What sort of approaches have proved effective?

There are many HIV/AIDS projects around the world working with MSM or self-identified gay men. The following are a selection of a few of them, all considered successful and innovative in their approaches.

SIGLA (Sociedad para la Integraciay/Lesbica en Argentina) in Argentina has a long history of AIDS prevention work. Its main AIDS project is Proyecto Sinsida, aimed at the gay community in downtown Buenos Aires, with plans to extend the project to the poorer neighbourhoods south of the city. Early activities involved handing out posters and leaflets. There followed outreach activities, including condom distribution in bars and discos in the cities of Buenos Aires and Rosario, as well as HIV counselling, and help in obtaining medicines for those living with HIV/AIDS.

SIGLA also runs regular workshops, both in gay bars and at its office. These include the showing of a Spanish-language video produced by the Colombian Lambda Project, demonstrations of condom use and general discussions. And in 1996, with support from the Pan-American Health Organization and a local teachers union, SIGLA launched an HIV training course for elementary and high-school teachers.

In addition, SIGLA produces a weekly radio talk show on gay and lesbian topics, every third one of which is devoted to AIDS issues, including an ongoing soap opera which contains messages on HIV.

The Naz Foundation works in Bangladesh and India, helping develop community-based local NGOs to work with MSM. In Dhaka, Bangladesh, it has recently set up two organizations, the Bandhu Social Welfare Society (BSWS), focusing on MSM (including male sex workers) from low-income groups, and the Association for Health and Social Development, involved mainly with middle-class MSM networks.

In setting up local organizations such as these, the Naz Foundation first trains a group of MSM from a local network to conduct a behavioural study. The group then interviews around 500 MSM and, after analysis of the data, a programme is developed. Further training is then given to the core group to help it form the organization involving programme design, monitoring, budgeting and evaluation.

From its experience in South Asia Naz has found that recruiting and training MSM from low-income and marginalized groups who do not self-identify is far more effective than using self-identified gay groups.

Part of Naz s strategy is community development. In Dhaka, BSWS is developing a micro-credit union and vocational training. The project also operates direct referrals to an STD service, and promotes the social marketing of condoms and lubricants.

In 1993, the Association marocaine de lutte contre le SIDA (ALCS) in Morocco launched the first project in the Arab-Muslim world aimed at MSM. The initial work involved conducting socio-logical research on the attitudes and behaviour of male sex workers in Casablanca and Marrakesh. This led to the HIV/AIDS project proper, where five key workers, including former male sex workers, were chosen for their close knowledge of the sex work circuit and trained as educators. These educators go to cruising areas, and distribute strong condoms and sachets of lubricant, together with information both printed and in the form of audio cassettes.

Two doctors working with ALCS give free weekly consultations, mainly concerning STDs. This has been hailed as a major breakthrough since male sex workers in Morocco, because of stigmatization, rarely consult doctors about STDs, choosing instead self-administered, home-made remedies.

The Gay Men’s Health Project (Helseutvalget for Homofile) in Norway started in 1983, early in the epidemic, and its work is entirely with MSM. Reaching individuals and talking to them in outdoor places, bars, discos and saunas constitutes a large part of its activities.

Helseutvalget has introduced a couple of particularly innovative ideas into this outreach work. One is in gay saunas, where its workers offer free massages to customers; during the massage, the masseur from Helseutvalget talks in a relaxed way to the customer about safer sex an instance, perhaps, of the massage being the message . A second innovation is in outdoor outreach work. Helseutvalget has introduced its own type of bird-house, which it sets up in public parks (with permission from the local authorities), filling the bird-house with condoms, sachets of lubricant, and instruction leaflets. It has already exported this concept to other European countries.

Other activities include organizing discussion and training groups for particular types of MSM including young men; those who have tested HIV-positive; and those who are HIV-negative but whose regular partners are positive.

The Library Foundation (TLF) in Manila, Philippines has been going for over five years. It has a drop-in centre in Manila, where social activities are also held, but its major activity is running workshops.

TLF recruits participants for its workshops from among gay men, particularly those who are more hidden and do not participate in the gay scene. The workshops try to instil a shared sense of identity and to develop community building. The intention is that each group of men who have attended a workshop should be encouraged to keep in touch with each other and stay close friends, offering mutual support when needed.

Because of its accumulated experience in the field, TLF is now in a position to offer advice to many newer groups outside Manila. One of these is the Iwag Davao project in Mindanao, with its Center for Gay Men , catering to low-income MSM.