In developed countries, when HIV was first found in gay men, gay activists groups were quick to lobby governments for access to care and improved prevention programmes.
However, in developing countries, because of social, cultural and political reasons, the response has been slow although now in Malawi, through organisations such as Centre for the Development of the People (Cedep) and political goodwill, provision of services to MSM is set to improve.
Behavioural interventions aimed at MSM are effective. They have been found to reduce the number of men having unprotected anal sex by up to 43 percent and increase condom use by 81 percent. Another important tool in prevention is access to condoms and lubricants.
A study conducted by Johns Hopkins School of Public Health, College of Medicine and Cedep of 537 MSM in Malawi, Namibia and Botswana found HIV prevalence was 17.4 percent. At least 16.6 percent had both concurrent relationships with men and women. Over 40 percent reported experiencing human rights abuses, including blackmail and denial of housing and health care.
 In Malawi, 30 percent fear disclosing their status because of concerns of stigma and discrimination despite feeling comfortable with their sexual orientation. They also found that only nine percent of the men in the study had ever disclosed to a health care worker and less than 60 percent of the men had ever had voluntary counselling and testing.
The researchers further report a strong link between MSM having been blackmailed and not taking an HIV test in the previous six months, which suggests that stigma was preventing men from going for HIV tests. Other studies have also pointed to inadequate training for health care workers in Africa to deal with the psychological and physical needs of MSM seeking health care.
During the Aids 2012 conference, there were pledges of support to programmes targeted at MSM. By continuing to deny MSM equality as members of society because of cultural, religious or political reasons, we seriously harm any progress in managing the HIV and Aids epidemic.
The Joint United Nations Programme on HIV and Aids (Unaids) and other international organisations have found that criminalising same-sex acts can in fact lead to greater HIV prevalence. A study found that countries that criminalise MSM have higher HIV prevalence in MSM than countries that do not.
The launch of the book Queer Malawi: Untold Stories by Cedep, a collection of stories of gay and lesbians in Malawi, will hopefully contribute to fair acknowledgement and support for the gay community in Malawi. Stigma and cultural intolerance are the main stumbling blocks preventing men who have sex with men accessing testing, prevention, treatment and care services.
