Report on the Global HIV/AIDS epidemic

Prevention: daunting challenges ahead
young gay men to take on the task of informing their own peers, as was done almost
two decades ago by the pioneers of AIDS education.
The high cost of neglect and denial
In much of the developing world, where expensive antiretroviral therapy is unavailable, the problem for many men who have sex with men is not complacency but
neglect and denial. Too few have been reached with appropriate prevention messages and helped to adopt safe behaviour.
Although sex between men is a major driving force for HIV infection in much of Latin
America and the Caribbean, a predominantly macho culture has stunted the development of gay identities and has led to widespread denial of male-male sex, at a
societal and sometimes at a personal level. Getting appropriate HIV prevention services to men who have sex with men but who do not consider themselves gay has
proved a major challenge in many countries.
In studies of the prevalence of HIV infection in Mexico between 1991 and 1997, 14%
of over 7000 homosexual men tested positive for HIV, and male-male sex was
shown to be the primary route of infection even among men who were also injecting
drug users. While Argentina has little sentinel surveillance among men who have sex
with men, over a quarter of all AIDS cases in Argentina were associated with sex
between men in mid-1999.
Even in countries where HIV transmission is believed to be overwhelmingly heterosexual and where the overall proportions of infected men and women are similar, sex
between men is a major risk factor for HIV. In a study of truck drivers in four cities in
Honduras, men who said they had had anal sex with men were six times more likely
than exclusively heterosexual men to be infected with HIV, syphilis or hepatitis B. In
Honduras, 8% of men who had sex with men were HIV-positive, as compared with
just under 2% of the whole adult population. In Jamaica, the prevalence of HIV infection among men who have sex with men rose from close to 10% in 1985 to 15% in
1986, then doubled to 30% in the decade that followed; the rate in the general adult
population was less than 1%. In Peru, the prevalence rate among men who engaged
in sex with men was 14% in Lima and almost 5% in provincial areas; one study
found that 60-77% of men reporting anal sex had never used a condom.
In many countries in Latin America, there is a deliberate willingness to ignore the
existence of this "socially undesirable" behaviour, as shown by the sparse information on homosexual activity, and perhaps even some unwillingness to promote
measures that would stop an undesirable behaviour from becoming a fatal behaviour. However, in countries where governments have supported nongovernmental
organizations in implementing prevention programmes, successes have been
recorded. In the Colombian capital, BogotA, for example, while sexual activity with
multiple partners remains common, the use of condoms for anal sex has increased.
Some 55% of men in one survey said they always used a condom during anal sex

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