Countdown to Tolerance

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Mon Nov 28, 2011

Maurice Tomlinson's Countdown to Tolerance: UNAIDS MSM Data Fiasco Could Have Been Avoided

By Maurice Tomlinson

The 2011 Caribbean HIV Conference, which took place at the lavish Atlantis resort in Nassau, Bahamas, from November 18-21, 2011, was held under the theme “Strengthening Evidence to Achieve Sustainable Action.” In his keynote address at the elaborate opening ceremony, the Bahamian Prime Minister proudly announced that one of the measures his country adopted to address its HIV epidemic (still the largest in the region) was the decriminalization of sodomy over 20 years ago. So what evidence exists that this sole act of decriminalization has reduced the HIV prevalence rate among Bahamian MSM? Sadly, the news is quite grim. What is worse is that confusing messages attributed to UNAIDS about this Bahamian initiative—still unique among the Anglophone Caribbean—may have set back regional decriminalization efforts by many years.

An oft-cited graph developed by the UNAIDS regional office in Trinidad shows that some countries in the Caribbean without sodomy laws (The Bahamas, Cuba and the Dominican Republic) have a lower HIV prevalence rate among MSM than countries where same-sex intimacy is still criminalized (Jamaica, Guyana, and Trinidad and Tobago). However, what this graph does not show is that between 2006 and 2008 the HIV prevalence rate among Bahamian MSM appears to have soared from 8.18% to over 25%. Those persons who oppose decriminalization have also been able to point out that some countries that maintain sodomy laws in fact have lower MSM HIV prevalence rates than The Bahamas. Simply put, the evidence presented by the principal world body charged with advising countries about an effective response to HIV is simply unhelpful in understanding the role of structural stigma and discrimination in perpetuating the concentration of the epidemic among this marginalized group.

Considering the deeply held prejudices against homosexuals in the Anglophone Caribbean and the overwhelming attachment these countries have to their sodomy laws, it is disgraceful that UNAIDS did not present clear and unequivocal data to support its long-stated position that decriminalization is good for the HIV response. To make matters worse, an article carried in the Jamaican media quoted Dr. Michel de Groulard, the creator of the infamous graph, as saying that there was no data that decriminalization in The Bahamas had any impact on the national HIV prevalence. I alerted the head of the UNAIDS Regional team, Dr. Ernest Massiah, as well as de Groulard to this article and pointed out that this statement attributed to de Groulard contradicted a very powerful plenary presentation made by Professor Peter Figueroa, former head of Jamaica’s national STI program, in which he positively cited de Groulard’s graph and advocated for decriminalization as critical to the HIV response among regional MSM populations. Massiah was very defensive and maintained that his staff had been misquoted. De Groulard then sought to correct this misquote in a subsequent interview which was again carried in the Jamaican press. In this interview he pointed out that the inadequate data he was referring to was HIV incidence, not prevalence (a regrettable oversight considering the press’s and the public’s unfamiliarity with the critical difference in the meanings of these terms). Unfortunately, in this later interview de Groulard was quoted using the much lower 2006 MSM HIV prevalence rate and not the more recent data from 2008. Not surprisingly, Dr. Wayne West, a senior lecturer in the Faculty of Medicine at the University of the West Indies, Mona and chairman of the “ex-gay” movement in Jamaica (who has previously used his medical credentials to publicly support retaining the anti-sodomy law as indispensible to the HIV response), was able to question the credibility of the UNAIDS data (and obliquely UNAIDS’ true agenda). The undeniable result is that UNAIDS’ credibility has been undermined.

This entire fiasco could have been avoided.

In April of this year, at the Caribbean Regional Dialogue of the Global Commission on HIV and the Law, I personally alerted Dr. Massiah to statements made to the Jamaican media by Shirley Richards, former head of the powerful Jamaican pro-criminalization religious lobby group, Lawyers Christian Fellowship, claiming that the country’s anti-sodomy law was indispensable to the national HIV response. Richards relied heavily on a study published in The Lancet that said HIV prevalence among MSM in France was “out of control” even though sodomy was decriminalized in France in the 18th century. I suggested then that UNAIDS, as the most credible global voice on HIV, needed to respond urgently to Richards’ statement, especially because of its potential to derail regional efforts to achieve greater tolerance for homosexuals in addressing the HIV epidemic. Massiah initially agreed that such a response would indeed be possible, but it was not until the just-concluded Conference that I was informed that UNAIDS sent an article (on November 15—a full seven months later) to the Jamaican press.

Meanwhile, a presentation I made at the Caribbean HIV Conference discussing the petition AIDS-Free World filed before the Inter-American Commission on Human Rights challenging the Jamaican anti-sodomy law was well received. Our human rights arguments for decriminalization considered sound, as was our strategic approach of documenting and publicizing human rights violations against Jamaican LGBT before launching the petition and our selection of prominent human rights voices in Jamaica to advocate on behalf of the petition once it was filed. Our approach contrasts quite favorably with that adopted in Belize, where the legal challenge against their anti-sodomy law has been met with vicious opposition by religious groups and little in the way of prominent support from influential voices or groups.

What is tragic is that both the Jamaican petition and the Belize legal challenge now face serious difficulties as the epidemiological evidence necessary to overcome the arguments against decriminalization remains unclear at best and non-existent at worst. By delaying its response and ultimately relying on stale data, UNAIDS has made the job of the legal teams arguing these cases much harder and arguably has set back the movement for tolerance toward MSM across the region.

Finally, while Jamaica’s gains in the reduction of the vertical transmission of HIV have been remarkable, and the national HIV prevalence rate is trending downward, as Figueroa demonstrated in his two conference presentations, the rate among MSM is trending upward. This will no doubt be compounded by the fact that The Global Fund to Fight AIDS, Tuberculosis and Malaria has decided to cancel its Round 11 due to financial constraints. States like Jamaica are therefore sitting on a time bomb. Tragically, UNAIDS has failed to provide the sort of incontrovertible data that will encourage states to make the structural changes necessary to achieve efficiencies in the face of reduced resources to combat the disease among MSM within the region. This is truly appalling.