Working with men who have sex with men in Bangladesh

1. Working with men who have sex with men in Bangladesh Shale Ahmed Bandhu Social Welfare Society Bangladesh Supporting Sexual Health and Well-Being of Males

2. 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) Context: Bangladeshi Society Supporting Sexual Health and Well-Being of Males

3. Six rounds of National HIV Sero-surveillance, 1998-2006 Less than 1% HIV among most studied groups Average 4.9% prevalence among IDUs in central A, in central-A1 HIV is 7.1% (spreading in other IDU sites) 1.7% prevalence of HIV among border-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 STIs/HIV among MSM/MSW HIV prevalence remains below 1% Statistically non-significant trend in active syphilis rates Source: National Sero-Surveillance, 6th round, GOB Supporting Sexual Health and Well-Being of Males

4. Active syphilis among MSM and combined MSM and MSW sites by round p= NS for all three sites Source: National Sero-Surveillance, NASP, GOB Supporting Sexual Health and Well-Being of Males

5. How many males having sex with males are there in Bangladesh? MSM & MSW = 40,000 to 150,000 Size estimation exercise in Bangladesh, FHI, 2005 2% - 5% of a country’s male population over 15 years may have sex with men (UNAIDS / WHO) In the absence of valid, reliable and necessary data, these estimates will always be questionable either as over or underestimates. Supporting Sexual Health and Well-Being of Males

6. Setting the history: Interventions on and for MSM/MSW • Interventions on MSM and MSW begun in 1996 by the Bandhu Social Welfare Society (BSWS) • Over the years, Bandhu has become the largest MSM organization in South Asia • ODPUP began intervention in 1997 • At present several other NGOs are involved • Multiple donors are supporting programming and intervention Supporting Sexual Health and Well-Being of Males

7. Bandhu Social Welfare Society Working to reduce risk and vulnerability to HIV and other sexually transmitted infections amongst males who have sex with males in Bangladesh since 1996. Supporting Sexual Health and Well-Being of Males

8. A service model evolves 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 Technical and institutional assistance and support Health Services Subsidised STI syndromic management General health management HIV testing Pre/post test counselling Care and support through collaboration Field Services Outreach and friendship building Community building and mobilising Education and awareness Information and advice Condom and lubricant distribution referrals Supporting Sexual Health and Well-Being of Males

9. 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 consultation meetings • Level of condom use higher according to behavioural surveillance. Supporting Sexual Health and Well-Being of Males

10. 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

11. 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

12. Bottom line – tackling social exclusion and vulnerability Unless we address the social, cultural, judicial and legal impediments to effective HIV/AIDS and sexual health work among males who have sex with males, and deal effectively with stigma, discrimination, violence and social exclusion, the fight against HIV and AIDS in countries like Bangladesh could be lost. Supporting Sexual Health and Well-Being of Males

13. Thank you all Supporting Sexual Health and Well-Being of Males