| COMMENTARY
Reaching out to MSM: Crossing Gender Boundaries at a Time of AIDS
by Jomar Fleras, Manila*
Mark is a 29-year-old married man who works as a manager in the personnel department of a bank in Makati City, the Philippines. Before driving back to his middle-class suburban house south of Makati, where his wife and one- year-old son await him, he whiles away his time by cruising the men's comfort rooms in a premier shopping mall near his office.
He gets to meet men who, like him, are so-called "straight trippers" looking to have quick clandestine sex.
Bruno is a nursing student who works part time as a 'macho dancer' to make ends meet. As a dancer in a gay strip club, he is expected to also provide sexual services to his clients in exchange for a handsome "talent" fee.
He practically does every sexual act regularly performed by a gay man. However, Bruno does not consider himself gay. He considers his job as a sex worker only as a temporary one. He dreams of marrying his girlfriend someday and raising a family.
Max is a middle-aged policeman, notorious for his rather brutal ways of treating his prisoners. He is married with five children who are in high school. But unknown to the police precinct, he leads a double life. Max runs a seedy male brothel and his wards confess that he also has his ways with the boys.
Fred is a famous radio announcer who has a popular program,e that churns out hot gossips about the sexual escapades of movie and TV celebrities. He is flamboyantly gay but everyone knows that he has sired nine children and lives with a wife. He says that having these children will ensure that his hard earned money will not go to waste.
There are many similar stories about men who lead a homosexual life. In the NGO community, we call them men who have sex with men.
"Male bisexuality is a very complex phenomenon that occurs throughout the world, crossing all ethnic and cultural barriers," according to the book 'Bisexualities and AIDS: International Perspectives', a compilation of cross cultural experiences edited by Peter Aggleton.
"A great many men will admit that they have bisexual behaviour but will not admit that they identify as bisexual. Men who exhibit bisexual behaviour consider themselves as normal and rarely will they admit that they may be 'partially homosexual.' Very few male bisexual relationships are considered symmetrical. That is, they do not have an equal amount of sex with women and men," it adds.
This book studies all aspects of bisexuality, "seeking to identify the roots of male bisexuality in cultural and historical variables as diverse as economic need, the social segregation of women and men, religious edict and cultural expectations about masculinity and virility."
In the area of HIV prevention, bisexuals are a problematic lot. There has always been the suspicion that bisexuals are the bridge between gays and straights in the passing of AIDS. The number of individuals who do not admit to being bisexual is great, yet these individuals many times do not practise safer sex with either their male or female partners.
A groundbreaking study conducted by Family Health International among men who have sex with men (MSM) in four urban centres in the Philippines showed that Filipino MSM are at extremely high risk to HIV due to: the variety of their sexual practices, including receptive and insertive anal/genital, oral/genital, anal/oral, and anal/manual sex activity; the large number of sexual partners with whom they engage in unprotected, casual and multiple sexual practices; the slow but increasing number of men becoming HIV-positive; and, the absence of health facilities and programmes that are men-friendly.
The 2004 study of 522 MSM reveals more than one third of them have sex with both men and women. Alarmingly, about 31 percent are infected with a sexually transmitted infection (STI). Condom use remains low especially during anal sex. About 57 percent of the 164 participants with an STI have no easy access to condoms; 69 percent of then do not have sufficient knowledge on how to prevent infection; and 70 percent have misconceptions about HIV transmission. About 51 percent of them have unprotected anal sex with any male and 90 percent have unprotected sex either with a male or female partner.
Surprisingly, HIV infection in the Philippines has remained low and the rate of transmission seems to be slow. The Department of Health AIDS Registry has recorded only 2,260 HIV cases from January 1984 to April 2005. Of these cases, only 40 individuals claim to be bisexual.
Why are the numbers so low? Why does it seem that the Philippines has been spared from a major HIV epidemic compared to its Asian neighbours? Maybe it's because most Filipino men are circumcised. Maybe Filipino men are not having as much sex as other Asian men. Or maybe, it's simply because government, civil society and donors have responded fast and early enough to halt the spread of HIV.
The Philippines has a landmark AIDS Law which spells out a humanitarian and multi-sectoral response to AIDS. As early as 15 years ago, gay groups have organised around the issue of AIDS. As early as 20 years ago, the U.S. Agency for International Development has funded several surveillance and education programmes to monitor the epidemic. Some of these programmes even specifically target men who have sex with men. Recently, the Global Fund on AIDS, TV and Malaria has funneled funding for MSM outreach work in key surveillance sites in the country.
But the work must not stop, as the FHI study reveals. The study also recommends that "the main goal of any intervention programme targeting MSM in the Philippines must address the need to create and provide activities that will respond to the health needs of MSM focusing on their susceptibilities and vulnerabilities."
There are obviously many sociocultural and religious barriers. Society is generally tolerant of gay men; however, the predominantly Catholic culture might still be considered discriminatory. It may also be difficult to access bisexual men as, unlike those who are already "out", they tend to shy away from gay groups. Denial of their true sexual identity is also another factor.
Intervention work must therefore include outreach, peer education, condom promotion, treatment of STDs, and developing communication tools that specifically target bisexual men.
(Jomar
Fleras is a pioneering AIDS activist in the Philippines. He
is the President and CEO of ReachOut
Foundation International, a non-government organisation
that implements HIV/AIDS projects in various parts of the
Philippines.)
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