Supporting Sexual Health and Well-Being of Males
Working with men who havesex with men in Bangladesh
Shale Ahmed
Bandhu Social Welfare Society
Bangladesh
Supporting Sexual Health and Well-Being of Males
Context: Bangladeshi Society
• Patriarchal society
• Compulsory marriage, preferably arranged
• Compulsory reproduction, preferably son
• Gender segregation & subordination to males
• Joint and extended families
• Social and sexual control on both males but particularly on females
• Widespread poverty & unemployment
• Over-crowded population
• Men ‘own’ public space
• Homo-social & homo-affectionate environment
• Women are advised to maintain veil (purdah)
Supporting Sexual Health and Well-Being of Males
Six rounds of National HIV Sero-surveillance, 1998-2006
Less than 1% HIV among moststudied groups
Average 4.9% prevalence among IDUsin central A, in central-A1 HIV is 7.1%(spreading in other IDU sites)
1.7% prevalence of HIV amongborder-belt female SWs in Northwest
HIV prevalence is yet low
among sub-populations
engaged in high-risk
behaviors
Prevalence of STIs (active
syphilis) is yet high
10% active syphilis in some brothel-FSW
9% active syphilis among male &female IDUs
Source: National Sero-Surveillance, 6th round, GOB
STIs/HIV among MSM/MSW
HIV prevalence remains below 1%
Statistically non-significant trend inactive syphilis rates
Supporting Sexual Health and Well-Being of Males
Active syphilis among MSM and combined MSM andMSW sites by round
p= NS for all three sites
Source: National Sero-Surveillance, NASP, GOB
Supporting Sexual Health and Well-Being of Males
How many males having sex with malesare there in Bangladesh?
MSM & MSW = 40,000 to 150,000Size estimation exercise in Bangladesh, FHI, 2005
In the absence of valid, reliable and necessary data, theseestimates will always be questionable either as over orunderestimates.
2% - 5% of a country’s male population over 15 years mayhave sex with men (UNAIDS / WHO)
Supporting Sexual Health and Well-Being of Males
• Interventions on MSM and MSW begun in 1996 by the BandhuSocial Welfare Society (BSWS)
• Over the years, Bandhu has become the largest MSM organizationin South Asia
• ODPUP began intervention in 1997
• At present several other NGOs are involved
•Multiple donors are supporting programming and intervention
Setting the history:Interventions on and for MSM/MSW
Supporting Sexual Health and Well-Being of Males
Bandhu Social Welfare Society
Working to reduce risk and vulnerabilityto HIV and other sexually transmittedinfections amongst males who have sexwith males in Bangladesh since 1996.
Number of one-to-one peer education contacts (includes new and repeat)
297,454
Number and % of new one-to-one peer education contacts
69,692 (23%)
Number of functioning Drop-In Centers and STI clinics
9
Number of social group meetings (SGM)
2369
Number of SGM participants (includes new and repeat participants)
59,584
Number of patient visits (includes new and repeat patients)
24,177
Number of STI patient visits (includes new and repeat patients)
7,598
Number of counseling sessions
27,377
Number of condoms distributed
702,311
Number of tubes of lubricant distributed
12,577
Supporting Sexual Health and Well-Being of Males
A service model evolves
Health Services
Subsidised STI syndromic management
General health management
HIV testing
Pre/post test counselling
Care and support through collaboration
Centre Services
Safe socialising space
Education
Drop-in services
Help line
Community building and development
Vocational and literacy training
Condom and lubricant distribution
Counselling Psychosexual and VCT
Advocacy
Field Services
Outreach and friendship building
Community building and mobilising
Education and awareness
Information and advice
Condom and lubricant distribution
referrals
Technical and institutional
assistance and support
Supporting Sexual Health and Well-Being of Males
Some significant achievements
MSM & MSW included in national strategic planning
Open discussion of MSM sexuality
Silent tolerance
Increased knowledge and awareness
Improved self-esteem and community support
Scaled up interventions in six districts with 9 DICs
Successfully hosted three National MSM consultationmeetings
Level of condom use higher according to behaviouralsurveillance.
Supporting Sexual Health and Well-Being of Males
Some major constraints
Discrimination & social exclusion
No legal protection
Harassed, abused, violence
Drug abuse
Unaddressed psychosexual health concerns
Poverty & unemployment
Low self-esteem
Supporting Sexual Health and Well-Being of Males
Priority issues for future intervention
Advocacy and policy to address the law i.e.section 377, 54, 87
Identity-based self-help interventions
Capacity and skills building
Addressing the female partners of MSM
Tackling drug use issues amongst MSM
Scaling up of MSM programming
Supporting Sexual Health and Well-Being of Males
Bottom line – tackling socialexclusion and vulnerability
Unless we address the social, cultural, judicialand legal impediments to effective HIV/AIDSand sexual health work among males whohave sex with males, and deal effectivelywith stigma, discrimination, violence andsocial exclusion, the fight against HIV andAIDS in countries like Bangladesh could belost.
Supporting Sexual Health and Well-Being of Males
Thank you all