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

Supporting Sexual Health and Well-Being of Males Six rounds of National HIV Sero-surveillance, 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 Source: National Sero-Surveillance, 6 th round, GOB STIs/HIV among MSM/MSW HIV prevalence remains below 1% Statistically non-significant trend in active syphilis rates

Supporting Sexual Health and Well-Being of Males 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 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 In the absence of valid, reliable and necessary data, these estimates will always be questionable either as over or underestimates. 2% - 5% of a country’s male population over 15 years may have sex with men (UNAIDS / WHO)

Supporting Sexual Health and Well-Being of Males 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 Setting the history: Interventions on and for MSM/MSW

Supporting Sexual Health and Well-Being of Males 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 Number of one-to-one peer education contacts (includes new and repeat)297,454 Number and % of new one-to-one peer education contacts69,692 (23%) Number of functioning Drop-In Centers and STI clinics9 Number of social group meetings (SGM)2369 Number of SGM participants (includes new and repeat participants)59,584 Number of patient visits (includes new and repeat patients)24,177 Number of STI patient visits (includes new and repeat patients)7,598 Number of counseling sessions27,377 Number of condoms distributed702,311 Number of tubes of lubricant distributed12,577

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

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