More than the virus: HIV prevention and men who have sex with men living with HIV

HIV prevention for Men who have Sex with Men (MSM) has largely focused on ensuring HIV negative MSM (MSM-) remain negative. MSM living with HIV (MSM+) have been cast into the role of ‘vectors of transmission’, and prevention programmes have mostly ignored the wide spectrum of prevention needs that MSM+ have that go beyond disclosing their HIV status to their (assumed) MSM-sexual partners.

This policy brief examines current best practice and guidance for MSM programming in Asia and the Pacific. It determines whether they meet the needs of MSM+ HIV prevention and, if not, how they could be enhanced to do so.

The brief argues that prevention guidance and best practice need to address three key areas to better represent the issues important to MSM+ in the prevention discourse: 

• MSM+ are entitled to a healthy and satisfying sex life. Prevention programmes need to provide opportunities to explore and discuss what this actually means from the perspective of MSM+
• MSM+ do have a role to play in protecting others. This is a shared responsibility and MSM+ should not shoulder the entire burden, particularly since most MSM+ do not know they are HIV+
• MSM+ need to be meaningfully engaged in discussions about HIV prevention. For this to happen, MSM+ must feel secure that they will not face discrimination or be stigmatised by people and organisations that support them.

The policy brief also makes a number of policy recommendations for the international community, Governments, NGOs and donors, focusing on the following areas:

• encouraging all MSM to test for HIV, know their status and take appropriate action
• ensuring that MSM+ who know their status seek appropriate support to discuss the impact that living with HIV may have on their sex lives
• ensuring that MSM- who know their status seek support to help them understand their role in protecting themselves and others
• MSM prevention programmes and staff should not ‘demonise’ MSM+ in prevention strategies that focus on the responsibility of MSM+ to disclose their status to all sexual partners.