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Linking structural factors with access to HIV services

Global survey finds homophobia, comfort with service provider, and community engagement make significant impact on access to condoms, lubricant, HIV testing, and HIV treatment.



A large-scale study of gay men and other men who have sex with men (MSM), conducted by the Global Forum on MSM & HIV (MSMGF), indicates that only one third of MSM can easily access condoms, lubricant, HIV testing, and HIV treatment. Combining a multi-lingual online survey and focus group discussions, the study suggests that structural barriers like homophobia play a significant role in blocking access to HIV services for MSM, while greater comfort with health service providers and more community engagement are associated with higher levels of service access.

The MSMGF’s study aimed to identify factors that affect access to HIV services for MSM. The online survey conducted earlier this year included 5,779 men from 165 countries. In addition, the MSMGF collaborated with African Men for Sexual Health and Rights (AMSHeR) to conduct focus group discussions with 71 MSM across five cities in South Africa, Kenya, and Nigeria.

Of men who participated in the online survey, only 35% reported that condoms were easily accessible, 21% reported easy access to lubricant, 36% reported easy access to HIV testing, and 42% reported easy access to HIV treatment. Levels of access differed by country income level, with reduced access to services more commonly reported in lower income countries.

Percent of MSM reporting that condoms, lubricant, HIV testing, and HIV treatment are easily accessible, organized by country income level using World Bank country income classifications

“Such poor levels of access at the global level are unacceptable,” said Dr. George Ayala, Executive Director of the MSMGF. “The differences in access by country income are especially important to note as the Global Fund moves into a new funding model where countries are grouped into bands by income level. Even in upper middle income countries, MSM still have extremely low access to services. Without targeted funding to MSM and other key populations, the new funding model may continue to deteriorate levels of access for the groups most affected by HIV.”

The MSMGF research team also conducted analyses to identify barriers (factors associated with lower access) and facilitators (factors associated with higher access) that impact the ability of MSM to obtain condoms, lubricant, HIV testing, and HIV treatment.

Adjusting for country income, greater access to condoms, lubricants, and HIV testing were associated with less homophobia, greater comfort with health service providers, and more community engagement. Among participants living with HIV, higher access to HIV treatment was associated with less homophobia and greater comfort with health service providers. Greater access to lubricants and greater access to HIV testing were also associated with less outness (the degree to which others know of one’s sexual orientation) and fewer negative consequences as a result of being out, respectively.

“As we collectively forge ahead into the new territory of treatment-based prevention, it is clear that many of the old challenges remain,” said Noah Metheny, Director of Policy at the MSMGF. “Addressing structural barriers remains essential to realizing the potential of HIV interventions for MSM, and it becomes more important with each new prevention and treatment option that is made available. Investments in the development of new interventions must be accompanied by efforts to increase access.”

The quantitative data from the online survey was supplemented with qualitative data from focus group discussions, helping to place barriers and facilitators in the broader context of the sexual health and lived experiences of MSM. Focus group discussion participants identified barriers and facilitators that were highly consistent with those found in the online survey, and many participants explained the ways that structural barriers at the policy, cultural, and institutional levels cascade down through the community and individual levels to block access to services for MSM.

Focus group discussion participants described how structural barriers like stigma, discrimination, and criminalization force MSM to hide their sexual behavior from health care providers, employers, landlords, teachers, and family members in order to protect themselves and maintain a minimum livelihood. The inability of MSM to reveal their sexual behavior to health service providers was linked to misdiagnosis, delayed diagnosis, and delayed treatment, leading to poor health prognosis and higher risk of transmitting HIV and other sexually transmitted infections to partners.

Conversely, focus group discussion participants explained that the negative consequences of structural barriers were moderated by the existence of safe spaces to meet other MSM, safe spaces to receive services, access to competent mental health care, and access to comprehensive health care. Participants described MSM-led community based organizations as safe spaces where they could celebrate their true selves, receive respectful and knowledgeable health care, and in some cases receive mental health services.

“The study’s findings underscore the urgent need to improve access to essential HIV services for gay men and other MSM worldwide,” said Dr. Ayala. “Interventions must both disrupt the negative effects of barriers and bolster the protective effects of facilitators. Study participants clearly indicated that community engagement and community-based organizations are central to moderating barriers and promoting service access. Successfully addressing HIV among MSM will require a real effort to address structural barriers, and the findings from this study suggest that investing in MSM-led community-based organizations may be the best way to do that.”

Read the full report: “Access to HIV Prevention and Treatment for Men Who Have Sex with Men: Findings from the 2012 Global Men’s Health and Rights Study (GMHR).


Over-45s at higher risk of contracting STIs due to negative attitudes on sex of middle-aged

Society’s reluctance to talk about older people having sex has led to increased numbers of STIs in age group.



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Mother Leony – in his 80s; and is one of the regulars of Home for the Golden Gays (HGG) – loves sharing about his sexual experiences. “Sa edad kong ito (At my age),” he says, somewhat jokingly, “malakas pa rin benta ko (I can still attract).”

Mother Leony, of course, belies the ill-conceived notion that members of the mature-aged population become asexual or at least have inactive sexual lives. But exactly because of the still-held stereotype that mature-aged people do not want to or are unable to have active, satisfying sex lives, people like him are among those not getting sexual health services.

This has been studied before; but it is now emphasized by yet another study undertaken by the University of Chichester, alongside organizations in the UK, Belgium and Netherlands. This study revealed negative attitudes and limited knowledge towards over-45’s sexual health needs, which is therereby associated with a generation unaware of the dangers of unprotected intercourse.

Stressing that over-45s are at a higher risk of contracting STIs than ever before because of society’s unwillingness to talk about middle-aged and older people having sex, the report also found that over-45s living in socially and economically-disadvantaged areas are at particularly risk of contracting STIs with little awareness of available healthcare services and limited access to doctors and nurses.

University of Chichester senior lecturer Dr. Ian Tyndall, who led the study, said that major changes in sexual behavior in recent decades has seen increasing numbers of sexually active older-people.

“Over-45s at most risk are generally those entering new relationships after a period of monogamy, often post-menopause, when pregnancy is no longer a consideration, but give little thought to STIs,” he said. “Given improvements in life expectancy, sexual healthcare needs to improve its intervention for older adults and vulnerable groups to provide a more utilized, knowledgeable, compassionate, and effective service.”

In the UK, there is a three-year SHIFT study, which was launched in 2019 to address the growing rates of STIs in over-45s and improve engagement of older people in sexual health services, including those facing socioeconomic disadvantage.

The latest SHIFT report included around 800 participants across the south coast of England and northern regions of Belgium and the Netherlands, nearly 200 of which face socioeconomic disadvantage.

Initial findings highlighted four critical areas where, the researchers believe, an intervention can address the gaps in current healthcare provision: awareness, access, knowledge, and stigma.

  • Awareness: The results showed that a significant number of participants were unaware of the risks of STI, while 46% did not know the location of their nearest healthcare center. Researchers did, however, find that social media was the most effective tool for encouraging engagement with sexual health services – ahead of leaflets or GP appointments.
  • Knowledge: The participants highlighted that their health professionals, including doctors and nurses, lacked sufficient sexual health knowledge – and consequently only half had a recent STI test. There is therefore an “urgent need” to create a tailored training program to increase understanding in the wider healthcare workforce, the researchers wrote.
  • Stigma: Shame was identified as the biggest barrier to accessing sexual healthcare services, according to the report. A number of participants felt that sexual health has become a “dirty” term which is discouraging people from attending regular check-ups.
  • Access: Limited information around the location of sexual health centers and restricted opening times were a consistent problem for many participants. Others living in more rural locations also mentioned that growing costs of public transport was a barrier to appointments.

Fellow SHIFT researcher Dr Ruth Lowry said: “It is clear from the numbers reporting fear of being judged by important others who know them and by health professionals that stigma remains a crucial barrier to address in any sexual health promotion intervention.”

Lowry also said that “the findings have also shown that groups with one or more socio-economic disadvantages, such as homeless people, sex workers, non-native language speakers and migrants, are at even greater risk of being unaware of their sexual health and unable to access the appropriate services.”

In the Philippines, an earlier study by Michael David Tan, John Ryan Mendoza and Raine Cortes (2012) – with the study also involving Mother Leony – highlighted that this is also an issue here.

At least for Tan, Mendoza and Cortes, recommendations include: broadening of existing HIV and AIDS programs for prevention and sexual health education to also target the mature-aged gay men population because they are also at risk given that they also practice MSM behavior; the need to inform government policy makers of the specific needs of mature-aged gay men, since existing laws “fail to consider the variations of the experiences of the sub-populations within the generalized mature-aged population”; and the need to “indiginize” the solutions provided to this population.

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Screening may bypass one-quarter of child abuse cases

Child sexual abuse survivors who do not acknowledge their experiences as abuse may be employing a protective mechanism wherein the survivor denies the existence of the abuse or takes personal responsibility for the abuse.



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Up to one-quarter of people who suffer child sexual abuse might be passed over for treatment because of current screening procedures, according to UC Riverside psychology researchers, who also found that whether survivors of child sexual abuse identify themselves as abuse survivors influences the outcomes they experience in young adulthood.

Research has previously shown sexual abuse survivors suffer from increased mental health problems, a poor view of themselves, and are more likely to engage in risk-taking behaviors. The new UCR research looks at the impact of the survivor’s perception of the abuse.

Sexual abuse is difficult to define and study. In this study, researchers defined sexual abuse as sexual contact between a minor and a person five or more years older. The study considered how age of onset of abuse, identity of the perpetrator, and degree of force influenced survivor’s later psychosocial outcomes and whether the survivor self-defined their experiences as sexual abuse..

The study surveyed 2,195 undergraduate college students, about two-thirds of whom were female. The sample was almost half Asian, about one-fourth Latino; 17% white; 7% Black; and 4% multiracial/other.

Survey questions sought to determine which participants had suffered abuse with questions such as: “Before the age of 17, were you ever touched in a sexual way that made you feel uncomfortable, when you did not want to be, or at a time when you couldn’t defend yourself?” and more specific follow-up questions about penetration, force, and identity of the perpetrator. Participants who reported experiences of child abuse survivors were then asked: “To the best of your knowledge, before the age of 17, were you sexually abused?” to identify survivors who self-defined their experiences as sexual abuse and those who did not.

The study found 252, or 11%, of those in the study reported experiences of child sexual abuse–similar to percentages researchers have found in the broader population.

Of those 252, 193, or about 77%, identified as sexual abuse survivors, but 59, about 23%, did not self-identify as sexual abuse survivors. Of the remaining group, 1,202 reported no maltreatment, and 741 were excluded because they reported other forms of childhood maltreatment, such as physical abuse or neglect.

“Child sexual abuse survivors who do not acknowledge their experiences as abuse may be employing a protective mechanism wherein the survivor denies the existence of the abuse or takes personal responsibility for the abuse,” said Linnea Linde-Krieger, lead author of the paper, which was published this month in the Journal of Child Sexual Abuse.

The results indicated that as child abuse survivors moved into young adulthood, the form and extent of their difficulties were influenced by how they defined their abuse experiences–even though the way they defined those experiences was not related to the severity of the abuse they experienced.

Neither form of identity was more advantageous, the researchers found. When participants identified as abuse survivors, they were more likely to exhibit distress and anger, and had more difficulty regulating their emotions. That group was also more likely to engage in substance abuse, criminal activity, and sexual risk-taking. However, participants who reported experiences of sexual abuse but didn’t identify as abuse survivors were more likely to have a poor self-concept.

“Our study shows that survivors who do not acknowledge their experiences as abuse might be protected from some negative outcomes, but they are more likely to have negative beliefs about themselves,” said Linde-Krieger, who is a graduate student in the lab of UCR psychology professor Tuppett Yates.

An additional finding: the study authors determined that children abused after the age of 6 were more likely to report that they did not believe they were sexually abused. Researchers said that may be because children are more likely to blame themselves when the age of onset is older.

Linde-Krieger said the research holds implications for organizations and government agencies that assess for adverse experiences in childhood, including for sexual abuse. Often, their questionnaires ask only a single question, such as: “Have you ever been sexually abused?” One-quarter of the survey’s abuse survivors would have answered “no” to such a question, Linde-Krieger said.

“Researchers and practitioners must employ multifaceted and behaviorally specific questions to accurately assess a history of child sexual abuse,” she said.

In addition to Linde-Krieger and Yates, educator Cynthia Moon, who completed her Master of Arts at UCR, contributed to the research paper, “The Implications of Self-Definitions of Child Sexual Abuse for Understanding Socioemotional Adaptation in Young Adulthood.”

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Living History

SOGIE Equality Bill passes Senate committee; still in limbo due to anti-LGBTQIA senators

The SOGIE Equality Bill – the latest iteration of the proposed anti-discrimination law that will protect the human rights of LGBTQIA Filipinos – was passed at the Senate Committee on Women, Children, Family Relations, and Gender Equality led by Senator Risa Hontiveros.



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Rainbow movement in the Philippine Senate.

The SOGIE Equality Bill – the latest iteration of the proposed anti-discrimination law that will protect the human rights of LGBTQIA Filipinos – was passed at the Senate Committee on Women, Children, Family Relations, and Gender Equality led by Senator Risa Hontiveros.

With Hontiveros, signing the committee’s report were Sens. Nancy Binay, Leila de Lima, Franklin M. Drilon, Imee R. Marcos, Grace Poe, and Ralph Recto.

With this, the bill now advances to the plenary; though whether it will be discussed at all is uncertain, considering that Senate President Vicente Sotto III has long insisted this law won’t see the light of day under his watch; and that at least 15 lawmakers would vote against the passage of the measure.

If the SOGIE Equality Bill fails to pass the Senate before the 18th Congress ends in 2022, it has to be re-filed (and has to be reconsidered by the Senate Committee on Women, Children, Family Relations, and Gender Equality), repeating a process that has been going on for 20 years now.

Though the bill basically only prohibits discrimination against people based on their perceived or actual SOGIESC, a lot of misconceptions continue to float (and be floated/promoted) about it, particularly among/by anti-LGBTQIA people.

Lagablab Network, a gathering of select LGBTQIA organizations has released information to counter the misconceptions.

Let’s set the record straight about the SOGIE Equality Bill. 🏳️‍🌈✊🏻

Here are some FACTS debunking common myths and misconceptions on the bill.


Posted by Lagablab LGBT Network on Saturday, November 21, 2020

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Oscar nominee and ‘Umbrella Academy’ star Elliot Page announces he is transgender

Actor Elliot Page, one of the stars of “Umbrella Academy”, posted a public letter on Twitter and Instagram to announce that he is transgender.



Screenshot of the Twitter account of Elliot Page

Actor Elliot Page, one of the stars of “Umbrella Academy”, posted a public letter on Twitter and Instagram to announce that he is transgender.

Previously known as Ellen Page, Elliot received an Oscar nomination for his performance in the 2007 film Juno.

“I want to share with you that I am trans, my pronouns are he/they and my name is Elliot. I feel lucky to be writing this. To be here. To have arrived in this place in my life… I can’t begin to express how remarkable it feels to finally love who I am enough to pursue my authentic self,” Elliot wrote. “I’ve been endlessly inspired by so many in the trans community. Thank you for your courage, your generosity and ceaselessly working to make this world a more inclusive and compassionate place.”

But Elliot also asked “for patience. My joy is real, but it is also fragile.” This is because he also fears of transphobic sentiments arising. “I am also scared,” Elliot acknowledged. “The discrimination towards trans people is rife, insidious and cruel, resulting in horrific consequences.”

“To all trans people who deal with harassment, self-loathing, abuse and the threat of violence every day: I see you,” Elliott also wrote. “I love you and I will do everything I can to change this world for the better.”

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Loneliness highest in the 20s and lowest in the 60s

A study found that levels of loneliness were highest in the 20s and lowest in the 60s, with another peak in the mid-40s.



Loneliness is a prevalent and serious public health problem impacting health, well-being and longevity. Seeking to develop effective interventions, researchers at University of California San Diego School of Medicine examined the psychological and environmental factors that lead to patterns of loneliness in different age groups.

Researchers used a web-based survey of 2,843 participants, ages 20 to 69 years, from across the United States.

The study, published in the November edition of the Journal of Clinical Psychiatry, found that levels of loneliness were highest in the 20s and lowest in the 60s, with another peak in the mid-40s.

“What we found was a range of predictors of loneliness across the lifespan,” said corresponding senior author Dilip V. Jeste, MD, senior associate dean for Healthy Aging and Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine.

The researchers noted that lower levels of empathy and compassion, smaller social networks, not having a spouse or a partner and greater sleep disturbances were consistent predictors of loneliness across all decades. Lower social self-efficacy — or the ability to reflect confidence in exerting control over one’s own motivation, behavior and social environment — and higher anxiety were associated with worse loneliness in all age decades, except the 60s.

Loneliness was also associated with a lower level of decisiveness in the 50s.

The study confirmed previous reports of a strong inverse association between loneliness and wisdom, especially the pro-social behaviors component (empathy and compassion).

“Compassion seems to reduce the level of loneliness at all ages, probably by enabling individuals to accurately perceive and interpret others’ emotions along with helpful behavior toward others, and thereby increasing their own social self-efficacy and social networks,” said Jeste.

The survey suggested that people in their 20s were dealing with high stress and pressure while trying to establish a career and find a life partner.

“A lot of people in this decade are also constantly comparing themselves on social media and are concerned about how many likes and followers they have,” said Tanya Nguyen, PhD, first author of the study and assistant clinical professor in the Department of Psychiatry at UC San Diego School of Medicine. “The lower level of self-efficacy may lead to greater loneliness.”

People in their 40s start to experience physical challenges and health issues, such as high blood pressure and diabetes.

“Individuals may start to lose loved ones close to them and their children are growing up and are becoming more independent. This greatly impacts self-purpose and may cause a shift in self-identify, resulting in increased loneliness,” said Nguyen.

Jeste said the findings are especially relevant during the COVID-19 global pandemic.

“We want to understand what strategies may be effective in reducing loneliness during this challenging time,” said Jeste. “Loneliness is worsened by the physical distancing that is necessary to stop the spread of the pandemic.”

Nguyen said intervention and prevention efforts should consider stage-of-life issues. “There is a need for a personalized and nuanced prioritizing of prevention targets in different groups of people,” said Jeste.

Co-authors include: Ellen Lee, Rebecca Daly, Tsung-Chin Wu, Yi Tang, Xin Tu, Ryan Van Patten, and Barton Palmer, all at UC San Diego.

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Combined intimate partner violence that includes sexual violence is common & more damaging

All types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.



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Women who experience sexual violence combined with other forms of intimate partner violence suffer greater damage to their health and are much more likely to attempt suicide, according to a study led by researchers at the University of Bristol’s Centre for Academic Primary Care published in the International Journal of Epidemiology .

Intimate partner violence – psychological, physical or sexual violence perpetrated by a current or former partner – is the most common form of violence experienced by women worldwide.

The study (titled ‘Categories and health impacts of intimate partner violence in the World Health Organization (WHO) multi-country study on women’s health and domestic violence’), conducted in collaboration with the World Health Organization (WHO) and University of Melbourne, found that all types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

Researchers analyzed data from the WHO multi-country study on women’s health, which has information from 16 different sites in 11 different countries on over 21,000 women who have ever had a partner. This new analysis assessed different combinations of psychological, physical and sexual intimate partner violence and their impacts on health.

They found that over 15% of ever-partnered women had experienced a combination of intimate partner violence that included sexual violence. Those who had experienced this in the last year were ten times more likely to attempt suicide than those who had not.

Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

All types of intimate partner violence were associated with long-lasting damage to health but combinations that included sexual violence were more common and markedly more damaging to women’s physical and mental health.

Study lead, Dr Lucy Potter a GP and NIHR In-Practice Clinical Research Fellow at the University of Bristol’s Centre for Academic Primary Care, said: “We know intimate partner violence is damaging to health. What this study adds is the recognition of the profound harm caused by multiple forms of abuse, particularly when it includes sexual violence, and how we do not see this when all forms of abuse are lumped together as one experience. Practitioners and policy makers must appreciate the diversity of experience of intimate partner violence to tailor support appropriately.

“We also found that these health impacts persist over a year after the abuse ends. So, effective prevention and early intervention are vital to the health of individuals and families and health systems.”

Senior author, Professor Gene Feder from the University of Bristol’s Centre for Academic Primary Care, said: “Violence against women is a violation of human rights that damages their and their children’s physical and mental health, with substantial health care and societal costs. It is an important cause of ill health among women globally and an indicator for Goal 5 – Gender Equality and Women and Girls’ Empowerment – of the United Nations’ Sustainable Development Goals.

“This study, analyzing the impact of different types and combinations of intimate partner violence, shows the severe health impact when these include sexual or psychological abuse. These types of abuse are often not recognized by health care providers.”

Women who had experienced multiple forms of abuse were also more likely to experience difficulty walking, difficulty with daily activities, pain or discomfort, poor memory or concentration, dizziness, and vaginal discharge, and to be taking sleeping pills or painkillers.

Intimate partner violence is a big issue in the LGBTQIA community.

In 2018, for instance, nearly half of men in same-sex couples suffered some form of abuse at the hands of their partner, according to a study that surveyed 320 men (160 male couples) in Atlanta, Boston and Chicago in the US to measure emotional abuse, controlling behaviors, monitoring of partners, and HIV-related abuse.

Unfortunately, a 2019 study found that domestic and family violence (DFV) and intimate partner violence (IPV) were perceived by community members and professional stakeholders to be a “heterosexual issue that did not easily apply to LGBTQIA relationships.” In particular, many community members held the view that relationships between (LGBTQIA) people could avoid the inherent sexism and patriarchal values of heterosexual, cisgender relationships, and, by implication, avoid DFV/IPV.

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