Black Diaspora Gay/MSM: Challenges and Response

1. Black Diaspora Gay/MSM: Challenges and Response Ivan Cruickshank Caribbean Vulnerable Communities Coalition

2. HIV in the Afro-Caribbean Diaspora • HIV prevalence is high in both Sub-Saharan Africa and the Caribbean • Evidence of similar patterns among diaspora communities in the global north - disproportionate rates of infection viz-a viz the size of the population. • Sexual transmission accounts for most cases with homosexual transmission at least as important as heterosexual transmission

3. Dimensions of the HIV epidemic in the Caribbean • Leading cause of death among 20-59 age group • Incidence closely linked to excluded populations with limited access to HIV services • A growing problem made more complex by the high level of population mobility in the region

4. MSM as a classification? • Homosexuality is not a clear-cut category in diaspora communities and same sex behaviour often is NOT equated with sexual identity but rather as activity • Complex interrelation between identity, desire behaviour and gender roles • Enormous diversity among MSM & men in these subcultures interact sexually among themselves and with men not identified as gay. • Co-existence of underground homosexuality and visible heterosexual lifestyle /bisexual practices among heterosexuals

5. Experiences of MSM across the Diaspora • MSM across the Black /African diaspora face common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality, low access to HIV drugs, threats of violence or incarceration • There is a generally low perception of personal risk which act as a barrier to HIV testing • Issues relating to homophobia and deeply rooted cultural barriers impacts their attitudes to sex and sexuality • Ethnically, culturally, linguistically, religiously diverse communities involved

6. Attitudes to MSM relations in “home” countries • Criminal offence in most countries • High level of stigmatisation and discrimination • Rejection by families and communities • Subject to physical violence • Individuals and practices driven underground • Sexual orientation not fully accepted • Sexuality is often linked economic imperatives • Safe sex known but hardly practised/ condom use mitigated by “knowledge” of partner • Limited support towards HIV+ MSM • Reluctance to seek treatment and care due to criminalization of same sex intimacy

7. The Mobility dimension

8. Relationship between HIV and Migration • Driven by socio-economic and political determinants - unemployment, poverty and labour migration, stigma, legislative barriers and human rights abuses • The circumstances of movement – e.g. whether voluntary or involuntary, or whether legal or clandestine – directly affect the potential risk of HIV- infection for migrants • Legal status determines level of vulnerability and access to HIV services • Undocumented immigrants more vulnerable and face greater obstacles in accessing care and support if living with HIV/AIDS

9. Impact of migration on HIV risk • Removal of social networks and support systems • Coercive and transactional sexual relations high among Mobile MSM • Gay and other MSMs due to stigma, legislative barriers and human rights abuses • Concerns regarding privacy in health care settings for testing and counselling • Heath care providers perceived as judgmental and unable to respect confidentiality • Reluctance to seek care from heterosexual medical practitioners

10. Challenges facing the MSM Diaspora • Limited disaggregated data to support programming • Fear limits access to services • Greater need for psychosocial and mental health services • Challenge around adherence and access to treatment due to living situations • Coping strategies include denial, illicit activities, sex work • Aslyees, Returnees/deportees: A unique challenge

11. Overcoming the challenges • Provide cross-border continuity of care by effective linking of originating, transit and destination country HIV responses • Collaboration among NGOs and CSOs working in the area of HIV across borders • Integrating culturally relevant HIV programmes into migrant services & increase provider knowledge and skills re needs of diaspora MSM communities • Incorporating migrants into program design and advocacy • Risk reduction /mitigation outreach to immigrants including undocumented persons

12. Overcoming the challenges • Culturally relevant and appropriate service provision • Visible leadership within diaspora communities to assess and address the populations’ needs and respond to the epidemic • Building “community” among MSM in the Diaspora • Better data on migrants/mobile populations including quality of care information, • Enhancing visibility, availability, access and quality of HIV and AIDS programs and services including confidential medical record transfer systems