World Health Organization (WHO)
"Young MSM are often more vulnerable than older MSM to the effects of homophobia - manifested in discrimination, bullying, harassment, family disapproval, social isolation and violence - as well as criminalization and self-stigmatization."
This technical brief aims to catalyse and inform discussions about how best to provide services, programmes, and support for young men who have sex with men (MSM). It offers an account of: current knowledge concerning the HIV risk and vulnerability of young MSM; the barriers and constraints they face to accessing appropriate services; examples of programmes that may work well in addressing their needs and rights; and approaches and considerations for providing services that both draw upon and build the strengths, competencies, and capacities of young MSM. They are among the key populations at higher risk of HIV that also include transgender people, people who inject drugs, and people who sell sex. Young people who belong to one or more of these key populations - or who engage in activities associated with these populations - are made especially vulnerable to HIV by widespread criminalisation, discrimination, stigma, and violence, combined with the particular vulnerabilities of youth, power imbalances in relationships and, sometimes, alienation from family and friends. These factors increase the risk that they may engage - willingly or not - in behaviours that put them at risk of HIV, such as frequent unprotected sex and the sharing of needles and syringes to inject drugs.
In the area of HIV risk and vulnerability, the brief examines: unprotected sex; drug and alcohol consumption; changes during adolescence; homophobia, stigma, and discrimination; lack of information and misconception of risk; relationship status; selling sex; vulnerability to homelessness or to living and working on the streets; migration; and racial and ethnic marginalisation. In the area of legal and policy constraints, the brief examines: criminalisation of same-sex behaviour; police harassment and violence; legal obstacles to outreach to young MSM; restricted access to services; and employment discrimination against MSM. In the area of service coverage and barriers to access, the brief examines: availability and accessibility; funding; uptake of HIV testing and counselling; uptake of antiretroviral therapy (ART); lack of services targeted to young MSM; stigma and discrimination by service providers; and competing priorities. Throughout, quotations by young MSM around the world are included. In addition, one section of the brief provides concrete examples in the form of text boxes illustrating promising programmes addressing the needs and rights of young MSM that are being implemented by governments, civil society organisations, and organisations of MSM themselves. Strategies examined focus on: youth-led education to increase sexual and reproductive health awareness among young MSM (Egyptian Family Planning Association, or EFPA); low-threshold services and linkages to care (New York State Department of Health, United States); strengthening risk reduction among young MSM through community engagement (YouthCO HIV and Hep C Society, British Columbia, Canada); using information and communication technology to reach young MSM (Save the Children Fund, Thailand); and online and telephone counselling (menZDRAV Foundation, Russian Federation)
The brief next outlines considerations for programmes and service delivery, stressing the importance of designing and delivering services in a way that takes into account the differing rights and needs of young MSM according to their age, specific behaviours, the complexities of their social and legal environment, and the epidemic setting. Sample suggestion: "Promote mobile Health staffed by trained operators, counsellors, and young people themselves, to provide developmentally appropriate health and welfare information to young MSM, as well as the opportunity for referrals to relevant services." Finally, there is a list of considerations for law and policy reform, research, and funding. Sample suggestion: "Address social norms and stigma around sexuality, gender identities and sexual orientation through comprehensive sexual health education in schools, supportive information and parenting guidance for families, training of educators and health-care providers and non-discrimination policies in employment." An annex examines the United Nations Convention on the Rights of the Child (1989).
This technical brief is one in a series addressing 4 young key populations (see Related Summaries, below). It is intended for policymakers, donors, service planners, service providers, and community-led organisations. This series was led by the World Health Organization (WHO) under the guidance, support, and review of the Interagency Working Group on Key Populations with representations from: Asia Pacific Transgender Network; Global Network of Sex Work Projects; HIV Young Leaders Fund; International Labour Organization; International Network of People who use Drugs; Joint United Nations Programme on HIV/AIDS (UNAIDS); The Global Forum on MSM and HIV; United Nations Children's Fund (UNICEF); United Nations Development Programme (UNDP), United Nations Office on Drugs and Crime; United Nation Educational, Scientific and Cultural Organization (UNESCO); United Nations Populations Fund (UNFPA); United Nations Refugee Agency; World Bank; World Food Programme; and WHO.
UNDP website, January 23 2017. Image credit: © UNICEF/802A2539 copy/Mawa