here - NFI
Transcription
here - NFI
Pukaar Issue 75 the journal of Naz Foundation International October 2011 an international HIV and sexual health journal focusing on south asian masculinities and sexualities Pukaar October 2011 Issue 75 Naz Foundation International (NFI) is a development agency specialising in providing technical, institutional and financial support for the promotion of sexual health, welfare and human rights of males who have sex with males in South Asia. NFI believes in a world where all people can live with dignity, social justice and well-being. With a primary focus on marginalised males who have sex with males, NFI's mission is to empower socially excluded and disadvantaged males to secure for themselves social justice, equity, health and well-being by providing technical, financial and institutional support. NFI believes in the innate capacity of local people to develop their own appropriate services, where the beneficiaries of a service are also the providers of that service. NFI will always support such initiatives. This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of the Naz Foundation International and can in no way be taken to reflect the position of the European Union. Pukaar Pukaar is the quarterly journal published by Naz Foundation International. It provides a forum for discussion, information, and advice, as well as general interest, regarding HIV and sexual health, focusing on South Asian masculinities and sexualities. The opinions expressed in Pukaar reflect the writer’s views only and do not necessarily reflect the views of Naz Foundation International unless specifically mentioned. We will always try to ensure that what we report is relevant to our readers, and we ask you, the reader, to keep us informed as to what is happening in your corner of the world. Send us your questions, letters, articles, stories (fact or fiction), poetry, drawings, photographs. Tell us about what you think and feel, whether it concerns HIV, your sexuality, or whatever. Names will be changed and addresses will be withheld if required. Send all material to Pukaar, Naz Foundation International, 9 Gulzar Colony, New Berry Lane, Lucknow 226001, India visit our website www.nfi.net 2 Naz Foundation International’s Ethical Policy Naz Foundation International is a development agency focusing on male to male sexualities and sexual health concerns in South Asia. In its work, Naz Foundation International will fully consider the implications of males who have sex with males, for themselves, for any male or female sexual partners such males may have, and for any clients of those males who do sex work. In this work Naz Foundation International will be guided by the following principles: 1. Promoting the reproductive, sexual health, and well-being of males who have sex with males by encouraging sexual responsibility and safer sexual practices. 2. Encouraging males who have sex with males to access sexually transmitted infections treatment whenever necessary. 3. Respecting confidentiality in the relationship between males and their sexual partners and/or clients. 4. Promoting the protection of children and non-consenting adults from abusive sexual relationships. 5. Promoting the reproductive and sexual health of any female partners of males who have sex with males, by encouraging sexual responsibility of their male partners. 6. Encouraging communication of sexual health information between sexual partners and promoting partner notification of sexually transmitted infections and HIV infection, irrespective of the gender of the partner. 7. Working with female reproductive and sexual health services, in order to facilitate appropriate access to services for infected female partners of males who have sex with males. Pukaar is produced and published for private circulation and not for sale by: Naz Foundation International 1.3 Quay House, 2 Admirals Way London E14 9XG, UK Distributed by: NFI Regional Office 9 Gulzar Colony, New Berry Lane, Lucknow, 226001, India Naz Foundation International is a Charity and company limited by guarantee in England and Wales Registration No. 3236205 Registered Charity No. 1057778 Registered office: 1.3 Quay House, 2 Admirals Way London E14 9XG UK Naz Foundation International Secretariat 1.3 Quay House, 2 Admirals Way London E14 9XG, UK Tel: +44 (0)20 7868 1519 Fax: +44 (0)20 7671 7062 Email: [email protected] Regional Programme 9 Gulzar Colony, New Berry Lane, Lucknow, 226 001, India Tel: +91 (0)522 2205781/2205782 Fax: +91 (0)522 2205783 Email:[email protected] Chief Executive's Office Email: [email protected] Contents p3 p10 p18 p21 p22 p23 p24 p25 p26 p27 p28 p29 p31 p32 In the beginning - 1988 and all that A model of technical support to MSM, transgender and hijra populations explicated At the 10th ICAAP, Busan APCOM Busan Declaration Homonormativity - the hegemony of 'LGBT' Gay sex is an unnatural disease Non-hijra transgenders struggle for identity The Gulf's gender anxiety US embassy's Pride celebrations in Islamabad more damage than support Building the momentum to prevent HIV in MSM Homosexuality in Islam Who takes risks? Gonorrhoea strain found 'resistant to antibiotics' 'Explosion' of sex-spread hepatitis C in HIV-positive men Pukaar online www.nfi.net/pukaar.htm Pukaar October 2011 Issue 75 In the beginning - 1988 and all that It started in a meeting organised by Shivananda Khan on June 11th, 1988 in a pub called The Angel in North London. A small group of six South Asian lesbian and gay men got together to discuss the need for some sort of social support group for people like us. Out of this discussion, Shakti was born, and we began to meet regularly once a month at a LGBT drop in centre . In October that year, Shakti organised its first income-generation disco, introducing bhangra to the LGBT disco crowd. By 1989, this disco was drawing some 500 people on a regular basis, and Shakti had grown to host several social services for its South Asia member, including counselling, emergency housing, HIV, as well as participating in gay pride marches, advocacy and challenging racism in the LGBT community. Shivananda in 1988 Celebrations and pride First seminar on HIV and South Asians in London, 1990 The Naz Project is born October 1991, with a small grant, The Naz Project was established in a corner office on the first floor of this building. The first services provided were a hotline staffed by volunteers, and training programmes for local authorities in London on South Asian issues with a focus on male-to-male sex, risks and vulnerabilities. The name Naz was the shortened form of the name of the first South Asian person that the founder personally knew living with AIDS – Nazir. Disgusted with the services he was receiving from both government and non-government agencies, the Naz Project was born – to fill the gaps in regard to prevention, care and support. In 1992, organised the first European consultation for South Asian and Muslim communities on HIV/AIDS. Brought together 140 participants from 12 European countries. During our first engagement with HIV in South Asia by attending the 2nd International Congress on AIDS in Asia and the Pacific in 1992, we as sexual minorities were told that there was no room to have a meeting specifically on "alternate sexualities" at the conference venue, so we all met at a park opposite. In 1993, with support from Ford Foundation, and in alliance with Sakhi, a lesbian organisation in Delhi, we organised the first seminar on alternate sexualities. It was here that Naz Foundation India Trust was first thought of with Anjali Gopalan, which was born in 1994 as an independent Indian organisation. 3 Pukaar October 2011 Issue 75 Strengthening our engagement in South Asia In December 1994, Humsafar Trust, along with support from The Naz Project, organised the first conference for gay men and other MSM and HIV in India, with funding support from The Mercury Phoenix Trust and The Naz Project, with NP further providing technical support and assistance. Over 90 participants from across India, with several overseas participants as observers. Sherman De Rose was also attending this meeting, and was inspired to establish Companions on a Journey as an LGBT and sexual health organisation in Sri Lanka in 1995. This conference also was able to empower several other individuals in India to develop their own MSM and HIV organisations over the next few years. In October 1995, the first consultation of representatives from NGOs working on HIV prevention and care issues within Muslim communities was held in Karachi, Pakistan with funding support from the UN Global Programme on AIDS (which eventually morphed into UNAIDS). The focus was on what eventually has become known as Most At Risk Populations, with some 80 participants from 17 countries, including MSM, female sex workers, and injecting drug users. The meeting was organised by The Naz Project and the Pakistan AIDS Prevention Society. 1996 - Beginnings Since 1991, the Naz Project had been working in London for the South Asia communities in the UK, as well as initiating activities in India and Pakistan. However, for Shivananda, the issues of males who have sex with males in the South Asia region, their enormous risks and vulnerability, along with the stigma, discrimination and violence so many faced, along with the very few appropriate services for their sexual health needs that were available, were increasingly becoming more and more important to him. At the same time, London donors were also expressing concern with the amount of work and involvement in South Asia of The Naz Project. Discussions with the Board of Trustees eventually led to the decision to break the The Naz Project into two separate and independent HIV organisations, one specifically focusing on MSM and HIV in Asia, and one continuing to focus on South Asia populations in the UK, along with other ethnic minority communities. In August 1996, The Naz Foundation International was born. This process of devolution was supported by its first grant from Ford Foundation to conduct a risk and needs assessment among MSM in Dhaka, Bangladesh Out of this study conducted in 1997, where 400 kothi-identified males were accessed for interviews, Bandhu Social Welfare Society was born. With initial funding from NORAD through the Norwegian Embassy, Bandhu began with a drop-in centre in central Dhaka providing an outreach programme,, counselling, STI referrals, advocacy, and social support groups. UI has rapidly grown over the years to become the leading MSM and hijra support organisation addressing sexual health needs in Bangladesh working in 22 cities, along with strong links with the government, media, and legal support. A remarkable achievement in a traditional Muslim country. Also in 1997, with funding support from the UK Foreign and Commonwealth Office and the Mercury Phoenix Trust, a capacity development workshop was conducted in Baku, Azerbaijan with male sex workers and other MSM on knowledge and skills building to develop their own HIV programme. Linguistic and logistic support was provided by the Azerbaijan AIDS Society. As a part of this project, this was immediately followed by a consultation meeting held in Almaty, Kazakhstan, for representatives from governmental organisations working on HIV prevention issues from the Central Asian Republics (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan), where the focus was on MSM and HIV issues, needs and concerns. Local assistance was provided by the UNAIDS Inter-Country Team for the region. Twenty-two participants from the government AIDS programme participated in this meeting In Baku 4 In Almaty Pukaar October 2011 Issue 75 With funding support from the Foreign and Commonwealth Office, a study on MSM risks and needs in Lucknow, India was also conducted in 1997, accessing some 400 kothi identified men for interviews. From this study, Bharosa was established with seed funds provided by this grant. Since then Bharosa has grown to becoming the lead MSM and sexual health agency in Uttar Pradesh, and is classified as a learning centre for UP. This was when we first meet Arif, who ran the assessment project, and became Bharosa's Project Director, eventually moving on to join Naz Foundation International in 2000. But more of that later. In 1998, NFI, with support from the Department of International Development, UK, NFI developed Sahodaran, an MSM and HIV sexual health organisation in Chennai, India, and also conducted training and capacity development for a group of MSM in Cochin, Kerala. Workshop in Chennai, Tamil Nadu Working group in workshop Arif Jafar as workshop facilitator Workshop in Cochin, Kerala In 1999, hosted the 1st Regional MSM Consultation meeting in partnership with Praajak and Sahodaran in Kolkata. Participating countries were Bangladesh, India, Pakistan and Sri Lanka, with observers from China, Indonesia, Malaysia, Thailand and Vietnam. Donors were Family Health International, UNAIDS, and USAID. Support was also given by NACO. A model of technical assistance from NFI was emerging from all this work, as NFI began to expand its assistance programme to support the development of local community based organising and mobilising to address the sexual health needs of MSM in South Asia. While this work was being funded by a range of donors, there was no core funding for NFI itself, so the work was being implemented by one person. Designing resource materials and tools, working with local networks to identify key resource persons, advocating nationally, regionally and globally for the needs of MSM in response to the growing HIV crises among them, this represented a major challenge in developing a strategic response, where so far NFI had been a reactive process depending on small project funds to be able to conduct this work. Out of this a range of policy papers, essays and articles had also been produced that articulated the issues, needs and concerns of MSM in South Asia, highlighting the differences in male-male sexualities in South Asia when compared with Western understandings of male sexualities and its binary approach. It was becoming very clear that in South Asia, gender performance was more relevant to sexual practices between males than sexual orientation, that stigma, discrimination and social exclusion was based on this gender performance as much as on same-sex behaviour. 5 Pukaar October 2011 Issue 75 In 2000, with support from FHI/USAID, four MSM situational assessments were conducted in Bangalore, Hyderabad, and Pondicherry in India, and Syhlet, Bangladesh. Out of these assessments, and with seed funding provided by the project, local MSM and HIV communitybased services were developed: Gelaya (Bangalore), Mithrudu (Hyderabad), Sneghidhan (Pondicherry), Bandhu-Syhlet. 2000 - A leap into the future Finally in late 2000, with support from the Department of International Development, UK, NFI was able to implement its strategic vision of responding to the sexual health needs of MSM in South Asia and was able to open a Regional Programme Liaison Office in Lucknow, India providing such technical and institutional assistance, along with staffing. This office hosted a Resource Centre and Library, along with a regional training centre. NFI's Secretariat remained in London, UK. In December 2000, NFI hosted its 2nd South Asia Regional MSM and HIV consultation meeting in partnership with the newly formed Mithrudu in Hyderabad, India. Over 140 participants from 10 countries and 17 NFI partners were engaged, with funding support from UNAIDS and FHI/USAID. It was at this meeting that Mithrudu received its first project funding from the Andhra Pradesh State AIDS Control Society. In 2001, NFI Regional Office conducted its first training of trainers programme. 6 Pukaar October 2011 Issue 75 2001 - the big bang - behind bars On July 7th, local police in Lucknow decided to raid the NFI Regional Office and arrested three NFI staff including the Executive Director Arif Jafar, along with the programme manager of Bharosa, the local MSM HIV organisation. The accusation was that the regional office was really a male brothel, and that NFI and Bharosa were promoting homosexuality. Initially bail was refused, and the four (eventually labelled as the Lucknow Four internationally) eventually spent 47 days in the Lucknow Jail, before being released on bail on 22nd August 2001. NFI was able to mobilise an enormous response to this vicious indictment and human rights abuse against itself and one of its partner agencies, including the government of Great Britain, Human Rights Watch, Amnesty International, UNAIDS, and others. Across India, human rights organisations, lesbian and gay groups, women’s organisations, along with a range of individuals and institutions protested, held marches, and sent letters to the appropriate Union and State government officials and bureaucrats. While the key charge of promoting homosexuality and aiding and abetting a criminal act (i.e. Section 377) has been dismissed, to this date monthly court appearances are still required. However, despite the horror of this experience, it stimulated the Naz Foundation India Trust petition to the Delhi High Court for the reading down of Section 377 of the India Penal Code which criminalises same sex behaviour, which eventually led to this being achieved in 2009. Did this stop us? No! We continued technical assistance to NFI partners, international NGOs working with MSM and HIV, as well as a range of non-government organisations, national AIDS programmes and other institutions. And ever more training and skills building programmes. Technical support provided to Blue Diamond Society, Nepal and to Bandhu Social Welfare Society, Bangladesh for their first national MSM and HIV consultation meetings in 2001 and 2002 In 2003, along with conducting a range of capacity strengthening programmes for MSM CBOs in India and Bangladesh, we also organised our third South Asia Regional Consultation meeting in New Delhi, India. Over 200 participants from 14 countries in the South and SouthEast regions, representing 40 MSM sexual health projects, of which 24 receive technical support from NFI. Funders were FHI Asia/India/Bangladesh, UNAIDS and NFI Between 2004-2005, NFI provided technical assistance to national partners in Bangladesh and Nepal, as well as supporting some 25 MSM CBOs in India, having held three more regional training of trainers programmes where 85 trainers were developed, and 15 local training programmes for 324 people had been organised. At the same time, a range of BCC materials and tool kits were developed in six different languages to support these local MSM sexual health interventions. 7 Pukaar October 2011 Issue 75 As a part of NFI's advocacy and policy support for MSM and HIV programming, in 2004 it organised and cohosted the 8th National Convention of the Indian Network of NGOs working on HIV and AIDS. This network consists of over 500 HIV and AIDS NGOs across India. Also at the 2004 XV International AIDS Conference, Bangkok Thailand, NFI was the key focus agency to develop the UNAIDS sponsored MSM Leadership Statement – a call for social justice and equity. NFI's Social Charter for Justice evolved from this work. 2006 -2007 - Scaling up coverage and advocacy in India With DFID funding support, a major pilot project was conducted in four states in India (Andhra Pradesh, Karnataka, Tamil Nadu and Uttar Pradesh, to validate the emerging model of technical support and assistance that NFI had evolved over the years since its beginning. This entailed developing 36 new MSM CBOs, conducting 36 MSM risk and needs assessment, testing out the new CBO capacity development tool-kit, and hosting four state level consultation meetings, all by project end in 2007. Participants from the Karnataka MSM state consultation meeting NFI developed a six volume tool-kit for the development of MSM and transgender community-based organisations that can provide HIV prevention, care and support services for their constituents in their locality. 8 Also, with the support of the DFID Social Marketing Fund, NFI field tested a new, low cost water-based lubricant formula based on aloe vera, and manufactured and distributed some 2.5 million sachets to these 36 new CBOs. During the same period NFI also was engaged in enhancing the capacity of the National MSM and AIDS Human rights, policy and advocacy Task Force to enable it to train, establish, monitor and coordinate the activities of 13 Local Policy and Advocacy Units in MSM Projects in 13 cities of India over the one year project period. At the 2006 XVIth International AIDS Conference in Toronto Canada, NFI was also one of the primary founders of the Global Forum on MSM and HIV that is engaged in advocacting for the sexual health rights of gay men and other MSM across the world. Currently Shivananda is on its Steering Committee. Being a part of this enables NFI to upstream its advocacy and policy development work. Pukaar October 2011 Issue 75 Size can matter A major milestone in the Asia Pacific Region, the Risks and Responsibilities consultation meeting, held in Septrmber 2006 in New Delhi and cohosted by NFI and the National AIDS Control Organisation, India, brought together some 380 delegates governments, policy-makers, donors, researchers, grassroots and community based organisations from 22 countries across the Asia-Pacific region and eight other countries from outside the region. The consultation was funded by many international donor agencies such as Department for International Development, UK, the World Bank, Canadian International Development Agency, Swedish International Development Agency, Australian Agency for International Development, HIVOS, Netherlands, International HIV/AIDS Alliance UK, and TREAT Asia/amfAR It was supported by many community organisations and networks from the region. UNAIDS, Naz Foundation International and the Resource Centre for Sexual Health and AIDS (RCSHA), India, provided technical support to the consultation. Key outcomes from this significant event were: 1) A Declaration of Collaboration by policy makers, civil society, and donors; 2) An agreed set of Principles of Good practices; 3) An agreement to develop a pan Asia-Pacific regional tripartite coalition of community sector representatives, along with the UN system and government sectors to provide a coordinated regional advocacy strategy for policy change, social justice, rights, and an equitable allocation of public resources for HIV interventions, care, treatment and other services for MSM and transgender What emerged from this agreement was the Asia Pacific Coalition on Male Sexual Health (APCOM), which was launched at the 8th International Congress on AIDS in Asia and the Pacific, held in June 2007, Colombo, Sri Lanka. NFI provides technical assistance and fiscal management for APCOM. Since then, APCOM has grown from strength to strength, and is rapidly becoming the leading advocacy voice for MSM and transgender populations and their sexual health needs in the Asia Pacific region. NFI sees this as a means to upstream its own advocacy work. In 2009, APCOM organised its first pre-conference satellite meeting at the 9th ICAAP in Bali, Indonesia, and at the 10th ICAAP in Busan, Korea, along with significant engagement during the conferences themselves through hosting satellitte sessions and caucus meetings. Funding support for APCOM and NFI's fiscal management has come from Hivos, the Dutch funding and support agency which has a strong focus on sexual minorities and health. 2007-2011 With the DFID Asia Regional Poverty Fund closing its doors in 2006, and the DFID India Community Fund and Social Marketing Fund ending in 2007, the next two years for NFI were a considerable struggle for survival. As a part of its emerging strategy for the provision of technical support to country partners in South Asia, NFI Regional Office devolved, and separated out all its India work to form (India) Naz Foundation International as a national and independent India registered, MSM community led technical support agency. All regional office staff engaged with India work were shifted to this new organisation. In 2007, with the support of the World Bank through its Institutional Development Fund, India NFI was able to continue its technical support programme, while NFI's secretariat continued programme management through a range of small grants and contracts. In January 2009, with a major input from the European Union, a three-year project on supporting the scale-up of HIV services for males-who-have-sex-with-males (MSM) in India, by strengthening the capacity of community-based organisations of MSM, and others to address MSM and HIV issues was implemented. This required INFI to provide technical assistance and support to 36 current MSM CBOs, and develop 14 new CBOs by the end of the project and ensure that all these projects were funded for their service delivery. NFI provided technical assistance and support to INFI through its Secretariat in the UK and the Regional Programme In 2010, India Naz Foundation International changed its name Office in India. This project ends in to Maan AIDS Foundation, joining NFI's other country partners: December 2011. (See "A model expliBandhu Social Welfare Society (Bangladesh), Blue Diamond Socated" page 10) ciety (Nepal), Companions on a Journey (Sri Lanka), Naz Male Health Alliance (Pakistan). 9 Pukaar October 2011 Issue 75 2011 and beyond A Round 9 Global Fund South Asia Regional Project for MSM and transgender populations Community systems strengthening In 2006, NFI submitted a South Asia regional proposal for the Round 6 Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). This was rejected because of inadequate engagement with Country Coordinating Mechanisms. In 2007, PSI Nepal approached NFI for a joint application for the Round 7 GFATM. In this application only three countries out of the eight in South Asia were included in the proposal, This was given a category three by GFATM which meant "please improve and re-submit" to paraphrase. At the beginning of 2008, NFI called a meeting with PSI Nepal, and all its country partners, bringing in Companions on a Journey in Sri Lanka to discuss the GFATM Technical Review Panel (TRP) comments on our Round 7 bid, and decide how to respond. It was agreed that we should totally revamp the proposal, and bring in the other countries of the region. NFI mobilised resources to be able to do this, with funds from Open Society Institute and the Technical Support Facility, South-East Asia, along with in-kind donations from PSI Nepal and NFI itself. Because of a range of issues, the final proposal was submitted as a Round 9 one, and following our responses to the GFATM Technical Review Panel comments, GFATM announced that they had approved the five year, $44million South Asia MSM and transgender proposal at the end of 2009. This project is a partnership of 10 agencies, with PSI Nepal as a principle recipient, and NFI as the key sub-recipient, along with UNDP as a technical partner. Seven country partners are also a part of this project. Afghanistan, Bangladesh, Bhutan. India, Nepal, Pakistan and Sri Lanka. Maldives was to be a part of the Coalition, but withdrew because of their sensitivity around the issues of MSM and transgenders, Principally the project builds on the strength and experience that NFI has developed over the years in providing technical assistance and support to its country partners, and scales this support substantively, bringing in additional country partners. PSI Nepal would provide overall grant management, and UNDP would provide regional and in-country advocacy and policy development support towards strengthening an enabling environment. 2010 saw a year of intense negotiations with the GFATM and PSI Nepal regarding programmatic and budget issues. As a efficiency savings exercise, GFATM required to cut the budget by at least 13% and a range of assessments on all partners needed to be conducted and approved. NFI finally signed its contract with PSI Nepal/GFATM in April 2011. Project DIVA is the name given to this project by all partners. A model of technical support to MSM, transgender and hijra populations explicated The mapping of the NFI technical assistance programme (page 11) illustrates the knowledge and capacity flow from NFI, which supports its country partners, which then is downstreamed to MSM/ hijra community-based and local organisations to strengthen their capacity to deliver quality HIV and sexual health services. Along with this, is NFI's relationship with a range of key national and international stakeholders, such as UNAIDS, UNDP, the International HIV/AIDS Alliance, MSMGF and APCOM which enables more upstream advocacy and policy development in regard to social justice and equity and access to health. However, this process took several years to evolve as the history of NFI demonstrates in the previous pages that outlined key achievements since it began. In 1992, The Naz Project hosted its first major multi-country consultation meeting on HIV and marginalised populations for South Asia and Muslim communities in Europe. The consultation model developed for this meeting was replicated for the 1994 Humsafar Trust/Naz Project Mumbai conference in 1994, and further tested at the First South Asian Regional MSM and HIV consultation meeting in 1999 in Kolkata. This has evolved as a basic template for organising our regional consultation meetings. Between 1996-1997, Naz Foundation International developed a range of study tools and training resources which were used to conduct the risks and needs assessment study in Dhaka, Bangladesh. These tools and study instruments were refined and replicated in each and every risk and needs assessment conducted by NFI over the years, including the 36 assessments conducted as a part of the DFID India Community Fund (2006-2007) project Increasing the coverage of sexual health services for MSM in Andhra Pradesh, Karnataka, Tamil Nadu and Uttar Pradesh, India – a pilot project. The six-volume training tool-kit to support the development of 10 Bandhu Social Welfare Society staff during workshop new CBOs arose from the many capacity strengthening workshops conducted by NFI over the years in regard to the community systems strengthening programmes it has held addressing institutional and programmatic issues for MSM community-based organisations. It had always been recognised from its beginnings that, by its very nature, NFI would not be implementing direct sexual health services to MSM and hijra communities and networks, but rather support the development of self-help groups and organisations to provide such services. NFI saw itself then as a development agency working across South Asia. However, its initial approach was often ad-hoc, responding to what funds were available, and without a Pukaar October 2011 Issue 75 clear strategic vision. Initially NFI worked at the local level, helping networks to become MSM and sexual health organisations, and then providing ongoing technical assistance to those organisations to strengthen their systems and capacity to deliver sexual programming. Thus, NFI assisted in the development of MSM HIV programming in Dhaka and Syhlet in Bangladesh, and services in Bangalore, Chennai, Hyderabad, Kolkata, Lucknow, New Delhi, Pondicherry and many other cities. By 2003, Bandhu Social Welfare Society in Bangladesh had grown from a small service project in central Dhaka to one covering some nine project sites, three in Dhaka alone and in six other cities. NFI was not working with individual MSM projects, but rather supporting emerging national partners, i.e. BSWS, which now developing as a national MSM and sexual health agency with service points in a range of cities in Bangladesh. In Nepal, initial technical assistance was developed with Blue Diamond Society which was also a national partner. Only in India was this emerging model problematic. In 2005, the World Bank Institutional Development Fund required an India registered organisation to transfer funds for the project, so NFI took the opportunity to realign its work in India and established an India partner, initially called (India) Naz Foundation International, which took over the responsibility of all work in India that had previously been done by NFI Regional Office. The World Bank IDF allowed (India) NFI to develop itself as an independent agency and to begin to replicate the NFI CBO development process in India. In 2009, the three-year European Union supported project for technical assistance to MSM CBOs in India, enabled to continue to build its capacity and scale up its technical support capacity to locally based MSM community organisations providing HIV services. The GFATM regional project enables Maan (INFI) to continue this process. However, as can be expected, the initial name of our India partner caused a great deal of confusion, and so in 2010, (India) NFI changed its name to Maan AIDS Foundation. India was now aligned with NFI in the same framework as the other countries in South Asia that NFI had developed technical support partnerships with. In October 2010, following technical assistance support to a group of MSM in Pakistan, Naz Male Health Alliance was formed as the country partner of NFI, as an initial step to implement the Round 9 South Asian GFATM regional project. And discussions began with an organisation in Afghanistan providing health services for men who have sex with men, Youth Health and Development Organisation (YHDO) to take this on board as our Afghanistan country partner. In Bhutan, with no appropriate MSM agency in the country, we will be working with the Bhutan National AIDS Control Programme to develop such a country partner as a part of the GFATM project. The GFATM South Asia regional project enables NFI to strengthen its Secretariat based in London, UK charged with the responsibility of overall programme oversight and management, where the Chief Executive's office is based at the Regional Programme Office in Lucknow. It also enables NFI to strengthen the Regional Programme Office by additional and dedicated staff to manage the technical support unit, along with developing a monitoring and evaluation. 11 Pukaar October 2011 Issue 75 A model explicated continued from page 11, col. 2 Reducing the risk of transmission of HIV and other sexually transmitted infections amongst males who have sex with males and their partners in South Asia Asia Regional Poverty Fund 2000 - 2006 Naz Foundation International was formed in August 1996 with a specific objective to provide technical, financial and institutional support to local MSM networks in South Asia, so as to empower them to develop their own STI/HIV/AIDS prevention and support programmes. Between 1996 and 2000, eleven such MSM sexual health projects were developed in the region. Experience gained during this period enabled NFI to develop a replicable strategy for project development, and a standardised model of service delivery. This increased the number of MSM sexual health projects in South Asia substantially over a five-year period. A three-year project proposal for increasing coverage of reproductive and sexual health programmes for MSM in South Asia through providing technical assistance to local MSM networks to develop their own sexual health services was submitted to the Asia Regional Poverty Fund of DFID. The proposal involved developing a Regional Office to be based in India to continue to develop MSM community based organisations addressing HIV and AIDS, the development of a regional MSM trainers’ network, enhanced advocacy and technical support, as well as the development of some 30 MSM community-based projects across the region. Funding was secured (ALA/779/551/001) and implementation began in October 2000. This project was extended a further three years - 2004-2006. During this period, the NFI South Asia regional office was developed that housed NFI’s Advocacy, Knowledge Management and Training Units, a regional network of 30 MSM trainers developed, 25 MSM HIV projects supported and an additional ten new MSM community-based HIV service providers developed, along with a number of training programmes, BCC materials, and training toolkits. Towards the end of the funding period, DFID conducted an evaluation of our work, which recommended continued support. To this end, DFID supported NFI in the development of a 5-year strategic development plan, which included: • Strengthening operations in India • Strengthening operations in South Asia • Institutionalising replicable, scalable and cost effective models • Enhance knowledge and research capacity • Strengthen resource mobilising • Upstream advocacy and policy development • Enhance NFI’s monitoring and evaluation capacity • Restructure NFI to achieve the above It was this process of development that NFI was able to evolve its fundamental structure of a small Secretariat office charged with the responsibility of over all programme management, with its Chief Executive's office based at the NFI Regional Programme Office in India in order to have a more effective oversight role close to programme activities, During this period, other resources were mobilised, including the UK Foreign and Commonwealth Office, DFID India, the World Bank, and various donors that enabled NFI to organise the Risks and Responsibilities meeting held in New Delhi, India, in September 2006. Outputs achieved under this project include: • Enhancing the Technical Support Unit for India • Developing four state MSM Technical Support Facilities • Developing four state level MSM and HIV Forums • Developing 36 MSM grass-roots organisations • Developing the NFI CBO development tool-kit into four vernacular languages • Conducting 16 training programmes • Advocacy work with State AIDS Control Societies and other donors for on-going support for the CBOs and State Technical Support Facilities A key outcome of this project was the piloting and full-scale testing of the NFI MSM CBO development tool-kit in a number of different environments. This also led to the development of an India country partner of NFI, Maan AIDS Foundation (formerly INFI) to join with BSWS in Bangladesh and BDS in Nepal. With the core support provided by the ARPF, and the mobilising of additional resources, other activities were implemented. DFID India Enhance the capacity of the National MSM and AIDS Human rights, policy and advocacy Task Force to enable it to train, establish, monitor and coordinate the activities of up to six Local Policy and Advocacy Units in MSM Projects in six cities of India over a period of one year Outputs included: • Supported the development of the National MSM and AIDS Task Force • Developed eight new MSM and human rights policy units within existing NFI partners • 12 training programmes conducted • A study conducted on MSM and human rights issues in these localities • Continued support provided to the existing five advocacy cells developed with funds from Foreign and Commonwealth Office Human Rights Programme • Four stakeholder workshops conducted with police, media, judi- DFID India: Community Fund 2006 - 2007 Increasing the coverage of sexual health services for MSM in Andhra Pradesh, Karnataka, Tamil Nadu and Uttar Pradesh, India – a pilot project. 12 A poster developed by the Knowledge Unit and produced in 11 languages Pukaar October 2011 Issue 75 ciary, lawyers and policy-makers • Advocacy meetings and seminars held with local stakeholders (total participants 1540) • Eleven workshops conducted in local cities where advocacy cells established for MSM on legal literacy and rights • Documentation on human rights violations, abuse and discrimination against MSM recorded in all 13 cities • Participation and technical support for the planning of National AIDS Control Programme's Phase III five-year HIV prevention programme in India, along with the development of recommendations for scaling up coverage of MSM and HIV services – adopted by NACO A key outcome was the upstreaming of advocacy work in India on MSM and HIV services and the inclusion of MSM and human rights issues into NACP’s Phase III plan. DFID India - Social Marketing Fund Development and field-testing of low-cost water based lubricant sachets to reduce the transmission of sexually transmitted infections (STIs) amongst males who have sex with males (MSM) in India. Outputs included • Manufacture and packaging of 2.5 million sachets of lubricant with an aloe-vera base • Distribution to 66 partner organizations for onward field distribution and testing for user friendliness and acceptability • Business plan for large-scale manufacture and distribution A key outcome was up-streaming advocacy work in regard to ensuring access to appropriate sexual health products for MSM within NACO’s Phase III plans, as well as demonstrating income-generating frameworks for MSM CBOs, along with enabling access to water-based lubricant by MSM. In addition, two other projects implemented through this period contributed significantly to development of the NFI achievements. Action to address legal, judicial, and social impediments to sexual health promotion amongst men who have sex with men in India and Bangladesh – funded by the British Foreign and Commonwealth Office; July 2003 – June 2006 Achievements included: • Study on the impact of social, legal and judicial impediments to sexual health promotion and HIV and AIDS related care and support for MSM in Bangladesh and India conducted and report disseminated (see From the Frontline, www.nfi.net) • Five advocacy cells developed in India and supported for project period (continued support beyond project period provided by DFID India – see above) • National MSM and AIDS Task Force in India developed and supported – continued development and support beyond project period by DFID India • Advocacy cell developed within Bandhu Social Welfare Society, Bangladesh, evolved into the National MSM and Human Rights Task Force, with continued support provided by DFID Bangladesh beyond project period A key outcome was the up-streaming of advocacy to address the impediments to national and state levels, along with down-streaming advocacy through the development of the advocacy cells, which was continued with the DFID India and Bangladesh support. Risks and Responsibilities: Male Sexual Health and HIV in Asia and the Pacific International Consultation, 23-26 September 2006. Development initiated in May 2005: • Co-hosted by NFI and the National AIDS Control Organisation, India with technical support from UNAIDS. • Brought together 380 delegates from 30 countries in Asia and the Pacific representing government national AIDS programmes, donors and other funding support agencies, as well as MSM and transgender organisations • Raised half-a-million GBP for the meeting Key outputs achieved • The Delhi Declaration of Collaboration between government, A working group at the RR meeting donors and community-based organisations to work together towards increasing investment and scaling up coverage. • Principles of Good Practice for implementing MSM/transgender HIV services developed and adopted by delegates • Development of a tripartite Asia Pacific Coalition on Male Sexual Health (APCOM) to support and advocate for increasing investment for scaling up coverage of MSM/transgender HIV services across the region In addition, as a part of the consultation development process, 21 countries in the Asia-Pacific region conducted an MSM needs assessment, the majority hosting their first national MSM consultation meetings, incorporating many of these issues into their national AIDS Programmes (an example of this was the five regional consultations in India developing the needs assessments and recommendations for NACO Phase III plan, which also involved the advocacy cells and the National MSM and AIDS Task Force – see above). Along with this has been significant developments in China, Malaysia, Japan, Indonesia and PNG since the consultation meeting, where governments are recognising the importance of addressing MSM and HIV concerns. Further, a range of key background papers were also developed with UNAIDS and USAID support for the Consultation Meeting, including an epidemiological review, a spending assessment, rights and MSM, socio-cultural frameworks, and good practice. A key outcome has been the upstreaming of advocacy in regard to MSM/transgender HIV and sexual health concerns involving governments and donors directly, along with the development of APCOM. The ARPF core support also enabled NFI to begin engagement in Pakistan, and test out its tools and development processes in this country. Developing MSM and transgender HIV services in Pakistan In May 2005, NFI was asked to be part of a UNAIDS Mission to Pakistan to review the World Bank supported Pakistan’s National Enhanced Programme on AIDS men who have sex with men service package projects. This was followed by a short-term contract with the World Bank to provide immediate technical support to the current MSM interventions funded by the Enhanced Programme on AIDS. A key outcome was the considerable advocacy work that was conducted with the National AIDS Control Programme, the Provincial AIDS Control Programmes, country donors, and civil society organisations regarding MSM and transgender sexual health issues, as well as skilling-up current NGOs who were implementing MSM HIV services. Continued on page 14, col.1 13 Pukaar October 2011 Issue 75 A model explicated continued from page 14, col. 2 However, we were not able to fully replicate the work we were doing in Bangladesh or India, because there were no MSM/hijra community based organisations in the country, where what services did exist were being provided by non-MSM NGOs. Nor could we attract any funding or support for such an initiative. It has only been with the South Asia regional GFATM project that this is being achieved. In summary then, with the DFID ARP fund as core support and along with additional resources: • Upstreaming advocacy work on MSM and a rights-based approach to HIV prevention, care and support towards Universal Access in Bangladesh, India, Nepal and Pakistan • Studies conducted on the impact of social, legal, and judicial impediments to sexual health promotion and HIV and AIDS related care and support for males who have sex with males in Bangladesh and India • Development of a National MSM and HIV Task Force in India, along with eight state level Advocacy Cells in partnership with MSM CBOs • Development of a MSM and HIV Advocacy Cell in Bandhu Social Welfare Society, Bangladesh • Working closely with the National AIDS Control Organisation, India in developing its Phase III plan where it involves MSM • Capacity building programmes for NGOs and CBOs working with MSM in Bangladesh, India, Nepal and Pakistan (total of 45 workshops) • Developed 36 new MSM CBOs working with HIV issues and concerns in India • Developed four state level MSM and AIDS Forums in India • Conducted 40 situational assessments of MSM in India and Bangladesh • Developed tool-kits for MSM CBO development and HIV programming in six South Asian languages • Developed a range of IEC templates specific to the needs of MSM in several South Asia languages • Conducted the Asia-Pacific consultation meeting on male sexual health (MSM) in New Delhi, India • Initiated the development of the Asia-Pacific Coalition on Male Sexual Health (APCOM) • Partnered a range of MSM and HIV organisations to develop the Global Forum on MSM and HIV • Produced a range of reports, papers and presentations • Upgraded the NFI website • Provided technical assistance and support to two national MSM CBOs (BDS, Nepal and BSWS Bangladesh who between them are working in 15 districts in these two countries • Provided on-going technical assistance and support to 58 MSM CBOs working in India • Provided technical assistance and support to 7 NGOs working with MSM in Pakistan • Provided technical assistance and support to PSI Myanmar for their national MSM and HIV prevention, care and support programme • Seed funding provided to 45 MSM CBOs in India Consolidation and reflection - a challenging period The model of technical and institutional support for community systems strengthening had proved to be cost-effective process of both strengthening our country partners, as well as downstreaming such institutional and technical assistance to locally based MSM community organistations. However, with the end of the Asia Regional Poverty Fund grant in March 2007, and with all the expansion of the work of NFI across the region, we were placed in the peculiar position of having increasing demands placed upon NFI to support its country partners, along with the newly emerged INFI (to become Maan in 2010), but with no resources to respond to these expressed needs.. A dramatic scaling down of technical assistance to our country The World Bank Institutional Development Grant for fighting HIV and AIDS and promoting sexual health amongst males who have sex with males in the South Asia Region Providing technical support to MSM networks, groups and organisations towards enabling them to develop as community-based HIV service providers promoting sexual health amongst their constituencies, Naz Foundation International (NFI) has primarily worked in Bangladesh, India, Nepal, and Pakistan, with increasing request for such support from these countries, as well as from Afghanistan, Sri Lanka, and Myanmar. The World Bank agreed to provide NFI with a 2 year Institutional Development Fund grant beginning July 1st 2007 to achieve the following: • Strengthened technical support capacity 14 partners resulted between 2007-2009, because of this lack of resources. The Secretariat staff was reduced, along with the regional office staff where small contracts were developed to keep key work going. This also had a dramatic impact on INFI, which also had to reduce their staffing and programming activities, with some core funding being provided by the World Bank Institutional Development Fund. There were even demands to close NFI down, but Shivananda agreed to work on a voluntary basis until such time as funds became available again. • Developing knowledge management capacity • Developing advocacy capacity • Strengthening financing and management capacity Funding was channelled through NFI’s India partner, India NFI to primarily support the above activities in India and the activities of the regional programme office which implemented the NFI regional work. Through the strengthening of the Technical Support Unit with staffing and equipment, has enabled INFI to continue its downstreaming of its technical assistance more effectively along with scaling up of this support. During the period of this grant, INFI has conducted two India state level training programmes on capacity building for 20 MSM CBOs (80 participants), 321 days of site visits in six states providing on-site technical assistance and addressing capacity needs with 43 MSM CBOs provided such assistance, agreements reached with these six State AIDS Control Societies to support such technical assistance, and sensitisation programmes conducted for 420 professionals engaged in HIV work (doctors, media persons and NGO staff). INFI has also responded to some 5373 requests for assistance. Pukaar October 2011 Issue 75 Further NFI, in collaboration with INFI, conducted two regional (South Asia) training of trainers programmes, a total of 18 days and 54 participants. The support provided by the World Bank IDF grant also enabled NFI to provided technical assistance and institutional support for the development of the Asia Pacific Coalition on Male Sexual Health (APCOM) by NFI and the engagement of NFI through its Chief Executive as the Chair of this institution, NFI has been enabled to significantly strengthen and upstream its advocacy work, with governments, donors, INGOs, national NGOs, and MSM and HIV groups and organisations, not only in South Asia, but also across Asia and the Pacific. This has been possible because both NFI and APCOM share the same advocacy objectives. It further led to the deepening engagement of the Regional Office of UNDP in supporting NFI’s country activities, including the first national MSM and HIV meeting in Sri Lanka, developing an MSM technical resource team for Pakistan, hosting the India and South Asia meetings in Lucknow, as well as financial resources, input and proposal partner, in the NFI GFATM regional proposal. NFI’s engagement with the Global Forum on MSM and HIV is also having a similar impact in strengthening its advocacy and technical assistance role, providing opportunities to disseminate NFI’s work and develop links with MSM and HIV agencies who wish to replicate NFI’s model of regional technical assistance in their parts of the world, including sub-Saharan Africa and Latin America. NFI’s support for INFI has also assisted in the development of consensus building among the various state and national MSM networks that in the past has been somewhat acrimonious. This has seen a greater engagement of all these networks in working together to achieve common goals. European Union Development Assistance Programme, India Supporting the scale-up of HIV services for male-who-have-sex-with-males (MSM) in India, by strengthening the capacity of community-based organisations of MSM, and others to address MSM and HIV issues. 2009-2011 Implementing this project enabled NFI to once again strengthen its Secretariat functions and activities to some extent, along with continuing to strengthen INFI's capacity as a technical assistance agency for MSM and hijra populations in India, implementing the model of community systems strengthening process. Results anticipated as a part of this project are: • India NFI’s technical support and knowledge units strengthened and office expanded and equipped to provide assistance to MSM CBOs on an on-going basis. • By the end of project, 50 MSM CBOs at state and district levels have been strengthened and are working with India NFI, receiving regular technical assistance and support in 16 states, a Union Territory, and the National Capital Territory of Delhi • By the end of the project, the National MSM and HIV Policy, Advocacy and Human Rights Network and the Network of India People of Alternate Sexualities Living with HIV are receiving technical assistance and support, and are linked to and working with all 50 MSM CBOs. • By the end of project, technical support and assistance, along with knowledge support have been provided to state AIDS control societies and district AIDS control units, to map MSM sexual networks, and to enable them to access MSM HIV prevention, treatment, care and support service providers in 16 states, a Union Territory, and the National Capital Territory of Delhi • Appropriate policies developed and implemented by governmental, and private and non-governmental organisations, which deliver HIV prevention, treatment, care and support services, to address stigma, discrimination and social exclusion against MSM • A range of appropriate BCC materials (posters, leaflets and booklets etc.), training and capacity building toolkits and manuals developed for, and available to MSM CBOs. • Effective monitoring and evaluation, including financial auditing has been undertaken, and the lessons learned from the project have been distilled and disseminated. In regard to the process of strengthening existing 36 CBOs and supporting the development of 14 new CBOs, this has been particularly challenging. This is because of the intense negotiations that were required with Alliance India, NACO and SACS to get a consensus on where such support and development should focus to ensure that no duplication occurred in respect to different funding streams, arising from the Round 9 GFATM India country project. Apart from validating the institutional and technical support process, a key output required by the project was to ensure that all these 50 MSM CBOs were being funded, hopefully by individual SACS. As of the end of December 2010 (2nd year of project), the following results have been achieved: 1. Maan AIDS Foundation strengthened The INFI project has been strengthened with additional staff and resources, and provided with eight capacity strengthening workshops conducted by NFI., and scroring above target in a capacity assessment. 2. Supporting 36 MSM CBOs and developing 14 MSM CBOs to respond to HIV issues impacting on MSM and transgenders 36 CBOs provided with technical assistance, and 9 new CBOs developed with 39 training sessions for 932 participants in 16 states; 7,205 emails and 11,425 phone calls from these partners. 26 out of 36 existing CBOs score above target in their capacity assessment. 3. Supporting organisations addressing MSM/TG HIV related human rights needs and MSM/TG living with HIV Support provided to 11 CBOs in the National MSM and HIV policy , advocacy and human rights Task Force and to six CBOs in the Network of Indian People with Alternate Sexualities Living with HIV/AIDS. 4. Supporting state and district governmental AIDS management organisations 17 CBOs are/will be receiving funds from SACS, 30 CBOs will receive funding from the GFATM India project. This leaves 6 CBOs to identify funding sources out of the anticipated total of 35 old CBOs and 18 new CBOs. In regard to District AIDS Pevention and Control Units (DAPCU), the anticipated result has not as yet been achieved as currently DAPCUs are only engaged in data collection and programming updating. Discussions still on-going in regard to the relative merits of composite programming, and community-led interventions. 5. Policy work with mainstream stakeholders working with Integrated Counselling and Testing Centres (ICTC) and Anti-Retroviral Treatment Centres (ARTC) This result is not being achieved. NACO policy dictates that the ICTCs must collect personal information which clients are not willing to give. A consequence has been a significant drop of in MSM/TG service users. Maan/NFI working with India Network For Sexual Minorities (INFOSEM) to request NACO to change its Continued on page 16, col. 1 15 Pukaar October 2011 Issue 75 European Union Development Assistance Programme, India continued from page 15, col. 2 policy on this. 6. Production and distribution of behaviour change communication materials Over the two year period • Eight editions of Pukaar produced • NFI website maintained and regularly uploaded with new documents with 917,274 hits alone in year two • New BCC resources developed and disseminated (posters, booklets, leaflets) • 156 products developed with 60 other resources uploaded on website 7. Undertaking effective monitoring and evaluation • 26 out of 35 of the original CBOs trained to use the NFI MIS system. This is included in the training programmes for the new CBOs. • Maan’s M&E system strengthened with regular reporting from CBOs. • NFI’s MIS system now in line with NACO requirements Challenges being faced 1. Clarifying the role of Maan AIDS Foundation and its engagement across India as a technical support agency for MSM/hijra service providers in the light of the state territorial division between the different SRs for the GFATM India project and Integrating this division and the India component of the GFATM regional project into an operational plan in terms of the inclusion of the Maan engagement in the GFATM round 9 country project and the upcoming PATH/ CIDA project; 2. NACO’s insistence on collection of personal information on MSM/hijra clients attending the ICTC and ARTCs leading to a drop-off of service users; 3. Policy engagement in advocacy development of the two national partners because of a lack of funding support for the networks themselves. Posters developed by the knowledge unit for downstream dissemination by Maan AIDS Foundation and other country partners. The Unit also produces booklets, leaflets and a range of institutional development tools available on the NFI website. The Global Fund to Fight AIDS, Tuberculosis and Malaria Reducing the impact of HIV on men who have sex with men and transgender populations in South Asia 2011-2015 NFI was finally successful in its third attempt to secure funding from the GFATM for a scaled up response to the community systems strengthening needs of its country partners across South Asia, and the downstream capacity needs of local community based organisations they work with. The project explicates the full implications of what NFI has been discussing over the years, and wanting to implement on a regional level, where this grant is the first MSM and transgender regional project that the GFATM was willing to fund. It is a five year project worth some $44 million USD. The project will be implemented in seven South Asian countries: Bangladesh, India, Nepal, and Sri Lanka (where there are currently active community-led partner organizations), as well as Afghanistan and Pakistan (where partners will be developed), and Bhutan (where we will work with the government). The main focus of the project activities will be supporting and building the capacity of in-country organizations to 16 deliver high quality services, engage in policy development and advocacy initiatives, and take part in research on HIVrelated issues affecting MSM and transgender populations. The project aims to strengthen the community systems to support and sustain this work. In order for the interventions carried out by CBOs to be both effective and sustainable, it is necessary to build their capacity, create stronger linkages and networks between community organizations and community-led interventions, and provide longer-term support to these groups. In the case where MSM and HIV country partners have their own local MSM and HIV organisation networks, the project will strengthen their capacity to enhance and share skills, capacity and knowledge downstream to their partners. Where such country partners do not exist, the project will develop the necessary capacity to strengthen national AIDS programmes to respond effectively and appropriately to the sexual health needs of MSM in their countries, whilst establishing new country partners. Such organizations will be Pukaar October 2011 Issue 75 developed and supported to undertake necessary policy and advocacy work, generate knowledge, and strengthen service provision so that MSM and TG can access and use appropriate HIV-related services. In addition, these organizations will further support the development and operation of local MSM and TG organizations providing HIV-related services to MSM and TG populations at a local level. Along with national level CBO strengthening, regionally, the project will enable sharing of knowledge, good practice, advocacy and skills across the various countries, and address cross-country issues through regional coordination and supporting regional initiatives. Cross-country learning will provide added value to country-level research, advocacy and capacity development, and improve the ability to address regional issues in a strategic way. In the development of the proposal to the Global Fund, a detailed analysis of what incountry work is currently being funded, will be funded, and will not otherwise be funded, on MSM and HIV issues was undertaken; this programme will not duplicate in-country work. It will add-value to national work by supporting it and facilitating regional learning and co-ordination. A multi-country approach has been adopted for the three main reasons: 1. It is more effective because of the many similarities across the countries in the region that affect the risks and vulnerability of MSM and TG to HIV—including sexual and gender identities, social norms, stigma and discrimination, and restrictive legislation and law enforcement—will enable the knowledge, skills and resources developed in one country to improve the outcome of activities in other countries in the region. For advocacy and policy development targeting sensitive issues, utilising regional platforms can help overcome barriers that would exist if these issues were just addressed at a country level, and which can create more effective dialogues, and encourage necessary change. Finally, the creation of a regional body of strategic knowledge covering a range of issues, including behaviour and other HIV risk factors for MSM and TG, community-led “good practice” models, and policy and advocacy initiatives addressing MSM, TG, and HIV-related issues, will be invaluable to help and improve community-led efforts to address these issues across the region. 2. It is a more efficient because human, financial and other resources will be shared across a number of countries, and the learning, skills and resources required in each country can be more easily accessed from these shared resources, without having to duplicate the effort of producing these from scratch. For example, training to support country-level MSM and TG CBOs, to support them developing, and scaling-up of HIV services for MSM and TG in their countries, will be done by holding joint multi-country trainings, BCC resource templates will be developed that can be adapted to each locale, and the knowledge and expertise gained in one locale, will be used and adapted to inform work in another. 3. It is more economic because of the need for fewer resources, as resources will be shared across countries, rather than having to have them duplicated, and from the economies of scale gained from the regional procurement of commodities (condoms, lubricants, HIV-testing kits, and STI drug treatments), that will be used to develop MSM, TG, and HIV-re- lated community based services in Afghanistan and Pakistan. Service Delivery Areas 1. Improve the delivery of HIV prevention, care and treatment services for MSM and transgenders in South Asia; 2. Improve the policy environment with regards MSM, transgenders, and HIV-related issues in South Asia; and, 3. Improve strategic knowledge about the impact of HIV on MSM and transgender populations in South Asia. With PSI Nepal as the principal recipient, and UNDP as a technical partner focusing on advocacy and policy development, NFI is the sub-recipient that is implementing the community systems strengthening programme. As a part of systems strengthening, Technical Advisors trained by NFI will be seconded to each of the country partners to provide on-going institutional support and development. In the case of Bangladesh, India, Nepal and Sri Lanka, funds are available to conduct a range of capacity strengthening programmes for downstream partners, as well as similar programmes for the national partner. In addition to this, for Bangladesh and Nepal, funds are available to develop their resource and training centres. For Afghanistan and Pakistan, beyond working to develop a national partner in these countries, funds are available to pilot the concept of MSM CBO development, and then work with the respective country's NACP to submit a GFATM country proposal for scaling up CBO development and engagement. For Bhutan, NFI will work directly with the Bhutran NACP to develop an MSM CBO partner in the country. Further NFI is now able to strengthen its Regional Programme office in regard to its technical, monitoring and evaluation, finance, and knowledge management departments with additional staffing and resources. In Pakistan, the development process has already begun and a new national MSM and HIV partner has been developed - Naz Male Health Alliance, where the word Naz means "pride". This new organisation will be implementing the Pakistan component of this project. For the Regional Of- You can access this and previous editions of Pukaar online at: www.nfi.net/pukaar.htm Other documents on related issues are available on the NFI website: www.nfi.net/publications.htm 17 Pukaar October 2011 Issue 75 At the 10th ICAAP, Busan, Korea 25th - 30th August, 2011 www.apcom.org The Asia Pacific Coalition on Male Sexual Health (APCOM) was significantly engaged at the 10th International Congress on AIDS in Asia and the Pacific (ICAAP) at Busan, Korea. Apart from hosting the pre-conference satellite on the 25th August (Beyond Numbers), it also hosted four satellite sessions on Emerging HIV and social research issues among MSM and transgender people, Engaging the health sector for scaling up services for MSM and transgender people, I am what I am: Transgender health and challenges, Sex, Drugs & Technology: Findings from Asia’s largest multicountry Internet survey, along with presenting at the first plenary session dedicated to MSM and transgender issues at an ICAAP. Activism, research and a concrete plan of action APCOM’s “Beyond Numbers” Forum proves a dynamic curtain-raiser to the 10th ICAAP Coalition and key stakeholders chart a roadmap to stemming the HIV epidemic among men who have sex with men and transgender people in Asia and the Pacific A call for activism to combat stigma and discrimination, the sharing of new research on HIV, and a blueprint for renewed action to address the epidemic in the most vulnerable populations in the world’s most populous region. These led the agenda at “Beyond Numbers”, the day-long forum organized by the Asia-Pacific Coalition on Male Sexual Health (APCOM) as a curtain-raiser to the 10th International Congress on AIDS in Asia and the Pacific. The meeting was subtitled “Getting to Zero: The forces driving HIV among men who have sex with men and transgender people in Asia Pacific” reflecting the theme of one of the day’s major presentations in which the various concurrent epidemics, or “syndemics”, that contribute to the challenges of these vulnerable populations were examined in terms of their impact on individuals and the epidemic itself. “We cannot view HIV in isolation,” explained Shivananda Khan, APCOM Chairperson and Chief Executive of Naz Foundation International. “There are so many factors at play -- self-stigma and depression, alcohol and drug abuse, sexual exploitation. All of these contribute to an individual’s risk to HIV infection, and must be taken into account when designing effective outreach and intervention strategies.” That point was driven home in an extensive presentation of research carried out by Dr. Frits Van Griensven of the U.S. Centers for Disease Control’s office within the Ministry of Public Health of Thailand. “Syndemics are quite simply a set of multiple epidemics acting synergistically or together, producing an extra burden of morbidity and mortality in a population,” Dr. Griensven said. “Our research focuses on the nexus of these epidemics, where they meet to interact with and reinforce each other. A study carried out among MSM in Bangkok clearly shows a direct correlation between these factors and increased risk of HIV infection. It may sound obvious, but you’ve got to provide solid data to substantiate what’s long been suspected. MSM and transgendered persons are vulnerable on so many fronts, right from childhood through sexual maturity. We’re only at the beginning of what is already proving to be a vital approach in understanding what really drives the HIV epidemic in these populations who for so long have been denied health as a human right.” The emphasis on understanding syndemic issues in a rights-based context was supported by senior United Nations officials present. “In order to prevent and control the spread of HIV, we must protect and promote the human rights of those most vulnerable, typically also the most marginalized parts of our societies,” noted Clifton Cortez, Regional Practice Leader, HIV/AIDS Health and Development for the United Nations Development Programme. “It’s encouraging 18 that key UN resolutions have called for promoting social and legal environments that are supportive of and safe for vulnerable communities, including this year’s UN General Assembly resolution that for the first time specifically included MSM but unfortunately ended up excluding transgender persons. While progress is being made, we clearly have a lot of work left to do.” A lot of work remains to be done in South Korea as well, where the 10th ICAAP is being held, when it comes to ensuring the rights of MSM and other sexual minorities. Earlier this year, the government of South Korea withdrew official support for the conference, and community organizations and other stakeholders eventually helped organize the event, which is expected to draw some 2,000 delegates from the region and around the world. “South Korea is part of APCOM’s Developed Asia sub-region,” observed Dr. Stuart Koe, APCOM co-chairperson, who is from Singapore. “But merely because a country is developed from an economic perspective doesn’t necessarily mean that it offers its LGBT citizens equal rights in an enabling environment.” That view was expanded by Jeong Yol, one of the leaders of the coalition Solidarity for LGBT Human Rights of Korea and Co-chair of the LGBT sub-committee, that played a key role in rescuing the 10th ICAAP. “For us, making ICAAP happen is just the beginning,” he said. “There has been frustration, there has been sorrow, and for the LGBT community in my country there are many obstacles to be overcome. But the very fact that we’re here today with all of you at ICAAP, with APCOM, makes it all worthwhile.” The Korean organizers joined APCOM forum delegates in six important breakout sessions that discussed ways forward in addressing syndemic issues, MSM and transgender rights, and universal access to HIV prevention, treatment and care services. One session focused on faith and religion, and their impact on how MSM and transgender persons view their sexuality and their access to health. Participants recommended that communities find ways to gain support among faith-based organizations and religious leaders, drawing upon successful examples that are already occurring in India and other places where faith leaders are helping reduce stigma and Pukaar October 2011 Issue 75 discrimination by working together with vulnerable populations and persons living with HIV. Another session discussed how stigma and discrimination in the health care sector, a long-running challenge in Asia and the Pacific region, could be addressed successfully. Participants recommended that APCOM, whose membership includes the Western Pacific Regional Office of the World Health Organization, push member states to include sensitization towards marginalized populations in the curricula of medical schools and colleges, with the support of community leaders who could better inform the process. A particularly lively session focused on how social media and the Internet, which have strengthened MSM networks but also impacted the spread of HIV, could be used innovatively within a behaviour change model aimed at safer sex practices and community empowerment. Such work is already underway in various parts of the world, and participants called upon the APCOM membership to help lead the way for such approaches and research in the region. The transgender health breakout session focused on the particular needs of the community. “For far too long we’ve been clumped together with MSM, but that needs to change, otherwise HIV and health interventions for our people will remain less than optimal,” emphasized Laxmi Narayan Tripathi of India, an APCOM Governing Board member representing the Asia-Pacific Transgender Network. “It should be so obvious that we are very different from MSM, but governments, funders and even civil society organizations alike have ignored this, to the detriment of my people. We appreciate the support APCOM has given us by including us and strengthening our capacity to grow and advocate for our rights, but we need to truly stand on our own and be recognized for the unique community that we are.” One of the largest breakout sessions was Living with HIV whose participants recommended the inclusion of HIV positive MSM in prevention messages, from conceptualisation to implementation, and called for the messaging to be more upbeat, in terms of an individual’s ability to live a healthier and better life given access to treatment which in turn helps protect oneself and one’s partners. The social research breakout session recommended significantly scaling up research into the factors that contribute positively to the lives and well-being of MSM in the region and not just negative factors, along with the promotion of evidence-based programming and health outcomes informed by research findings. Conducting robust social research to generate evidence to help advocate for better services was the conclusion. “Men who have sex with men, transgender persons, people living with HIV, government representatives, United Nations organisations – there’s truly unity in diversity,” said Shivananda Khan, while unveiling the APCOM Busan Declaration (see page 21) that reiterates APCOM’s commitment to working on all the fronts explored during the “Beyond Numbers” forum. “The APCOM rank and file may not always be in agreement on every issue, but we engage in honest and transparent debate with one common goal – the eventual eradication of HIV and AIDS in our region, and our world. Today’s forum is proof that we’re doing all we can to get to zero – the UNAIDS vision of zero HIV infection, zero stigma and discrimination and zero AIDSrelated deaths. It’s a lofty goal, but we don’t believe it’s impossible. The very fact we’re all here together today is proof of that.” Satellite sessions organised at the 10th ICAAP by APCOM Moving from sheer quantity to queer quality: Emerging HIV and social research issues among MSM and transgender people Co-sponsors: APCOM, ARCSHS, UNESCO Co-chairs: Gary Dowsett, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia, and Pimpawun Boonmongkhon, Center for Health Policy Studies, Mahidol University, Thailand Speakers: Jeffrey Grierson, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia; Jan Willem De Lind Van Wijngaarden, Pakistan, UNAIDS/UNICEF, Pakistan; Hoang Tu Anh, Centre for Creative Initiatives in Health and Population, Hanoi, Vietnam; Thomas Guadamuz, Center for Health Policy Studies, Mahidol University, Bangkok, Thailand. Number of participants: 140 The goal was to bring together a wide range of actors involved in social research on men who have sex with men and transgender people, along with HIV prevention, care and support practitioners, to highlight the importance of social research in informing and improving the quality and effectiveness of HIV responses in Asia Pacific countries. Four social research studies related to sexual health, HIV and human rights were presented and discussed. A report from the presentations is to be developed as a possible blueprint for a best practice document on social research and HIV in the region. Engaging the health sector for scaling up services for MSM and transgender people Co-sponsors: APCOM, WHO, UNDP and UNAIDS Co-Chairs: Dr Zhao Pengfei, WHO Western Pacific Regional Office (WPRO), Manila, Philippines, and Laxmi Narayan Tripathi, Founder and Chairperson, Astitva Trust, Mumbai, India Speakers: Dr Ying-ru Lo, HIV Department, WHO Headquarters, Geneva, Switzerland; Addy Chen, MSM Working Group, Asia Pacific Network of People Living with HIV/AIDS (APN+), Thailand; Dr Maninder Singh Setia, Karanam Consultancy, Mumbai, India Number of participants: 130 Experts from the Asia Pacific region describe the reasons behind the current exclusion of men who have sex with men (MSM) and transgender people from mainstream health services (both public and private), give best/good practice examples from the field, and develop effective ways forward with the ICAAP delegates who are present. The goal is to provide up-to-date evidence on the health sector HIV response at the global and regional levels, to share experiences on providing sexually-transmitted infections (STI) and other health services, to address stigma and discrimination concerns related to health care providers, and to discover ways forward. Particular attention will be given the recent WHO, UNAIDS and UNDP global guidance entitled “Prevention and treatment of continued on page 20, col. 1 19 Pukaar October 2011 Issue 75 APCOM satellites at Busan continued from page 19, col. 2 HIV and other STI among MSM and transgender people in low and middle-income countries: Recommendations for a public health approach”. Delegates will understand how to foster effective and evidence-based responses to meet the needs for HIV/STI related health services and address challenges and barriers to access to services by men who have sex with men and transgender people in the community. I am what I am: Transgender health and challenges Co-sponsors: APTN, APCOM, TSF South Asia, Alliance TS Hub, UNDP, UNAIDS Co-chairs: Khartini Slamah, Core Group, Asia Pacific Transgender Network (APTN), Malaysia and Laxmi Narayan Tripathi, Founder and Chairperson, Astitva Trust, Mumbai, India Speakers: Prempreeda Pramoj Na Ayutthaya, Core Group, Asia Pacific Transgender Network (APTN), Thailand; Manisha Suben Dhakal, Programmes, Blue Diamond Society, Nepal Number of participants: 135 Little effort has been made to create a new demographic category for the purpose of epidemiology (that is, for tracking health conditions, including HIV, in different populations). Male-to-female transgender women have often been categorized as “men who have sex with men” in data collection and service design; that label may not accurately reflect gender identity or sexual orientation. Since population-based studies and global health surveys rarely include gender-variance variables, the data remain extremely patchy for the trans community and this leads to an inability to identify and meet the health needs for this community. This satellite helped develop good practices and supportive policies worldwide that promote health, research, education, respect, dignity, and equality for transgender community and gender-variant people in all cultural settings. Delegates understood the need for - and how to develop - strategic partnerships and alliances between Trans communities, the legal profession, human rights bodies, parliamentarians and governments, policy makers and the media. Sex, Drugs & Technology: Findings from Asia’s largest multi-country Internet survey Co-sponsors: APCOM with DAN, M.A.C. Fund, UNDP and UNAIDS Technology break-out session at the preconference Chair: Stuart Koe, Co-chair of APCOM; Co-Chair of DAN (Developed Asia Network for HIV in MSM & TG) Speakers: Laurindo Garcia, AIMSS and Positivevoices.net, Philippines; Sin Howie Lim, Epidemiology and Public Health, National University of Singapore, Singapore; Thomas Guadamuz, Center for Health Policy Studies, Mahidol University, Thailand; Chongyi Wei, Department of Epidemiology, University of Pittsburg, USA Number of participants: 110 AIMSS, the 2010 Asia Internet MSM Sex Survey, was a voluntary online survey conducted simultaneously in nine languages and dialects, with over 26,000 respondents mostly from 9 countries in Asia. The survey provides an enormous set of data with rich insights and unprecedented opportunities to understand the sexual risk behaviours of MSM in Asia and elsewhere who use the Internet. The session demonstrated the potential for the use of Information and Communications Technology (ICT) for communitydriven research, while discussing the forces driving HIV and risk behaviour amongst MSM using the Internet for sexual networking. Topics covered included factors associated with extreme high-risk behaviour, use of drug and recreational substances, young people, HIV status disclosure, and living as a positive MSM. Researchers from the project reviewed procedures and analysis of AIMSS data for socio-behavioural factors related to HIV transmission among MSM internet users including how study implementation leveraged innovative technology and community networks. Delegates were given fresh insights into the forces driving HIV among tech-savvy MSM in Asia, better understood the use of ICT in the design and execution of community-driven research intended to gain new evidence for policy, advocacy and programmatic design to reach hidden populations. APCOM is a coalition of MSM/TG community representatives, donors, government sector, UN agencies, and technical experts. Community sector representatives are nominated from across Asia and the Pacific through sub-regional network: Australasia, China, Developed Asia, India, Insular South-East Asia, Pacific South Asia, and also from the Asia Pacific Transgender Network, and the Asia Network of Positive People (MSM Working Group). Its Secretariat consists of an Interim Secretariat Coordinator Midnight), Administratve Assistant (Vaness), Executive Management Consultant (Paul Causey) and a Communications Advisor (Roy Wadia) 20 Pukaar October 2011 Issue 75 APCOM Busan declaration APCOM 25th August 2011 Notable progress has been made in the global response to the HIV epidemic, but with regard to men who have sex with men and transgender persons in Asia and the Pacific there remains a real and ever-expanding gap between the rhetoric of focused responses and the reality of the increasing HIV prevalence among these populations in the region. The September 2006 “Delhi Declaration,” urgently called for a scaled-up response to HIV prevention and care for men who have sex with men and transgender people. The Declaration was developed at the first Asia and Pacific consultation on male sexual health, which brought together over 400 people in a tripartite coalition of MSM and transgender community-based HIV organisations, along with representatives from government, donors and international and incountry agencies. Since then, a range of political actions have been taken to which governments in the region have signed up to, including: • The Economic and Social Commission for Asia and the Pacific (ESCAP) Resolution 66/10 (May 2010) and 67/9 (May 2011) • The UN Human Rights Council 17th Session Resolution on human rights, sexual orientation and gender identity (June 2011); and • The UN General Assembly Political Declaration on HIV and AIDS 65/277 (June 2011). These have all called for a more focused response to HIV, taking into account the extent of stigma, discrimination and social exclusion of men who have sex with men, and transgender persons that is impeding the development and delivery of appropriate HIV and sexual health services for these populations. The 2008 Independent Commission on AIDS report “Redefining AIDS in Asia – Crafting an effective response” highlighted the negative health impact that low investment and service coverage has, and will continue to have, on men who have sex with men, and transgender persons. This continues to be true. In 2010, UNDP issued two reports: “An agenda for action on legal environments, human rights and HIV responses among men who have sex with men and transgender people in Asia and the Pacific” and the World Health Organization – Western Pacific Regional Office, along with UNAIDS and UNDP, issued a document on “Priority HIV and sexual health interventions in the health sector for men who have sex with men and transgender people in the Asia-Pacific region.” Both these reports urged governments in Asia and the Pacific to abide by their commitments, and international donors and multilateral institutions to support these commitments. The Asia Pacific Coalition on Male Sexual Health (APCOM) and the delegates attending the APCOM pre-conference meeting at the “10th International Congress on AIDS in Asia and the Pacific,” in Busan, Republic of Korea, on the 25th August 2011, Noted the continued worsening of the HIV epidemic and the spread of other sexually transmitted infections (STI) among men who have sex with men, and transgender persons in the Asian and Pacific countries; Reminding all of the many agreements made by governments to abide by a range of international human rights commitments, and United Nations declarations, policies and guidelines, addressing those affected, infected and vulnerable to HIV, including men who have sex with men, and transgender people; Urged by the immediate need for coordinated and sustained responses to the HIV epidemic in Asia and the Pacific, for men who have sex with, men and transgender people; for international donors, multilateral institutions and civil society throughout Asia and the Pacific, to strengthen the spirit of partnership and collaboration to work together to: • Significantly expand financial investments for the provision of appropriate HIV and sexual health services for men who have sex with men, and transgender persons - within the framework of universal access for all; • Increase the scope, scale, intensity and quality of prevention, treatment, care and support services for men who have sex with men, and transgender persons across the region; • Maintain momentum and escalate investment in the development and assessment of new prevention technologies, and ensure that these are made accessible to men who have sex with men and transgender persons across Asia and the Pacific quickly and equitably; • Acknowledge men who have sex with men, and transgender persons in Asia and the Pacific, as key partners in country and regional responses to HIV and other STI, and actively provide institutional, financial and technical support to enhance the capacity of men who have sex with men, and transgender people to be meaningfully involved in decision making, policy development, programme planning and implementation; • Address the legal, judicial, and policy impediments to effective and appropriate HIV and sexual health services for men who have sex with men, and transgender persons in Asia and the Pacific, and completely eradicate stigmatizing and discriminatory punitive laws and practices - whether by governments, bilateral or multilateral agencies, or service providers; • Collectively step up efforts to combat stigma, discrimination, violence and abuse faced by men who have sex with men including gay men, transgender people, and those living with HIV. Only then can we, by working together, reach Zero stigma and discrimination, Zero new infections and Zero AIDS-related At the APCOM pre-conference: Clifton Cortezt, Practice Leader, HIV, Health and Development, UNDP Asia-Pacific Regional Centre on the dias along with Stuart Koe, Co-Chair of APCOM. We, the Governing Board of APCOM, specifically call upon governments to honour their political commitments on HIV, and 21 Pukaar October 2011 Issue 75 Homonormativity - the hegemony of ‘LGBT’ The mainstream Western LGBT movement has become a commercialized monolith in the years since 1960s “gay liberation,” and its impact is in no way limited to the US and Europe. This mainstream movement not only embraces a “with us or against us” mentality that demands queer people come out (as L, G, B, or T only) or be left behind, but it also creates a very narrow definition of acceptable genders and sexualities. The movement then punishes those who don’t fit into that definition by stigmatizing non-mainstream identities and refusing to allow these stigmatized gender and sexuality minorities to have a voice on legal and policy priorities. There are countless examples of how the mainstream LGBT movement uses stigma to limit access to legal and policy agenda-setting to those who meet its narrow identity criteria. In this post I’d like to focus on two places in particular: the example of third-gender kathoeys in Thailand and the example of alternative queer genders and sexualities in the US. In Thailand, as Sonia Katyal describes in her piece “Exporting Identity” (14 Yale Journal of Law and Feminism 97-176), there was an understanding before the Western mainstream LGBT movement showed up of three genders: male, female, and kathoey. If the word “gay” did come up, it would probably refer to a kathoey, but what Westerners would term “homosexual behaviour” was generally private. When the Western LGBT movement arrived in the 1980s on the heels of globalization and the spreading AIDS crisis, a new masculine-identified image of the gay man showed up in Thai culture. “Gay” became public, seeking legitimacy through masculinity. The word “gay,” Katyal posits, may have come into common use in Thailand specifically to distinguish these masculine-identified gay men who aligned themselves with the Western movement from kathoeys. Whereas gender identity had not previously been regulated by the state, the adoption of the Western LGBT model in Thailand made private public. Thai gay men turned social stigma on kathoeys, alienating both kathoey identity and effeminate gender expression. They began to define themselves in opposition to the newly-stigmatized kathoeys, who were then socially and legally sanctioned due to their public visibility. Ironically, they also became an easy target for state actors who objected to the arrival of the LGBT movement in Thailand. This shift in understandings of gender and sexuality also affects access to legal and policy priorities in Thailand. As Katyal explains, kathoey identity is not a public sexuality, so rights such as protection from sexual orientation-based discrimination and the freedom to identify as gay without being harassed are far less important to this population than rights such as privacy, the legality of private sexual acts, the right to education, and the ability to legally identify as a third gender. The Western LGBT model is also harmful in that it tries to address all gender identity issues by using a Western understanding of transgender identity. Non-binary genders are either stigmatized or simply erased. For example, a 2008 TIME Magazine article conflates kathoey identity with transgender female identity and puts most of the spotlight on ID cards and bathrooms. Though some Thai people who would fit into the definition of the English term “transgender” are now lumped in with kathoeys in Thailand, the original definition is closer to “third gender,” and many kathoeys do not want to transition from male to female, but rather consider themselves a separate gender that should be legally recognized as such. This is not only a problem in Thailand. My own experience in the United States is that queer minorities are often pushed aside and stigmatized, encouraged to feel shame for not slotting neatly into the mainstream LGBT movement. Those who practice alternative sexualities–for example, polyamorous or kinky queer Americans–are particularly stigmatized as the LGBT movement tries to focus on family, assimilation, and marriage. Anyone who deviates into gender 22 fluidity or alternate sexual values risks being avoided, ignored, or actively shunned by big players in the LGBT movement, whose priorities include marriage, adoption, and gays in the military. In the media, mainstream LGBT leaders meet conservative fears of leathermen in parades, drag queens teaching their children, and a slippery slope into polygamy with the language of assimilation. “We’re just like you,” these spokespeople are quick to reassure. “We have normal families, our kids go to school, and our identities are not about sex.” As someone who writes and talks about sex, is pro-kink, and is openly polyamorous, I am discouraged from being too vocal in mainstream spaces. I don’t feel comfortable attending many activist workshops or social gatherings because I do not fall into the LGBT acronym as a queer, gender queer activist. Online, I have found some support at the margins, but am discouraged by threads such as this one on Queerty, where gay and lesbian commenters take the attitude that trans people, lacking money and power, simply must live with the fact that only LG(B) priorities will be achieved. The numbers of gender fluid, gender queer, and non-binary people are of course even smaller. Even as the acronym expands (QUILTBAG is the largest I’ve seen so far), the use of an acronym itself alienates those who can’t claim one or more letters and the movement still tends in reality to focus on the L and the G, and much more infrequently, the B and T. Other groups may get a letter, but that’s pretty much all we get. For example, I’ve frequently seen issues that are mostly of relevance to non-binary genders, like the problem of “Male or Female” checkboxes on forms, described as a “transgender issue,” meaning that many non-binary people might not be able to find the discussions that are relevant to us. We are encouraged to push ourselves into the T as much as possible, and if not, resources and support may simply be unavailable. While trans identities are stigmatized on the one hand by many gays and lesbians, fluidity is stigmatized on the other. Even when “queer” is part of the acronym, this means little in practice. In my experience, stigma operates as a silent force to keep our priorities on the back burner. It’s not only vitriol in comment threads that makes me think twice before coming out as polyamorous, standing up for the legal right to practice BDSM, or loudly criticizing the same-sex marriage movement. It is a fear that I live with after years of hearing “innocuous” comments about gender and sexuality, the kind of fear that piles up when a marginalized community is subjected to stigma and shame. It is a fear that comes from not hearing many loud voices like mine and thus allowing stigma some power over me, the possibility that I may really just be weird and my priorities unreasonable. This fear is very powerful, because it doesn’t require a constant voice to keep us down. I don’t have to ask my boss whether she’d fire me if I talked openly about my gender and sexuality. I don’t have to poll the organizations I might like to work with one day to ask how they’d feel if they Googled my name and found an article on alternative sexualities. I know that the loss of opportunity and livelihood is a real danger if I am open about my marginalized gender and sexuality. I also know from the above examples that the mainstream LGBT community is unlikely to support me and that it is a huge uphill battle to amass enough funding to achieve my policy priorities. However, I would like to end on a hopeful note. If you feel marginalized by the LGBT movement, wherever you live, there is hope for change. If we can find each other, start building our own movements, and figure out creative ways to be sustainable, then we can start to change the conversation. From a place of stigma, we can say “enough is enough” and build pride around our identities without requiring anyone in our community to feel a certain narrow way about his/her gender or sexuality. http://www.genderacrossborders.com/2011/09/20/the-hegemony-of%E2%80%981lgbt%E2%80%99? Pukaar October 2011 Issue 75 Gay sex is an unnatural disease For the Indian Union health minister Ghulam Nabi Azad, men having sex with men (MSMs) is not only “unnatural” but also a “disease.” According to Azad, “this disease has come to India from foreign shores”, and Indian society needs to be prepared to face it. Unfortunately, he said, the number of “such people” is increasing by the day. In statements made while addressing zilla parishad chairpersons and mayors on HIV/AIDS, Azad said, “The disease of MSM is unnatural and not good for Indian society. It’s a challenge to identify such people. In case of female sex workers, we can identify the community and reach out to them since they live in clusters. But in case of MSMs, it isn’t always possible.” These comments have not only caused uproar among civil society, but also in the National AIDS Control Organization (NACO), which incidentally reports to Azad. “How can this be a disease? It is just a form of sexual orientation. It’s definitely not unnatural,” a NACO official told TOI . NACO has been working towards identifying MSMs and giving them a rightful place in society. A large number of targeted interventions (TI) have been put in place by NACO to specifically cater to the needs of the MSM community. According to NACO’s latest surveillance data, India is home to an estimated 4.12 lakh* MSMs of whom 2.74 lakhs have been identified. Around 4.2% of all sexually-active males in India are believed to have sex with other men, with Chennai, Andhra Pradesh, Gujarat, Tamil Nadu and Orissa reporting the highest number of such cases. Of the total number of 1,511 TIs, 168 exclusively cater to MSMs. Each TI, catering to 1,000 MSMs, cost Rs 15 lakh. The 2010 UNAIDS report on the global AIDS epidemic found that among the high-risk group that got HIV infection in India last year — 9.2% were intravenous drug users, MSMs (7.3%) and female sex workers (4.9%). “MSMs are those who are involved in very high risk sexual behaviour. They usually have multiple partners. Some are also involved in commercial sex activities,” the report said. Till now, a single TI would cater to MSMs and transgenders. Now, NACO has decided to have separate interventions for transgenders and MSMs. Experts say that after Article 377 or homosexuality in India was decriminalized by the Delhi high court, virtually legalizing consensual sexual relation among adults of same gender, more MSMs started visiting TI sites. “India has for long ignored the MSM community. India, like other Asian countries, had been addressing HIV/AIDS in high-risk groups such as female sex workers and injecting drug users, with the MSM population being left out because many men are married and do not identify themselves as gay or bisexual. That caused an alarming rise in HIV infections in the MSM community,” explained an expert. Dr Charles Golks, head of UNAIDS in India, told TOI that MSMs are a key population, who are at higher risk of acquiring HIV and the Indian government’s initiatives is helping reduce the threat. “India was the first country in Asia to recognize the vulnerability of the MSM population and put in place interventions required. NACO was also instrumental in putting down Section 377 that criminalized homosexuality as it was proving to be an impediment to effective public health intervention. In the next five years, under India’s National Aids Control Programme IV, stronger interventions with higher community involvement will be put in place to reach out to the MSM community.” Data from 78 countries revealed that condom use among MSMs was more than 50% in 54 countries, including India. Treat Asia’s report, “MSM and HIV/Aids: Risk in Asia”, which compiled studies conducted in 19 countries, said access to information and condoms is limited, with prevention programmes available to only 2% of MSMs in 16 Asia-Pacific countries. What’s worse, sex between men is illegal in 11 of the countries surveyed. The Times of India, 5/7/2011 * 1 lakh is 100,000 UNAIDS rejects prejudice and misconceptions about men who have sex with men and transgender people UNAIDS welcomes the call by the Prime Minister of India, Dr Manmohan Singh, to have an “HIV sensitive” policy and programmes so that the marginalized populations affected by HIV are not denied the benefits of health and development programmes. “We should work to assure for them a life of dignity and wellbeing. We have to ensure that there is no stigma and discrimination towards HIV infected and affected persons,” said Dr Singh. During the inauguration of the National Convention, Dr Singh reiterated his government’s strategy to provide HIV services to groups at higher risk of HIV infection. “There is no place for stigma and discrimination on the basis of sexual orientation,” said Mr Sidibé. “I welcome the bipartisan call by Mrs Sonia Gandhi and Mrs Sushma Swaraj to end all forms of stigma and discrimination against people at increased risk of HIV infection.” “Consistent with WHO’s disease classification, UNAIDS does not regard homosexuality as a disease,” said Mr Sidibé. According to the recently released UNAIDS and WHO guidelines on prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people, legislators and other government authorities should establish anti-discrimination and protective laws in order to eliminate discrimination and violence faced by men who have sex with men and transgender people. UNAIDS is committed to providing support to India’s successful AIDS response, which has seen new HIV infections drop by more than 50% in the last decade. India currently produces more than 85% of high-quality generic antiretroviral drugs for the majority of low- and middle income countries.India’s courts have progressively protected the human rights of people living with HIV and men who have sex with men by striking down discriminatory laws. UNAIDS will work with the Government of India, civil society and community groups in realizing the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths in India. Why we must work with male-to-male sex and HIV prevention, care and support Because: • It is the right thing to do on humanitarian grounds • It is the right thing to do epidemiologically • It is the right thing to do from a public health perspective Males who have sex with males (MSM) whether their self-identity is linked to their same sex behaviour or not, have: • The right to be free from violence and harassment • The right to be treated with dignity and respect • The right to be treated as full citizens in their countries • The right to be free from HIV/AIDS MSM who are already infected with HIV have the right to access appropriate care and treatment equally with everyone else, regardless of how the virus was transmitted to them. 23 Pukaar October 2011 Issue 75 Non-hijra transgenders struggle for identity Hijra isn’t the only transgender identity. There are others, such attention to themselves, and struggle to find recognition as anything but a ‘deviant’ community, writes Gee Ameena Suleiman.There are several transgender identities that exist in South India. There are the female to male transgender identities of Thirunambigal in Tamil Nadu, Magaraidu in Andhra Pradesh and Gandabasaka in Karnataka. Then there are male to female identities such as the kothi, hijra (also called Aravanis and Thirunangaigal in Tamil Nadu), Jogappa in Northern Karnataka, Jogatha in Andhra Pradesh and Shiva Shakti in Maharashtra and Andhra Pradesh. Not all of these various identities are as well known as the hijra identity which has become societally synonymous with transgender identity. This is mainly because of the historic visibility of this community which has self-organised a cultural and social space through a Guru-Chela system. This acts as a support to a lot of young hijras/kothis who leave their homes and join one of the seven Gharanas as ‘daughters’ or ‘chelas’ under their gurus. The hijra/kothi can often be seen at traffic lights carrying out their “basti collections” — one of the few occupations this community has struggled to provide for itself in a hostile and discriminatory society. The HIV/AIDS funding that India receives has resulted in the setting up of many NGOs across the subcontinent which “target” the kothi as a primary carrier of the infection. But the gender identity of the kothi is glossed over by the easy conflation of the NGO term MSM (men who have sex with men) with kothi. Kothis are not men. They are male-bodied but identify as female. Jogappas are young male children usually from dalit or other ‘backward’ castes, sometimes even from Muslim families in northern Karnataka, who are dedicated to the Goddess of Yellamma. They wear female clothes and act as mediators between devotees and the Goddess. They are forbidden to marry. The Jogappa is not a category exclusively for transgenders but is a traditional space that permits cross-gender expression. This provides a lot of transgender women with a legitimate space to express their non-normative identities in society. I identify as a Thirunambi. Female to male transgender. Long before I knew what I was, I knew I was gender non-conforming. Only recently did I find the terms that best describe what I am and found people who are similarly gendered. A person born as female but with the gender expression that is male. I struggled for several years of my life trying to articulate what I am. To tell my family, friends and lovers that I am not a woman who is boyish. But a man. There are diverse ways to be a transgender man. Some of us want sex change surgeries, some don’t, some of us identify as heterosexual, some as lesbian or gay, yet others as multi-sexual. Some of us are more fluid with our genders than others. Some of us have been forced into marriages with men by our families, while others managed to leave our biological families to find limited freedom by migrating to other cities. But the oppression that we have faced due to our “deviant” gender expression cuts across the variety of gender expression within the community. The levels of oppression of course vary according to the caste and class positions that we occupy. I write as a Nair-born, English-speaking, middle-class FTM. I write for my working class, dalit, non-English-speaking FTM brothers. I write because our voices are never heard. We are silenced before we can speak. We face the double oppression of being female-born on top of our non-conforming gender expression. We don’t have a system like the hijras. We don’t have Gurus who will mother us when we leave our biological families. We are invisible because we are conditioned to “pass” in public as men, to say that our bodies don’t matter because we feel disconnected with them. Is that body that bleeds every month, the body with breasts, that is seen as female mine? This is a question that all of us have grappled with. It is difficult for us to transition with respect to our bodies because of the lack of awareness about our genders in society. The medical establishment is largely ignorant of our needs and don’t offer affordable sex reassignment surgeries for working-class femaleborn transgenders. Some of us have been in lesbian relationships, not knowing how to articulate that we are men. Trapped as butch lesbians. Very few funders are interested in our struggle for recognition. Even queer/ feminist groups exclude us as ‘anti-feminist’ for joining the oppressive side by identifying as male. A reductive feminism that ignores the female-bodied experiences that we have. A feminism that does not recognise how difficult it was for us to leave our homes and express our gender in spite of being born female. We don’t clap our hands drawing attention to ourselves, we slide past the crowd, knowing that transphobic violence will follow if we are outed as female bodied. We are directed to urinals where biological men stand and pee. We are beaten up if we step into women’s toilets by women who think we are voyeuristic, male harassers. Most of our public spaces are gendered spaces — buses, toilets, queues at the cinema hall, etc. Our struggle is to find a space where gender non-conformity is not condemned as abnormal. To push from the margins to claim a place in the centre, fearlessly and unapologetically. This is a call to recognise the existence of non-hijra transgender persons. This is a call for support from those of you who are straight, gay, lesbian, feminist, bent, non-labelled, gender queers, multi-sexual. A call for the annihilation of gender as we know it. Gee Ameena Suleiman is a transgender man who works with LesBiT, an organisation working with Lesbian, Bisexual and Transgender men DNA, 18/9/2011 Monks teach maleness to Thai ‘ladyboys’ ladyboys, have their controversial work cut out. “Sometimes we give them money to buy snacks but he saved it up to buy mascara,” headteacher Phra Pitsanu Witcharato said of Pipop. Novice monks’ days pass as in any other temple -- waking before dawn, collecting alms and studying Buddhism -- but every Friday attention turns to the katoeys at the attached school. “Were you born as a man or a woman or can you not specify your gender - not man or woman?” asked Phra Pitsanu at a recent assembly. “You cannot be anything else but your true gender, which is a man. As a novice you can only be a man.” The temple has a stricter interpretation than others of rules governing behaviour during Buddhist training that is a key childhood The 15-year-old aspiring “ladyboy” delicately applied a puff of talcum powder to his nose -- an act of rebellion at the Thai Buddhist temple where he is learning to “be a man”. “They have rules here that novice monks cannot use powder, make-up, or perfume, cannot run around and be girlish,” said Pipop Thanajindawong, who was sent to Wat Kreung Tai Wittaya, in Chiang Khong on the Thai-Laos border, to tame his more feminine traits. But the monks running the temple’s programme to teach masculinity to boys who are “katoeys”, the Thai term for transsexuals or 24 continued on page 25, col. 1 Pukaar October 2011 Issue 75 Thai 'ladyboys' continued from page 25, col. 2 experience for many Thai boys. Pupils are banned from using perfume and make-up and prohibited from singing, playing music and running. “We cannot change all of them but what we can do is to control their behavior to make them understand that they were born as a man... and cannot act like a woman,” said Phra Pitsanu. The Kreung Tai temple has run the course for boys aged between 11 and 18 since 2008, after former principle Phra Maha Vuthichai Vachiramethi devised the programme because he thought reports of katoeys in the monkhood had “affected the stability of Thai Buddhism”. He told AFP that he hopes the teaching methods will be rolled out to other temple schools to “solve the deviant behavior in novices”. It is an attitude that enrages gay rights and diversity campaigner Natee Teerarojanapong, who said trying to alter the boys’ sense of gender and sexuality was “extremely dangerous”. “These kids will become self-hating because they have been taught by respected monks that being gay is bad. That is terrible for them. They will never live happily,” he told AFP. Gay and katoey culture is visible and widely tolerated in Thailand, which has one of the largest transsexual populations in the The Gulf’s gender anxiety Moral panic over transgender men and women is symptomatic of the Gulf’s problem with shifting gender roles. As women in the Gulf become more visible, both socially and politically, and as migrants bring with them different ways of living, the region’s governments are stepping up their gender policing. To allay fears among conservative elements, they are regulating more tightly what is deemed acceptable behaviour for men and women. The direct targets of this backlash are those who visibly challenge gender norms – in particular, boyat (an Arabisation of the English word “boy”, generally referring to women with a masculine appearance) together with transgender men and women. In the past few years, dozens of articles and talkshows in the mainstream media have decried the spread of boyat and “the third sex” – a term used disparagingly to describe effeminate men and transgender women. This media frenzy has propelled a moral panic that manifests itself in discriminatory legislation across the region, in police crackdowns and in campaigns to “set them straight”. In 2007, Kuwait criminalised “imitating members of the opposite sex”, leading to the arbitrary arrest and detention of hundreds of transgender women. In research in Kuwait this year, Human Rights Watch found that most of those targeted by the police had suffered abuse, torture, sexual assault and harassment at their hands. In 2009, Dubai began a public awareness campaign, “Excuse Me, I am a Girl”, warning Emirati women of the dangers of masculinisation and attempting to set them on the path to “femininity”. The National daily newspaper reported recently that police and the community development authority would collaborate to combat the spread of boyat. Plainclothes policewomen have been deployed in shopping malls and popular hangouts to catch women violating arbitrary codes of female dress and behaviour, although it remains to be seen what this campaign actually entails and whether any boyat have been arrested. The anxiety over the perceived erosion of cultural norms may be seen as a reaction to the emirate’s rapid opening up and swift demographic changes. The regulation of public morality has always been a means for the state to reinforce its sovereignty, particularly in rapidly changing societies. There are many ways to understand this panic beyond facile world, and Natee said the temple’s programme is “very out of date”. But Phra Atcha Apiwanno, 28, disputed the idea that society accepted ladyboys and said he joined the monkhood because of social stigma about his sexual identity. “The reason I became a monk is to train my habits, to control my expression... I didn’t want to be like this,” he told AFP. Monks have had limited success in their project -- three of the six ladyboys to have graduated from the school are said to have embraced their masculinity, but the remaining three went on to have sex changes. Pipop said he has struggled with his sexuality at the temple. At home in Bangkok he dressed like a girl, putting on make-up and taking hormones until he developed breasts, but he has since stopped the treatment and wears only a surreptitious dab of powder at the temple. He does not believe he will live up to his family’s hopes that he will become more manly. “I can make them proud even I’m not a man,” the teenager said, adding he had given up his ambition to be an airhostess and now aspires to work in a bank. He thinks he will have a sex change after graduation. “Once I leave the monkhood the first thing I want to do is to shout, to scream out loud saying: ‘I can go back to being the same again!’” Aptransnet elits, 18/7/2011 explanations of “transphobia” and “homophobia”. In several of the more liberal Gulf states such as Kuwait and the UAE, there is a relative margin of state tolerance for both male and female homosexuality among their citizenry as long as it is discreet and doesn’t visibly challenge norms of acceptable male and female behaviour and dress. In fact, most arrests have been for “gay weddings” and boisterous parties. Other arrests took place when behaviour became too public, such as the case of the Saudi man who appeared in a YouTube video behaving suggestively and gender-inappropriately in 2010. This indicates that the greater fear is the perceived challenge to orthodox practices and gender roles, family structures and “cultural values” rather than homosexual behaviour per se. The visibility of both boyat and transgender women as identifiable markers of gender transgression has led to a disturbing public vilification of both. In various media reports, the homosexual component, while present, is not necessarily the most important aspect of their behaviour; rather, attraction to women is seen as a natural outcome of masculinity and vice versa. The crossing of gender norms is far more salient in public discourse about boyat and other gender-transgressive individuals. For example, an Emirati psychologist publicly advocated treatment for female masculinity early on, so that it does not lead to homosexuality. Psychologists, social scientists and social commentators treat what they understand as a rejection of women’s natural place as a pathology that needs to be contained. This is a symptom of a deeper anxiety about the erosion of traditional gender norms and roles. In Kuwait, for example, the parliament has been a battlefield over the role and behaviour of women in the public sphere since 1996, with liberals making gains such as securing women’s right to vote and run for public office while conservatives succeeded in maintaining the sex-segregation law in universities. The backlash is far from over, however, as more conservative MPs try to ban “revealing” women’s swimwear and “regulate” plastic surgery by banning any form of sex reassignment surgery and gender correction. In Dubai, where only about 12.5% of the residents are Emirati while the rest are western, Asian and Arab expatriates and migrant workers, tensions over a perceived loss of the city to foreigners and continued on page 26, col.1 25 Pukaar October 2011 Issue 75 US embassy’s Pride celebrations in Islamabad more damage than support In accordance with the US President Barack Obama’s May 31, 2011 GLBT Pride Proclamation that, “we rededicate ourselves to the pursuit of equal rights for all, regardless of sexual orientation or gender identity,” US Ambassador for Pakistan, Richard Hoagland and members of Gays and Lesbians in Foreign Affairs Agencies (GLIFAA) hosted an event declared as ‘Islamabad’s first ever Gay, Lesbian, Bisexual, and Transgender (GLBT) Pride Celebration’ on June 26, 2011in the Federal Capital of Islamic Republic of Pakistan. This high profile event was reportedly attended by 75 people including Mission Officers, U.S. military representatives, foreign diplomats, and leaders of Pakistani LGBT advocacy groups who showed their “support for human rights, including LGBT rights in Pakistan at a time when those rights are increasingly under attack from extremist elements throughout Pakistani society”. Unthankfully, all the sensational and flowery claptrap peddled around this event turned out to be a disaster for the budding underground Pakistani LGBT movement as the US Embassy conveniently oversaw the repercussions this event would have brought in an already critical country which is fighting against terrorism and radicalization while sacrificing its peace, its liberty, its sovereignty and countless lives of its law enforcement agencies and civilians alike. Within a few days, the streets of major urban cities of Pakistan namely Islamabad, Karachi and Lahore were hailed with the students and political workers of Jamaat-e-Islami, a religious political party, chanting slogans at their highest pitches against homosexuals and America. For them it was a golden opportunity to kill both ‘the evils with a single stone’. Banners were displayed in major cities, especially in the federal capital, within a few days demanding persecution of gays and accusing Americans of propagating and imposing this ‘westernized’ idea. The lash back didn’t remain limited to the Jamaat-e-Islami only but sooner most of the political parties joined this bandwagon to form a coalition against the government for their menial political interests. On the other hand, the Pakistani media, especially the local Urdu newspapers and channels dealt with the issue with their usual approach i.e. lacking all the required sensitivity and knowledge to handle this crucial issue. Their sole concern was to raise their circulations and that’s all. Although a few liberal and sensible voices were raised through articles by Nuwas Manto, Hashim bin Rasheed, The Gulf’s gender anxiety continued from page 25, col. 1 the subsequent erosion of morals has led to a similar backlash. In 2008, two Britons were arrested and deported for allegedly having sex on a beach. Newspaper commentators were quick to decry the invasion of “foreign values” and the local press subsequently reported that the government had detained dozens of tourists for a variety of “indecent acts”. In times of social strain, gender and sexuality often become the focal point of broader anxieties, a phenomenon evident in media frenzies, new proposed legislation, and the brutality of the police and the impunity with which they act against an already vulnerable population. These actions violate the most basic human rights of these individuals: the right to be free from violence and torture, to adequate healthcare (which precludes “reparative therapy”) and the right to self-expression and privacy. Within this logic, the bodily autonomy of women and those who transgress gender norms will unfortunately continue to be eroded and subject to politically sanctioned containment and violence. 26 Marvi Sirmed and Mohsin Sayeed but most of these were published in English dailies or in their online o-peds and blog sections while leaving a huge void for majority Urdu readers. There was a dire need to represent a sensitive and sensible portrayal of the issue in the Urdu media to counter the venomous articles and hate speeches by Orya Maqbool Jaan, Aamir Liaquat and Ibtisam Elahi Zaheer, who not only openly condemned homosexuals but also denounced them as sinful, non-Muslims, lesser than human beings and demanded capital punishment for them with full zeal. Meanwhile, our media circulated and aired all this hate speech while completely overlooking its ethical and social responsibilities. I guess it’s high time that our mushrooming news channels and newspapers start differentiating between free speech and hate speech because without it, they are only damaging the fabric of an already complex and fragile society. This unnecessary brouhaha by our sensational media started not only an untimely debate in our society but also in our households. I had never heard my mother, an ardent Urdu daily follower, having any strong stance against anyone, say it a murder, a rapist or a dacoit but one day she said, “All homosexuals should be stoned to death.” Being a gay, living in Pakistan, from a traditional Muslim family background, it was already an ordeal to be myself but after this US Embassy triggered media frenzy things have turned even worse. The people I am out to, are now looking at me with a different perspective. They either consider me an undercover CIA agent with hidden agenda to ‘westernize’ the cultural values of Pakistan or look as if declaring that when the rogue mullahs will come and deliver me from my deadly sins, they will religiously mind their own business. This isn’t solely my own story but of several completely out or partially out queers in Pakistan. On the other hand one can imagine the suffering and tension of all those unheard, closeted voices, which were already afraid of coming out and pretending to be ‘normal’. The level of concern and uneasiness resulted from this highly inefficient and implausible event has made them even more vulnerable at the hands of the society, which is always ready to prosecute anyone different. Surprisingly, it has also been reported that US embassy which claimed to “support LGBT rights in Pakistan” isn’t going to entertain LGBT Pakistanis for asylum. It’s as if that after starting a storm in the cocktail, they are also having an easy way out. After talking to several local LGBT activists I have gathered two main stances regarding this whole fiasco and the future of Pakistani LGBT movement. A very small number of activists suggested that this event should be considered as a golden opportunity to come out formally and launch a full blown LGBT movement in Pakistan, after we had missed a similar opportunity in 2007 at the time of ShazinaShumile case. On the other hand, the majority of the activists opined that it’s very sensitive and crucial time to come out and it’s better to remain underground for the survival of this movement. Change can be brought slowly and gradually, in safe and calculated ways. The recent incident where a young LGBT activist Falak Ali of Neegar Society was severely beaten up by the mullahs in the streets of Multan, a southern Punjab city, in the presence of police is just an example of the reaction of the public about this whole issue. Still, Pakistani LGBT activists are hopeful and determined about the future of LGBT movement in Pakistan and they strongly believe that whenever there’s going to be any LGBT movement in Pakistan, it will be most definitely by Pakistani people for Pakistani people. No one else can decide or force the time for what and when we need to emancipate ourselves from the restrictions of the heterosexist society. We can have allies and support from other international organizations but the primary stakeholders will be ourselves. http://www.galaxymag/com/blog/index.php/2011/08/us-embassypride-celebations-in-islamabdad-more-damage-than-support/ Pukaar October 2011 Issue 75 Building the momentum to prevent HIV in MSM The Global HIV Epidemics among Men Who Have Sex with Men Chris Beyrer, Andrea L Wirtz, Damian Walker, Benjamin Johns, Frangiscos Sifakis, Stefan D Baral World Bank, 2011 The Lancet, Vol 378, July16 2011 Larry Kramer, on accepting the Tony Award last month from the Theatre Guild-American Theatrical Society for The Normal Heart as Best Revival of a Play said: “To gay people everywhere, whom I love so dearly…we are a very special people, an exceptional people, and…our day will come.” My day came in 1982 when I secured an Assistant Professorship in the Department of Medicine at the University of California, San Francisco. I set about establishing a behavioural medicine clinic fully integrated into general medicine practices, researching chronic disease prevention, and teaching interns and residents about psychological issues. One guest speaker, a social worker, led a discussion with the residents about the special medical needs of gay men. He was dead a month later from what later became known as AIDS. The “special and exceptional people” cited by Kramer had lived through the 1970s and fought for human rights in the USA. That was followed in 1981 with the scourge of AIDS that could have knocked the wind out of the gay community. Instead, the community rallied and used its skills and talents to advocate for resources to develop community-based systems of care and prevention, and to ensure that human rights were not trampled. Unleashing that energy and skill to build a global movement to improve HIV prevention and care services for men who have sex with men (MSM) is long overdue. Momentum is building and Chris Beyrer and co-authors make an important contribution. The Global HIV Epidemics among Men Who Have Sex with Men documents the extent of the HIV epidemic and outlines what needs to happen to ensure that everything possible is being done to prevent and treat HIV infection in MSM worldwide. This volume documents the need in terms of the numbers, but also addresses the scenarios in which HIV epidemics among MSM exist in low-income and middle-income countries. The first scenario they describe, characterising the HIV epidemic in most of Latin America, is one in which MSM are the predominant exposure mode for HIV infection in the population. In these countries MSM are ten to over 100 times more likely to have HIV than the general population. By contrast, eastern Europe and central Asia have the highest rates of HIV among injection drug users (IDUs), but MSM are still several times more likely to have HIV than the general population. A different scenario is found in sub-Saharan Africa where HIV is widespread among heterosexuals, but even in these contexts MSM can have two to 20 times higher prevalence of HIV than the general population estimates. South, southeast, and northeast Asia are characterised by epidemics that have equal contributions from MSM, IDUs, and heterosexuals, although MSM are still at least ten times more likely to have HIV than the general population. The needs come not only from the numbers. Beyrer and his co-authors document well the lack of prevention technologies focused on maleto-male transmission. They note that much effort has been expended on encouraging voluntary HIV counselling, testing, and behavioural interventions to decrease rates of unprotected anal intercourse by encouraging less risky sexual behaviours. Although important, such strategies are probably insufficient to produce immediate or lasting change in HIV transmission. Male circumcision may be effective for reducing acquisition of HIV through anal intercourse but we will never know for sure because of the challenges of conducting a trial to prove efficacy. Antiretroviral-based prophylactic approaches provide the best opportunity for managing HIV among MSM. In the wake of the IPREX, CAPRISA 004, and HPTN 052 trials, it is now time to accelerate efforts to determine if similar benefits can be obtained with rectal use of these or similar compounds. In some countries, like Peru where the epidemic is concentrated in MSM, providing universal access to care with MSM-sensitive services could actually change the overall trajectory of disease spread. Kramer’s use of the term “exceptional people” referred to the gay community’s creativity, resilience, and energy to ensure that the response to HIV was all that it could be in resource-rich countries of the world. But not everyone views homosexual exceptionality in a positive light. Many parts of the world view same-sex relations as abnormal, deviant, sinful, and illegal. At best, most governments and donor agencies have ignored HIV among MSM. At worst, MSM are stigmatised and prosecuted. Homosexuality is criminalised in just less than half of the UN member states with punishment ranging from jail time to the death penalty. Beyrer and his colleagues show us that MSM are everywhere in the world and disproportionately affected by the HIV epidemic. They highlight how MSM are underserved nearly everywhere and that the global response to HIV will stall without access to treatment and prevention services in the context of protection of fundamental human rights. The HIV global epidemic among MSM is only beginning to be addressed. Beyrer’s book is a key part of the momentum that will continue to propel us in the right direction. Part of the Faith, MSM and stigma and discrimination posters series produced by NFI Knowledge Unit in regard to Chritianity, Hinduism, Islam and BUddhism, available on our website www.nfi.net 27 Pukaar October 2011 Issue 75 Homosexuality in Islam Critical reflections on gay, lesbian and transgender Muslims Scott Siraj al-Haqq Kugle Published by Oneworld Publications 2010 From the back cover Many Islamic authorities claim that homosexuality is categorically forbidden, but the reality is much less clear-cut. There are no verses in the Qur’an that unambiguously condemn homosexuals, and there are even some that suggest they can be tolerated in Muslim communities. In addition, reports from Hadith that denounce homosexual and transgender persons are of dubious authenticity. This pioneering work is the first to tackle this complex and controversial issue from a religious perspective. Scott Kugle [as a practicing Muslim] critically engages with scripture, law and tradition to examine the foundations for prevailing attitudes towards homosexuality in Islam. Arguing that Muslims can reconcile themselves with the inevitable diversity in society without compromising their principles, Kugle makes a forceful case for a renewed Islam that accepts all followers, regardless of sexual orientation or gender identity. From the Preface Bismillah al-rahman al-rahim … In the name of God, the compassionate One, the One who cares. All praise belongs to God, the singular and subtle One, who created the universe and made humankind reflect its diversity. All thanks be to God, who made from one human being two, and from two made many and declared, we created you all from a male and female and made you into different communities and different tribes. Glory be to God who made a multitude in which each is unique and urged them to reflect upon their differences, overcome their egoistic judgment of others, and find the good in each reflected in others – so that you should come to know one another, acknowledging that the most noble among you is the one most aware of God (Qur’an [Q.] 49:13). Then to God they are called and all return. So let us each revere that God, the forbearing One, the One who is just. book does not convince them, it may encourage them to see the issues Muslim communities, like all other religious groups, face the in a new light, and in that sense it will have succeeded. challenge of confronting diversity. Like other groups, Muslims Why talk about gay, lesbian and transgender Muslims now? We hesitate and stumble – sometimes inflicting violence along the way must talk about them because they exist and are suffering – are – before dealing justly with people in their diverse ranks who are increasingly refusing to bear suppression in silence. Some turn to different in appearance, language, ethnicity, creed, or bodily ability. their religious tradition with faith-filled criticism, seeing it as not Among the diverse ranks of people are some who are different in merely part of the problem but as essential to possible solutions. gender identity or sexual orientation. Such people are always a small This book is based upon the experiences and hopes of those who are minority yet they appear in every culture and religious community. not content to wait for their Muslim sisters and brothers gradually to This book is about the challenge before contemporary Muslims to come to tolerate them. It offers theological reflections and insights acknowledge, understand, and accept the diversity in their midst, arising from lesbian, transgender and gay Muslims’ efforts to build especially with respect to sexual orientation and gender identity. It support groups to help them reconcile their sexual orientation and contributes to the ongoing process of meeting that challenge and gender identity with Islamic faith. Their struggle beckons Muslims to urges Muslim actively to reconsider prejudgments they may hold pay attention to this minority community’s experiences and insights about gay, lesbian, or transgender members of their communities. before dismissing them or opposing them. Muslims have profound resources for dealing with theologically and In that spirit and hope, I offer this book to the public. In the end, ethically with diversity, but often ignore them when facing difference only God knows best. I seek protection with God, the One who opens and conflict. In their long history, Muslims have intensively dealt possibilities (al-fattah). The loving One (al-wadud), the One with with sectarian differences. Through this debate, the classical Islamic sciences developed one of their best characteristics – the tolerance subtle grace (al-latif). 1 for diversity of interpretation of sacred texts; this is expressed in the Abou El Fadl, Speaking in God’s Name, p.10 note 8 words of Abu Hanifa, the renowned jurist, who is reported to have said, “We know this [position] is one opinion, and it is the best we Editors comment: can arrive at, [but if] someone arrives at a different view, then he This is an excellent book, despite acknowledged weaknesses, that adopts what he believes [is best] and we adopt what we believe [is begins to address the issue of faith and sexual diversity. The author best].”1 This book invokes that long tradition of tolerance within acknowledges that it does not look at same-sex behaviour and the faith – which is often ignored or lost in contemporary Muslim gendering amongst Muslims, but rather seeks to look at the essentialist communities – in searching for faith-based response to gay, lesbian approach to sexual diversity. That he admits is for another book. and transgender Muslims. Similar work is arising within the Christian faith, as well as in For many Muslims, dealing with homosexuality or transgender others, such as Hinduism and Buddhism, a growing critique of how issues is a matter of sin and heresy, not difference and diversity. organized faiths often evolve in systems of social policing of sexual But when pressed, such Muslims often have no clear idea of what and gender diversity , different from the original teachings. homosexuality means, or simply deny that there are any homosexual If we are to ensure that faith-based gay men, lesbians, transgenders, people in Muslim families and communities. But there are Muslims and others in the broad spectrum of sexual and consensual behavioural who face issues squarely with open minds and humble hearts; they diversity, to ensure access to citizenship, well-being and social justice, may read this book and grapple with the issues it raises. Even if this then this book helps us understand the issues. 28 Pukaar October 2011 Issue 75 New report shows major AIDS funders fail to track investments for gay men and transgender people Country-level data indicates severe underfunding for these highly vulnerable populations A new report indicates that most major bilateral, multilateral and private philanthropic funders that focus on HIV do not consistently track their investments targeting men who have sex with men (MSM) and transgender people. Produced by the Global Forum on MSM & HIV (MSMGF), the report also examines tracking of domestic government funding dedicated to these populations in all UN Member States, revealing that only 25% these countries recorded levels of HIV prevention spending for MSM in 2010 and no country tracked spending for transgender people. “With overwhelming evidence for the need to prioritize MSM and transgender people in the global fight against AIDS, it is shocking that so few funders actually know how much money they are spending on these populations,” said Dr. George Ayala, Executive Officer of the MSMGF. “Funders often talk about the importance of investing in key affected populations, but budgets offer a clear reflection of what their priorities actually are. HIV investments must be accounted for in order to ensure that MSM and transgender people are getting the support they need.” In the few countries that did track HIV prevention spending for MSM, expenditures fell far below the amount required to achieve universal access. According to country reports made to the United Nations in 2010, an average of 2% of national HIV prevention budgets was dedicated to MSM in the 42 low- and middle-income countries that tracked spending for this population – $15.8 million in total. Nearly 75% of that sum came exclusively from international sources, highlighting the role of bilateral, multilateral and large private philanthropic funding in service provision for MSM in lowand middle-income countries. The report follows a number of recent publications arguing in favour of targeted investments for most-at-risk populations like MSM and transgender people. In June of this year, the World Bank issued a report demonstrating that increased access to HIV prevention and treatment for MSM can change the trajectory of a national epidemic. That same month, the Lancet published a new global HIV investment framework that emphasizes the importance of targeted investments for key affected populations. “After 30 years of diffused investment, the world is realizing that a focused approach is the only one that will work,” said Dr. Ayala. “It is time for funders to reflect that in their budgets and track their investments by population. Donor agencies must communicate and coordinate to ensure adequate coverage without duplication, and we must all aim for a higher level of accountability to the people we serve.” The full report, “An analysis of major HIV donor investments targeting men who have sex with men and transgender people in low- and middle-income countries,” can be accessed online at http://www.msmgf.org/files/msmgf/Publications/Global_Financing_ Analysis.pdf Who takes risks? and children. The difference between the lab and the real world, Figner says, is partly the extent to which they involve emotion. In an experiment where adolescents’ emotions got triggered strongly (with a gambling task in which they made stepwise decisions of increasing risk and got immediate feedback on how good or bad they were doing, a situation much closer to real-world incremental or dynamic risk decisions), they looked very different from children and adults and took bigger risks, just as observed in real world settings. Emotion can affect decisions about risk-taking in all age groups, not just adolescents, Figner says. And the emotion doesn’t necessarily have to be triggered from the decision situation itself even, for example. if you’re angry about an argument, you might later drive too fast on the highway. Science Daily (July 27, 2011) It’s a common belief that women take fewer risks than men, and that adolescents always plunge in headlong without considering the consequences. But the reality of who takes risks when is actually a bit more complicated, according to the authors of a new paper which will be published in the August issue of Current Directions in Psychological Science, a journal of the Association for Psychological Science. Adolescents can be as cool-headed as anyone, and in some realms, women take more risks than men. A lot of what psychologists know about risk-taking comes from lab studies where people are asked to choose between a guaranteed amount of money or a gamble for a larger amount. But that kind of decision isn’t the same as deciding whether you’re going to speed on the way home from work, wear a condom, or go bungee jumping. Research in the last 10 years or so has found that the way people choose to take risks in one domain doesn’t necessarily hold in other domains. “The typical view is that women take less risks than men, that it starts early in childhood, in all cultures, and so on,” says Bernd Figner of Columbia University and the University of Amsterdam, who cowrote the paper with Elke Weber of Columbia University. The truth is more complicated. Men are willing to take more risks in finances. But women take more social risks -- a category that includes things like starting a new career in your mid-thirties or speaking your mind about an unpopular issue in a meeting at work. It seems that this difference is because men and women perceive risks differently. That difference in perception may be partly because of how familiar they are with different situations, Figner says. “If you have more experience with a risky situation, you may perceive it as less risky.” Differences in how boys and girls encounter the world as they’re growing up may make them more comfortable with different kinds of risks. Adolescents are known for risky behavior. But in lab tests, when they’re called on to think coolly about a situation, psychological scientists have found that adolescents are just as cautious as adults Sexual Health Sexual health is a state of physical, emotional, mental and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. WHO Definition Sexual rights embrace human rights that are already recognized in national laws, international human rights documents and other consensus documents. These include the right of all persons, free of coercion, discrimination and violence. 29 Pukaar October 2011 Issue 75 MSM can effectively self-test for chlamydia, gonorrhea Men who have sex with men can self-test for chlamydia and gonorrhea as effectively as health care providers can, according to findings from a study involving 286 adult men. Data from previous studies show that the risk of HIV infection increases in men who have sex with men (MSM) who have other sexually transmitted diseases, said Dr. Marybeth Sexton of Columbia University, New York. Therefore, regular STD testing for MSM is important, however “less than 14% of physicians routinely screen male patients for chlamydia and gonorrhea,” Dr. Sexton said at a congress of the International Society for Sexually Transmitted Diseases Research. Lack of time, lack of staff, and lack of knowledge were the reasons most often given for not screening. In this study, Dr. Sexton and colleagues in Washington, D.C. compared the results of nucleic acid amplification testing (NAAT) for chlamydia and gonorrhea when MSM administered the tests themselves and when a health care provider administered the tests. Patients were recruited from the Whitman-Walker Clinic in Washington, and they were eligible for the study if they reported having intercourse with a man within the past 6 months and if they wanted to be screened for rectal and pharyngeal chlamydia and gonorrhea. The screening tests were performed twice on each patient, and the patients were randomized to initially perform self-tests or to be tested by a health care provider. For the self-test, patients were given instructional cards, and a health care provider was present, but offered no additional assistance. Overall, both providers and patients had positive test results for 12 cases of rectal gonorrhea, 15 cases of pharyngeal gonorrhea, 25 cases of rectal chlamydia, and three cases of pharyngeal chlamydia. Both providers and patients had negative results for rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia in 193, 256, 183, and 277 tests, respectively. The only time a provider’s test was positive and a patient’s test was negative was a single case of pharyngeal gonorrhea. However, patients’ tests were positive when providers’ tests were negative in six cases of rectal gonorrhea, nine cases of pharyngeal gonorrhea, three cases of rectal chlamydia, and two cases of pharyngeal chlamydia. The prevalence of rectal gonorrhea, pharyngeal gonorrhea, rectal chlamydia, and pharyngeal chlamydia using only the provider’s positive tests was 5.7%, 5.7%, 12%, and 1.1%. The prevalence using both the patients’ and providers’ positive results was 8.5%, 8.9%, 13.3%, and 1.8%, respectively. There were no significant differences in the detection of gonorrhea between the patients and providers, Dr. Sexton said. Patients appeared to identify significantly more cases of gonorrhea, which might be due to false positives, cross-contamination, or more rigorous testing on the part of the patient, she noted. Test results were no different based on whether the patient or the health care provider collected samples first. Self-administered STD tests could reduce the time burden on health care providers and expand the number of MSM who are tested, said Dr. Sexton. In addition, informal feedback from patients suggested that, for the most part, the tests were easy to perform and more acceptable than allowing a health care provider to collect the samples. “I talked to a lot of the patients, and many of them said they would prefer to do the testing on their own,” Dr. Sexton said. The results suggest that self-testing is a feasible option. However, some modifications need to be made to the testing instructions, and more research is needed to determine the best way to incorporate self-testing into a clinical setting, she noted. Dr. Sexton had no financial conflicts to disclose. Test kits used in the study were provided by Gen-Probe. MSM Asia, 23/7/2011 New city-based HIV strategy in China to address HIV infection among men who have sex with men Government officials in Chengdu, China, hosted a workshop today to address the city’s rapidly-growing HIV epidemic among men who have sex with men (MSM). Participants in the workshop discussed a new five-year strategy that calls for a dramatic scale-up in the coverage of HIV prevention and treatment for the MSM population in Chengdu and promotes the participation of community-based organizations in the city’s response to HIV. “Cities have a critical role to play in the AIDS response,” said Mr Yang Xiaoguang, Director of Chengdu Health Bureau, speaking at the workshop on 9 July. “By working to build a strong, multi-sectoral response in Chengdu, with meaningful community participation, we can scale up coverage of prevention, treatment and care services among MSM and halt the spread of HIV in our city,” he added. Also joining the workshop were senior officials from China’s Ministry of Health, government officials from Sichuan Provincial Health Bureau, representatives from civil society and Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). According to government figures, approximately 5% of men who have sex with men in China are living with HIV—88 times higher than the national HIV prevalence of 0.057%. In the city of Chengdu, more than 10% of the MSM population is living with HIV. Across China, HIV prevalence is generally higher in cities and urban areas, reaching almost 20% in some south-western cities. “Cities are at the heart of China’s development and progress, and 30 must remain at the forefront of its HIV response,” said Mr Sidibé. “Through bold action to address HIV among men who have sex with men, cities can lead the way to achieving the UNAIDS vision of zero new HIV infections, zero discrimination, zero AIDS-related deaths. We hope that over the next year, many more Chinese cities will implement city-based MSM strategies,” he added. Approximately one in three new HIV infections in China is among men who have sex with men. However, according to government figures, less than half of the MSM population has access to HIV testing services and less than 15% of HIV-positive MSM who need treatment are receiving it. Chengdu’s new strategy underscores the critical role that community-based organizations can play in reaching men who have sex with men and other populations at increased risk of HIV infection. Tong Ge, Coordinator of China’s MSM Health Forum and a participant in the Chengdu workshop, noted the importance of ensuring strong cooperation between government and civil society. “By building on the experiences of cities like Chengdu, which already have well developed AIDS responses, we can help to promote multisectoral collaboration on an equal, orderly basis and strengthen the response to HIV nationwide,” said Mr Tong. “The next step will be to implement similar strategies in other cities nationwide,” he added. World Bank, 09 July 2011 Pukaar October 2011 Issue 75 The bottom line Anal-sex talk still makes people blush. But it’s also increasingly popular in the hetero world. Every couple of years, another once-scandalous sex taboo starts making its way toward the commonplace. A decade ago, blow jobs were what people whispered about; then three-ways became the naughty bedroom act. Now, it’s anal sex—but according to the Centers for Disease Control’s National Survey of Family Growth, it’s rapidly becoming a regular feature of hetero couples’ horizontal activities. The survey, released last year, showed that 38.2 percent of men between 20 and 39 and 32.6 percent of women ages 18 to 44 engage in heterosexual anal sex. Compare that with the CDC’s 1992 National Health and Social Life survey, which found that only 25.6 percent of men 18 to 59 and 20.4 percent of women 18 to 59 indulged in it. Anecdotal research also demonstrates curiosity is on the rise. Babeland’s anal-sex workshops are now held three or four times a year, instead of once, and they’re filled with straight couples. “More and more, people are devoting themselves to learning about anal pleasure,” says Carolyn Riccardi, education coordinator for Babeland’s New York retail stores. “Male-to-female anal sex has been happening since the dawn of time,” she says. “What’s different now is that women are actively learning how to enjoy it and have fun with it.” “I first did it with my husband,” says Lisa, a recently divorced thirty something from across the Hudson. “It was a regular part of our married sex life, and I enjoyed it. I think it can feel good for anyone—except if you’re too uptight about it, meaning, you’re literally tight-assed.” Ah, yes, the anal-sex dilemma: If you think it’s going to hurt, it will. Relaxation isn’t the only requirement for a good experience: Too much aggression (and no lube) can put a woman off anal sex permanently. And not all guys are anal enthusiasts, either. Jim, a 27-year-old consultant, has been given the opportunity by willing partners but hasn’t taken the plunge. He agrees that it seems to be on the rise among his friends but wonders whether it’s “really a cultural shift or just something we ease into semi-contemporaneously as we age, like marriage or buying real estate or listening to jazz rap.” The idea that anal is something couples eventually turn to for sexual variety seems to be supported by the CDC survey, which shows the lowest numbers among those who’ve never been married and are not cohabiting, compared with those who are cohabiting, married, or divorced. For me, anal sex is very intimate, much more so than regular sex. If I care about someone, I’m willing to experiment,” says Irene, a 33-year-old East Village environmentalist who has been doing it with Lax, a 30-year-old Wall Streeter. But when we press Lex on whether he likes to receive anal attention from his girlfriends, he responds, “Call me old-fashioned, but the guy should be the penetrator, not the penetratee, no?” It’s an attitude still widely held by many straight men today, and one that’s reflected in the CDC survey: Though the report is chock-full of all kinds of straight, gay, and lesbian sex in fairly graphic detail, there’s absolutely no research on female-to-male anal play. It turns out that the straight-male fear of reciprocal anal play is a potent mix of sexism and homophobia; a straight man can do it to someone else, but having it done to him isn’t okay. But the newly discovered anti-cancer benefits of prostate stimulation are giving straight guys—especially the progressive New York breed—a legitimate excuse to be more, shall we say, open to exploration. And men’s magazines, which until recently discussed anal sex only in terms of how to trick a girlfriend into giving it up, now publish articles on the Aneros—the doctor-created, FDA-approved prostate stimulator—and the male G-spot, a.k.a. the P-spot, a.k.a. the He-spot. “Straight guys come in looking for the Aneros,” says Riccardi, “but once they get all their questions answered, they’ll walk out with something more fun and less medical for themselves. Or their girlfriends will come in looking for ways they can be the penetrator, too.” When Riccardi first started working at Babeland three years ago, she would gently ask straight female customers if they’d ever tried sticking a finger up their boyfriend’s or husband’s bum, and they’d shoot her looks of horror. “Now when I ask them that question, they almost all say, ‘Oh, sure.’ ” The store’s strap-on sales have never been higher. “My wife is totally turned on by the idea of ‘having’ me, as that’s just not something women really get to do most of the time, and it’s not something that guys have usually had done to them. It really is a reversal in the most primal of ways,” explains newlywed Brooklynite Anthony. “I think anyone who doesn’t enjoy it or thinks they wouldn’t is hindered by their own hang-ups. It feels good, period. And breaking taboos is sexy. Variety is sexy. Being vulnerable is sexy.” IRMA, 14/7/2011 Gonorrhoea strain found to be ‘resistant to antibiotics’ A new strain of the sexually transmitted disease gonorrhoea has become resistant to antibiotics, international research shows. Analysis of the bacterium that causes gonorrhoea found a new variant which is very effective at mutating. Scientists from the Swedish Reference Laboratory warn that the infection could now become a global threat to public health. New drugs to delay the spread of the infection are needed, experts say. The first case of antibiotic-resistant gonorrhoea was found in Japan. By analysing this new strain of neisseria gonorrhoea, called H041, researchers identified the genetic mutations responsible for the new strain’s extreme resistance to all cephalosporin-class antibiotics. Cephalosporins are used to treat a wide variety of bacterial infections. They are also closely related to the penicillins. “A team of researchers will present its findings at a conference run by the International Society for Sexually Transmitted Disease Research in Canada. Dr Magnus Unemo, from the Swedish Research Laboratory for Pathogenic Neisseria, said it was an alarming and predictable discovery. “Since antibiotics became the standard treatment for gonorrhoea in the 1940s, this bacterium has shown a remarkable capacity to develop resistance mechanisms to all drugs introduced to control it. “While it is still too early to assess if this new strain has become widespread, the history of newly emergent resistance in the bacterium suggests that it may spread rapidly unless new drugs and effective treatment programs are developed.” Prevention not cure Rebecca Findlay, from the Family Planning Association, said it was a worrying sign. “Prevention becomes more important because we know antibiotics won’t always work. Gonorrhoea can affect people of all ages and everyone should be now focusing on looking after their sexual health.” Dr David Livermore, director of the antibiotic resistance monitoring laboratory at the Health Protection Agency, said that the cephalosporin antibiotics used in the UK are still effective for treating gonorrhoea. continued on page 32, col. 1 31 Pukaar October 2011 Issue 75 'Explosion' of sex-spread hepatitis C in HIV-positive men There is an ongoing “explosion” of deadly hepatitis C among men who have sex with men. It’s spread mainly by anal sex, often enhanced by methamphetamine, according to a report in the July 21 issue of the CDC’s Morbidity and Mortality Weekly Report. “We are having an explosion of sexually transmitted hepatitis C,” study researcher Daniel S. Fierer, MD, of New York’s Mount Sinai School of Medicine, tells WebMD. “We have uncovered an emerging epidemic of sexual transmission of hepatitis C. And the main reason is men having anal sex without a condom.” It’s no surprise to experts who treat hepatitis C. Liver cancer and cirrhosis caused by hepatitis C virus (HCV) already is the leading cause of death among people with HIV infection who have access to HIV drugs. Some 30% of Americans with HIV are co-infected with HCV. Sexual transmission of HCV among people without HIV is rare, notes Eugene R. Schiff, MD, director of the Center for Liver Diseases at the University of Miami, who was not involved in the Fierer/CDC study. Among heterosexual couples, he says, only 2% of those with HCV infect their partners after 20 years of monogamous marriage. The same may be true for men who have sex with men -- if they practice safe sex. “Our data do not support sexual HCV transmission between HIV-negative men,” Fierer says. “There is reasonable data that HIV-negative men are not part of this epidemic.” But that’s not the case for HIV-positive men, notes Lynn E. Taylor, MD, of Brown University. Taylor was not involved in resistant gonorrhoea strain continued from page 31, col. 2 “But our lab tests show that the bacteria are becoming less sensitive to these cephalosporins, with a few treatment failures reported. This means that we are having to change the type of cephalosporin that is used and to increase the dosage. “The worry is that we will see gonorrhoea becoming a much more difficult-to-treat infection to treat over the next five years. “Prevention is better than cure, especially as cure becomes harder, and the most reliable way to protect against STIs - including resistant gonorrhoea - is to use a condom with all new and casual partners.” Gonorrhoea is one of the most common sexually transmitted diseases in the world. Some 50% of women infected with gonorrhoea have no symptoms. The same is true of 2-5% of men. When symptomatic, gonorrhoea is characterised by a burning sensation when urinating and can cause discharge from the genitals. If left untreated, gonorrhoea can lead to serious and irreversible health complications in both women and men. http://www.bbc.co.uk/new/health-14078098 Naz Foundation International has moved its Secretariat in London to: 1.3 Quay House. 2 Admirals Way London, E14 9XG, United Kingdom Phone: +44 (0) 20 7868 1510; Fax: +44 (0) 20 8741 9841 32 the Fierer study. In a study published last March, Taylor and her colleagues showed that new HCV infections are relatively common among HIV-positive men who do not use intravenous drugs -- a phenomenon previously reported in Europe and Australia. “We have robust evidence of increasing HCV incidence among men who have sex with men who do not inject drugs but do engage in high-risk sexual behaviors,” Taylor, who was not involved in the Fierer study, tells WebMD. “It is the new sexually transmitted infection in this population. I am very concerned.” Schiff notes that when HIV-positive men get HCV, they have much higher levels of the hepatitis C virus in their blood. Taylor and Schiff warn that hepatitis C infection progresses quickly in people with HIV infection. “These men are sitting ducks for liver cancer,” Taylor says. “If they don’t get treated and get HCV eradication, they are at risk of cirrhosis or liver cancer. ... We are seeing tons of gay men newly diagnosed with HIV, and then with HCV. I could go to a funeral of an HCV patient every week.” Anal sex, methamphetamine linked to HCV Fierer and colleagues gave detailed questionnaires to 34 HIVpositive men with new hepatitis C infections, as well as to 67 closely matched HIV-positive men who tested negative for HCV. In detailed questioning and interviews, the men denied any form of intravenous drug use -- even the use of prescription testosterone. There was “quite a laundry list” of behaviors linked to new HCV infections. But careful statistical analysis revealed two factors that independently raised an HIV-positive man’s risk of HCV infection: • Receptive anal intercourse with ejaculation of the partner increased HCV risk 23-fold. • Having sex while high on methamphetamine increased HCV risk 28.5-fold. “This is a smoking gun for classic sexual transmission with semen,” Fierer says. Fierer warns that while the study implicates semen, it does not suggest that anal sex without ejaculation is safe. It isn’t. And a troubling study of outbreaks of HCV among HIV-positive German men suggested last March that prolonged or traumatic anal intercourse often exposes both partners to infected blood. As for methamphetamine, Fierer says the problem is that it removes sexual inhibitions while prolonging the sex act. “Crystal meth is an incredibly disinhibiting drug. This is very much used for sex, and judgment and all kinds of other things go out the window,” he says. “Patients tell me, ‘Well, now it seems like a very bad idea to take meth and have unprotected sex with a partner who ejaculates in you. But at the time it seemed like a great idea.” Taylor warns that using erectile dysfunction drugs to prolong sex also appears to be a risk factor for HCV transmission among HIVpositive men. Sex-spread HCV threatens new HCV treatments New HCV treatments make it much more likely that a person can be cured of hepatitis C. But there’s a catch. Schiff notes that a person can be infected with hepatitis C over and over again. He’s already seen patients who seem to be getting better with treatment, and then suddenly are reinfected. That’s going to be a problem, he says, because powerful new hepatitis C drugs have an Achilles heel -- the virus quickly becomes resistant. If a person is reinfected with HCV during treatment with one of the new drugs, there’s a good chance the virus will acquire resistance to all similar drugs. “If people are re-exposed to HCV after treatment with new antivirals, there will be resistant virus,” he predicts. CDC Morbidity and Mortality Weekly Report, 21/7/2011