Meeting the sexual health needs of men who have sex with men in North Africa and Lebanon
25 August 2006
Findings from participatory community assessments carried out by the Alliance in Lebanon, Morocco, Algeria, and Tunisia between September 2005 and June 2005 are informing new Alliance HIV prevention projects which aim to improve the sexual and reproductive health of men who have sex with men. In addition to mobilising gay men and other men who have sex with men in these countries, the assessments have shown that these men had low levels of awareness about sexual health and were engaged in high levels of risky behaviour. They faced stigma, discrimination, and violence, and did not have access to services aimed specifically at them.
The new projects being shaped by the findings are building on the principles of community participation, with activities including:
- community mobilisation
- peer education
- participatory development of educational materials
- setting up specialised communication and support services such as telephone hotlines and safe spaces/drop-in centres.
The projects also aim to improve understanding of the issues faced by men who have sex with men and to improve the quality of medical and support services.
Findings
The assessments, part of the North Africa and Lebanon regional pilot project for men who have sex with men, show that knowledge about sexual health, sex organs, and the specific risks faced by men who have sex with men was, on the whole, often incorrect or non-existent. Participants also described themselves engaging in relatively high levels of sexual behaviour that put them at risk of HIV transmission.
This was taking place in a context of high levels of stigma and discrimination, and participants did not have access to specialised services aimed at men who have sex with men – whether the provision of information, condoms and lubricants, or the diagnosis and treatment of HIV and other sexually transmitted infections.
The main sources of information on sexual health for most of the men were other men who have sex with men and foreign sources such as European newspapers and websites. Men who have sex with men working in medical professions were, in rare cases, a source of confidential, effective sexual health services.
The assessments highlighted the unacceptability of male-male sex within society and within the law. Men who are known to have sex with other men are regularly victims of insults, discrimination (in terms of employment and within the family), and, not infrequently, violence – including sexual violence. Throughout all of the sites, it also emerged that members of certain sub-categories of men who have sex with men – such as sex workers, effeminate men, and transvestites – are far more likely to be poorly informed, are more frequently victims of abuse and violence, and are the least accepted by society. The highest levels of risky sexual behaviour were also found in these groups.
In addition to informing the new projects, the participatory community assessments were a community mobilisation intervention in their own right. In a context where sex and sexuality, and in particular same-sex relationships, are seldom openly discussed, they created a space for discussion and reflection. Bringing together men who have sex with men from different social and educational backgrounds demonstrated the wide range of realities and challenges faced by men who have sex with men. At the same time, the process enabled participants to identify a number of common challenges, to agree on the need to act, and to propose strategies to do so.
A short report, available in English and French, provides a synthesis of the process and outcomes of the participatory community assessment. It also gives an overview of the regional programme and the local partner organisations.
