Elizabeth Futrell is an associate technical officer at FHI360, where she works on activities related to community-based family planning and youth sexual and reproductive health.

According to the Council for Global Equality, as of June 2011, homosexuality is criminalized in more than 80 countries around the world, most of them low- and middle-income nations. In Uganda, for example, where homosexual acts are already illegal, a controversial bill was introduced earlier this year that would increase the penalty for those convicted to life in prison. The penalty for “aggravated homosexuality”—defined as when one of the participants is a minor, HIV-positive, disabled, or a “serial offender”—would be the death penalty. In addition, anyone who failed to report a person they knew to engage in homosexual acts would also face prosecution. While international pressure prevented a vote on the bill this spring, it will likely be reintroduced next year. Uganda is not alone. Homosexual acts are also punishable by death in Nigeria, Iran, and Yemen, and are considered criminal activity in 37 countries in Africa, 22 in Asia, two in Europe, 15 in the Middle East and North Africa, and 11 in the Americas and Caribbean.* Even in countries without explicit laws against homosexual activity, men who have sex with men often face arbitrary persecution.

The stigma, discrimination, homophobia, violence, and criminalization often faced by men who have sex with men—and particularly young people within this population—can prevent them from accessing the services they need for HIV prevention, treatment, and care. Not only is it challenging for young men who have sex with men to be honest about their behaviors, but it is also difficult for organizations that serve this population to operate and stay funded. As a result of these challenges and the high biological risk—transmission of HIV is five times more likely to occur through unprotected anal intercourse than through unprotected vaginal intercourse—men who have sex with men are considered one of the populations most at risk of HIV. In fact, men who have sex with men are on average 19 times more likely to be infected with HIV than the general population, yet fewer than one in 20 has access to HIV care. In many places such as Russia and the United States, young men who have sex with men have a significantly higher HIV prevalence than older men in this population.

Worldwide, great strides must be taken to prevent the spread of HIV among young men who have sex with men. Evidence-based sexuality education materials focused on same-sex behaviors are sorely needed. One unintentional but widespread consequence of heterosexually-focused HIV prevention education is that some young people report that they consider anal intercourse to be risk-free. It is important that HIV prevention programming for young men who have sex with men focus on behaviors and avoid labels, as many people who engage in same-sex partnerships do not consider themselves “gay” or “homosexual.” Organizations that serve young men who have sex with men must find creative ways to reach those who need services using media and technology, social networks, and peer education. Perhaps most integral to the ability of the public health community to meet the needs of young men who have sex with men is a cultural and political shift away from criminalization of same-sex sexual activity and of HIV-infection and toward tolerance and equal rights, including access to services, for all. The direction this pressing human rights issue—and the HIV pandemic—will take lies in the hands of today’s young people. 

Want to learn more about HIV risk and young men who have sex with men?

FHI 360 is hosting an e-forum on behalf of the IYWG to discuss the sexual and reproductive health needs of young people most at risk of HIV (young men who have sex with men, young people who use injecting drugs and young people who sell sex). Click here to view the sub-topic pages and read the bios of our experts from UNICEF, amfAR, Youth R.I.S.E., and the Nossal Institute for Global Health at the University of Melbourne. This forum will give participants an opportunity to discuss ways to meet the sexual and reproductive health and HIV needs of most-at-risk young people and to ask questions about the report Young People Most at Risk of HIV.

Join the conversation, online: http://deck.ly/~Us3Aw, or on Twitter: #IYWGMAR.