Introduction

Men who have sex with men (MSM) have been the population most affected by HIV in Latin America and the Caribbean. Although heterosexual transmission is increasing rapidly in the region, homo- and bi-sexual transmission represents about half (48%) of AIDS cases, compared to 25% attributed to heterosexual transmission.

This epidemiological vulnerability is strongly linked to sociocultural and political vulnerability. Men who have sex with men face social discrimination at work, school, university, in clinics, hospitals and in their own families. Legally, homosexual behaviour is criminalized in Chile, Ecuador and Nicaragua.* In other countries, other forms of repression are used to discriminate against men who have sex with men.

* This was the status at the time of the regional consultation. At the date of publication, homosexual behaviour is no longer a criminal offence in Chile and Ecuador.

Faced with this multifactoral vulnerability to HIV of men who have sex with men, national AIDS programmes, the United Nations and other cooperation agencies have generally responded inadequately, focusing their efforts on the “community at large” or other populations. Few multifaceted interventions designed by nongovernmental organizations (NGOs) have been supported adequately by the governmental sector.

Recognizing this as an area in which action was a priority, UNAIDS, in cooperation with the Colombian League for AIDS Control, organized a Regional consultation on HIV/AIDS prevention, care and support programmes in Latin America and the Caribbean for men who have sex with men, held in BogotColombia.

Representatives from four national AIDS programmes¹ from nine NGOs², from the Colombian National Sex Education Project, from the Bogotistrict health department, from CAREC Trinidad, from the UN Theme Group on HIV/AIDS in Colombia, and from UNAIDS, Geneva, met to analyse the situation and develop recommendations on male-to-male transmission of HIV in the region.

It was the first consultation of its kind in the region. First, it brought together an intersectoral group on a regional scale to debate a specific theme in the spirit of GIPA (greater involvement of people living with HIV/AIDS); and secondly, it explored a subject, homo- and bi-sexuality, which has been infrequently addressed in the region.

The objectives of the consultation were:

· to analyse existing approaches to this group at the regional level;

· to review and recommend policies and concrete actions in support of activities with MSM in the region;

· to revise a draft manual on prevention with MSM.

During the three days of the consultation, the 23 participants addressed the following topics: the epidemiological situation in Latin America and the Caribbean, a regional overview of HIV/AIDS prevention, care and support programmes, the policies of national programmes³, and four NGO projects⁴. Networking and technical cooperation were also addressed. Working groups were organized to analyse strengths, weaknesses, opportunities and threats (SWOT) and to develop three sets of recommendations intended for national AIDS programmes, NGOs and community-based organizations (CBOs), and UNAIDS and technical cooperation agencies. Finally, a draft manual on how to carry out activities with MSM was presented.

¹ The national programmes of Argentina, Brazil, Colombia and Mexico.

² NGOs from Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guatemala and Puerto Rico.

³ Argentina, Brazil, the Caribbean and Mexico and Colombia.

⁴ Brazil, Costa Rica, Ecuador and Puerto Rico.