1. Ivan Cruickshank Caribbean Vulnerable Communities Coalition

2.   HIV prevalence is high in both Sub-Saharan Africa and the Caribbean  Evidence of similar patterns among diaspora communities in the global north - disproportionate rates of infection viz-a viz the size of the population.  Sexual transmission accounts for most cases with homosexual transmission at least as important as heterosexual transmission HIV in the Afro-Caribbean Diaspora

3.   Leading cause of death among 20-59 age group  Incidence closely linked to excluded populations with limited access to HIV services  A growing problem made more complex by the high level of population mobility in the region Dimensions of the HIV epidemic in the Caribbean

4.   Homosexuality is not a clear-cut category in diaspora communities and same sex behaviour often is NOT equated with sexual identity but rather as activity  Complex interrelation between identity, desire behaviour and gender roles  Enormous diversity among MSM & men in these subcultures interact sexually among themselves and with men not identified as gay.  Co-existence of underground homosexuality and visible heterosexual lifestyle /bisexual practices among heterosexuals MSM as a classification?

5.   MSM across the Black /African diaspora face common experiences such as discrimination, cultural norms valuing masculinity, concerns about confidentiality, low access to HIV drugs, threats of violence or incarceration  There is a generally low perception of personal risk which act as a barrier to HIV testing  Issues relating to homophobia and deeply rooted cultural barriers impacts their attitudes to sex and sexuality  Ethnically, culturally, linguistically, religiously diverse communities involved Experiences of MSM across the Diaspora

6.   Criminal offence in most countries  High level of stigmatisation and discrimination  Rejection by families and communities  Subject to physical violence  Individuals and practices driven underground  Sexual orientation not fully accepted  Sexuality is often linked economic imperatives  Safe sex known but hardly practised/ condom use mitigated by “knowledge” of partner  Limited support towards HIV+ MSM  Reluctance to seek treatment and care due to criminalization of same sex intimacy Attitudes to MSM relations in “home” countries

7.  The Mobility dimension

8.   Driven by socio-economic and political determinants - unemployment, poverty and labour migration, stigma, legislative barriers and human rights abuses  The circumstances of movement – e.g. whether voluntary or involuntary, or whether legal or clandestine – directly affect the potential risk of HIV- infection for migrants  Legal status determines level of vulnerability and access to HIV services  Undocumented immigrants more vulnerable and face greater obstacles in accessing care and support if living with HIV/AIDS Relationship between HIV and Migration

9.   Removal of social networks and support systems  Coercive and transactional sexual relations high among Mobile MSM  Gay and other MSMs due to stigma, legislative barriers and human rights abuses  Concerns regarding privacy in health care settings for testing and counselling  Heath care providers perceived as judgmental and unable to respect confidentiality  Reluctance to seek care from heterosexual medical practitioners Impact of migration on HIV risk

10.   Limited disaggregated data to support programming  Fear limits access to services  Greater need for psychosocial and mental health services  Challenge around adherence and access to treatment due to living situations  Coping strategies include denial, illicit activities, sex work  Aslyees, Returnees/deportees: A unique challenge Challenges facing the MSM Diaspora

11.   Provide cross-border continuity of care by effective linking of originating, transit and destination country HIV responses  Collaboration among NGOs and CSOs working in the area of HIV across borders  Integrating culturally relevant HIV programmes into migrant services & increase provider knowledge and skills re needs of diaspora MSM communities  Incorporating migrants into program design and advocacy  Risk reduction /mitigation outreach to immigrants including undocumented persons Overcoming the challenges

12.   Culturally relevant and appropriate service provision  Visible leadership within diaspora communities to assess and address the populations’ needs and respond to the epidemic  Building “community” among MSM in the Diaspora  Better data on migrants/mobile populations including quality of care information,  Enhancing visibility, availability, access and quality of HIV and AIDS programs and services including confidential medical record transfer systems Overcoming the challenges