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Young gay men face violence, lack housing and access to HIV services, global survey finds

A new study indicates that young men who have sex with men (YMSM) around the world experience higher levels of homophobia, unstable housing, violence and other factors that hinder access to HIV services, compared to older MSM.

Conducted by the Global Forum on MSM & HIV (MSMGF), the analysis shows YMSM fare worse than older MSM in their attempts to access numerous HIV services, including HIV treatment.

“Existing data indicates that rates of HIV are rapidly increasing among YMSM in low and high income countries alike,” said Dr. George Ayala, MSMGF executive director.

“However, most research fails to disaggregate data focused on YMSM from broader samples of MSM and young people, making it impossible to understand the unique needs of this population. This is the first study to look at these issues among YMSM on a global scale, and the results are alarming.”

The analysis uses data from the 2012 Global Men’s Health and Rights study (2012 GMHR), a multilingual online survey of 5779 MSM from 165 countries, including 2491 YMSM (aged 30 and below). Data from YMSM participants was examined to assess levels of access to HIV services and factors that impact access to services for YMSM. Results are presented in a new policy brief titled “Young Men Who Have Sex with Men: Health, Access, & HIV,” released Monday by the MSMGF.

The policy brief reveals that only 33% of YMSM surveyed reported that low-cost condoms were easily accessible, and even lower percentages of YMSM reported easy access to low-cost lubricants (18%), low-cost STI treatment (14%), HIV education materials for MSM (9%), and HIV risk reduction programs for MSM (7%).

Of participants living with HIV, nearly half of YMSM with a CD4 count below 350 were not engaged in treatment (44%), compared with 17% of older MSM. Only 38% of YMSM living with HIV reported viral suppression, compared to 73% of older MSM.

Findings also indicate that 20% of YMSM surveyed had no income and 30% had no stable housing, which have both been linked to greater HIV vulnerability and reduced access to HIV services. Compared to older MSM in the 2012 GMHR sample, YMSM experienced significantly higher levels of homophobia and violence. Among all MSM surveyed, homophobia was significantly associated with reduced access to condoms, lubricants, HIV testing, and HIV treatment.

“While homophobia can be damaging to gay men of all ages, it can be particularly harmful to younger gay men,” said Daniel Townsend, MSMGF Steering Committee member. “Like many young people, they often have no income and depend on family for housing. If their family does not understand or accept their sexuality, they risk ending up on the street. Without stable housing or resources, many young gay men face extreme challenges in meeting their basic needs.”

YMSM not only reported greater barriers to HIV service access compared to older MSM, they also reported significantly lower levels of community engagement and comfort with service providers. These factors, along with family support and availability of safe spaces, were associated with increased access to HIV services among MSM of all ages in the 2012 GMHR.

“This data shines light on our collective failure to ensure that YMSM have the resources they need to keep themselves healthy,” Dr. Ayala said. “Moreover, it is a powerful reminder that HIV among MSM is an international development issue, inextricably linked with housing, health, education, and security. Donors and policy makers must treat HIV among MSM of all ages with the same level of urgency afforded to other international development priorities, and they must take concrete steps to ensure that the unique needs of YMSM are accounted for.”

Produced in collaboration with the MSMGF Youth Reference Group, composed of 18 YMSM advocates from 11 countries around the world, the policy brief concludes with a set of recommendations for addressing HIV and its social drivers among YMSM. Recommendations include addressing housing stability and economic dependence, providing comprehensive HIV prevention tailored to the needs of YMSM, improving treatment and care for YMSM living with HIV, taking action to reduce barriers and increase facilitators to HIV service access among YMSM, and supporting YMSM leadership and involvement in the HIV response.

The full policy brief can be found on the MSMGF’s website HERE.