). This correlation is attributed to improved access to services. Therefore, The United Nations Development Program (UNDP) has recently launched an initiative to address the current situation regarding men who have sex with men in Guyana where the HIV prevalence in this population is 19.4% in contrast to 1.8% in the total population.
This rapid assessment has been commissioned to supplement two previous studies that were conducted in Guyana in informing the design of upcoming activities to support local capacity building to enhance access to services and respect for the human rights protections for MSM. Unfortunately, in Guyana, like much of the Caribbean, MSM tend to be a hard to reach population, perhaps due to elevated levels of stigma and discrimination and difficulty in accessing men who might participate in high risk same sex behaviors yet do not self-identify as an MSM. As a result, there is a relative paucity of data concerning the knowledge, attitudes and behaviors of this total population in Guyana. (i.e. those who self –identify and those who do not)
The baseline report is organized as follows: the methodology is explained followed by the study limitations, the review (literature and desk). The report then proceeds with describing the reality of work and working with sexual and gender minorities in Guyana, the status quo and entry points. The main findings of the capacity assessment and focus groups are then discussed. Issues relating to the uniformed forces and health services providers are then presented followed by discussions and conclusions.