Living as a Queer Peace Corps Volunteer
in a World with HIV
-Alan Silverman, RPCV, Senegal
When I was a PCV in Senegal in the early 70s, the world
had not yet seen the first case of HIV. Today, a quarter century after
the first cases were identified, nearly 40 million people are living
with HIV - and an estimated 90% of these people don’t even know
they are positive. Most of these people live in the developing world.
Given that HIV/AIDS is one of the most serious development issues of
our times, it is no surprise that many Peace Corps volunteers are working
to respond to this global epidemic. But is this just a development issue
- or does HIV also affect gay, lesbian, bisexual and transgender PCVs
personally?
HIV transmission among GLBT people in the developing world
With the exception of a few countries such as South Africa, Brazil and
Thailand, most places where Peace Corps works do not even acknowledge
that men have sex with men or that women have sex with women. Many
countries are actively hostile, making homosexuality illegal with strong
sanctions, including jail, flogging, stoning and even death. Yet we
also know that in spite of these human rights abuses, homosexual partnering
continues.
With homo-sex pushed underground, too often this results in unprotected
sex. In Vietnam, for example, a UNAIDS study found that only 6% of men
who have sex with men (MSM) believed they were at risk for HIV, with
similar patterns found in China, Pakistan, the Philippines and Nepal.
Low rates of condom use are reported in the developing world among MSM.
Too often, not using a condom is due to impaired judgment as a result
of drugs or alcohol. And injection drug use adds another layer of risk
with shared needles leading to HIV transmission through infected blood.
Still, across the globe, UNAIDS says “fewer than one in twenty
men who have sex with men have access to the HIV prevention and care
services they need.” This trend is true even among people who self-identify
as gay, bisexual or transgender.
HIV among MSM in the developing world…and
at home
Data about MSM is very scarce - many countries
do not report statistics at all. But we do know that…
- In Asia and the Pacific, the number
of HIV cases among MSM is increasing - drastically. HIV positive
MSM in Bangkok grew by 11% from 2003 to 2005. In Mumbai, India 18.8%
and in Phnom Penh, Cambodia 12.8% of all MSM were reported to be
positive. Among MSM in Beijing, one study reported that 28% say they
had sex with both men and women within the previous 6 months, and
11% of these reported unprotected sex with both. In one province
in India, 42% of MSM were married and just under half of those sexually
active within the previous 3 months had used a condom.
- In Senegal, in 2005, it was estimated that
21.5% of all HIV cases were attributed to MSM. And a 2000 study among
MSM in Senegal indicated that only 14% of those engaging in receptive
anal sex used condoms.
- In almost all Latin American countries, MSM
have been an important part of the epidemic. In Brazil, Bolivia and
Peru, MSM account for from 13 to almost 20% of all cases. In most
capital cities in the region, HIV prevalence has been found to affect
from 10 to 20% of all MSM.
And HIV rates are increasing among young gay
men in the western world. More are having unprotected sex; HIV status
is often assumed rather than known. In Sydney, Australia last year,
one study showed an astounding 60% of casual unprotected sex occurred
between partners whose HIV status was unknown. And a recently released
survey of gay men in Ireland revealed that almost 50% had had unprotected
sex, but only 46% had ever been tested for HIV.
Women who have sex with women
If HIV statistics are scarce for MSM, they are even more meager when
it comes to women who have sex with women (WSW). No surprise: overall
consensus is that WSW are at very low risk for HIV. In the US, while
there have been some reported cases of HIV among WSW, as of March 2005
there had been no confirmed cases since the beginning of the epidemic.
The reported cases almost all involve other potential risk factors
- having also had sex with men or injection drug use.
Sex and the GLBT PCV: Seven ways to protect yourself
Everyone has a different tolerance for risk when it comes to sex, so
it is important to think ahead and make a personal plan of how to protect
yourself from HIV. Seven recommendations:
One: Never assume that those you have sex with are negative, whether
with host country nationals, other volunteers or other expatriates.
Two: Always, always, always practice safer sex. Unless you are negative
and in a mutually monogamous relationship with another confirmed HIV-negative
partner, wear a condom for anal sex! If using a sex toy, be sure to wash
it well after each use – or use a new condom on the toy for each
person if you are sharing it. While the risk of HIV transmission via
oral sex is low, it is not impossible, especially if there are cuts or
lesions in the mouth. WSW should consider using a barrier for oral sex
such as a dental dam or a cut open latex condom.
Three: Be picky about condoms. Make sure the condoms
are made of high quality latex. (If you are allergic to latex, use a
polyurethane condom, but these are much less readily available and much
more expensive.) Check the expiration date. Store the condoms in a well
ventilated and dry place. Check the unopened package to make sure it
is not wet from lubricant. Open the package carefully to avoid tearing
the condom – don’t
use your teeth!
Four: Know how to use a condom correctly. Do you pinch the tip to get
the air out? Do you only use water-based lubricants with latex? Do you
use lots of lubricant to reduce the risk of tearing the rectal tissues?
Do you use one condom per ejaculation? Do you make sure that no ejaculate
leaks when withdrawing?
Five: Know your status. The only way to know is by taking an HIV test
- and this should be at least 3 months after exposure for the HIV antibodies
to be detected. If you have had any risk behavior in which you may have
exchanged semen, blood or vaginal fluids since your last test, you may
have seroconverted.
Six: Be sure to weigh the risks not only of HIV, but of other sexually
transmitted infections. There are notable increases in gonorrhea, HPV,
hepatitis B and syphilis among MSM - and condoms do not always protect
you from these infections. Women are at risk for syphilis, genital warts,
herpes, hepatitis and gonorrhea, among others.
Seven: Protect yourself from the possible consequences,
including violence and imprisonment, which may result from having homo-sex
in your countries of assignment. Steve, a PCV in Africa wrote on the
listserv, “Not
to be a conservative voice of dissension, but hooking up is not only
country specific, but also site specific. If you are in the capital of
most countries you can find something but always be careful. You have
to decide what you are here for and what you are willing to risk in order
to get laid.”
An action plan for queer volunteers to address HIV and AIDS in their
communities
Apart from the personal steps to protect yourself and others from HIV,
here are some ideas for working with the wider community of MSM and WSW
in your countries:
- Help any groups of MSM and WSW that exist to organize themselves
to talk about HIV, demand action from government, set up their own
AIDS service organizations, etc. This may be difficult if not impossible in
many places, but more and more countries have groups speaking out.
- Advocate
with your host country counterparts to address HIV based on evidence
of what works, not based on so-called moral agendas.
- Work
with counterparts in government and civil society to destigmatize
if not to legitimize same sex acts and relationships (yes,
we still have a long way to go even in the States - even in Peace Corps
itself!). Again, this may not be possible for you to do directly as
a PCV in many countries, but you may find host country nationals who
are looking for support, if only to talk about the issues.
- Work
with local groups to make sure that free or cheap condoms are available
where MSM gather: bars, bathhouses, parks, etc.
- Recognize
that in many cultures MSM and WSW do not self identify as gay, lesbian,
bisexual or transgender and look at culturally appropriate ways to
address them so that they practice safer sex without threatening
their image of “not being gay.”
- Educate MSM and
WSW whom you meet about what safer sex means – don’t
assume that they already know. Rick, a member of the GLBT
PCV listserv wrote, “Part of the solution would be to facilitate a dialogue
among gay men about addressing the interest in fun, liberating sex that feels
good and the ethical need to take care of ourselves and
the men we have sex with at the same time. Sex that feels great is a lot of fun,
and it would be great to be able to have it without thinking of the consequences,
but that’s not the world we live in…”
Alan Silverman works for the United Nations (UNAIDS),
leading a global strategy to build the competence of UN staff to respond
to HIV and AIDS, both internally in the workplace as well as in the
UN’s efforts
to support national responses to the epidemic. He can be reached at asilverman@unicef.org.
|
