Among the trends discussed at the recent International AIDS Conference in Mexico City was the alarming prevalence of HIV infections among men who have sex with men. MSM, as it's known, is a description of a behavior and not a homosexual lifestyle. In low and middle-income countries, HIV infections among men who have sex with men are many times greater than the rate in the general population.  As we learn in this report activists want funding priorities redirected and are calling for a reversal of the widespread homophobic policies fueling the epidemic.

Five thousand people took to the streets in Mexico City in early August for the first International March against Stigma, Discrimination and Homophobia.  Led by Mexico's Secretary of Health, they carried banners and handmade signs, and waved multi-colored flags. Their T-shirts had slogans denouncing repression of people with HIV. 

Under the shade of an orange parasol is an outspoken man from India.  With curly brown hair and a long green skirt, he lives his life as a woman.  He says he's joined drag queens, sex workers and activists from hundreds of non-profit groups to advocate for the right to health care for people marginalized by society. "I am over here to contribute to this historic march [in] solidarity for this cause."

Thirty-three million people worldwide are living with HIV/AIDS. The number of new infections is growing by 2.5 million a year.

Those statistics are not lost on Moises Lopez-Calderon, 39, a long-time AIDS activist in Mexico City.  Lopez-Calderon is the director of a non-profit group whose focus is on HIV education, especially among MSM.

On this afternoon, he is in the Zona Rosa, the center of the gay community in Mexico City, to survey passersby about a new trend of risky MSM behavior.  He stops outside a bar to question a young man dressed jeans and a checkered shirt. Lopez-Calderon will compile the answers from many such interviews into a pamphlet for young men, a population at high risk for HIV infection.

He says he can get accurate information back to youth on the street faster than any government run program.  He says that's because by the time a new administration recognizes a problem and begins to address it, the elected officials are already out of office. "There is no continuity, and that is what non-governmental organizations like ours can provide," he says.

Lopez-Calderon hopes that raising awareness about HIV/AIDS will help reduce the prevalence of HIV among MSM. In Mexico, men who have sex with men make up one quarter of the infected population. 

It's this kind of data that helped amfAR, the Foundation for AIDS Research, put together a new report on global MSM trends. The 128-nation report finds that MSM is a large and growing portion of the AIDS epidemic in every region of the world, and the least served.

At the International AIDS Conference in Mexico City, amfAR CEO Kevin Frost explained that the problem is rooted in long-standing homophobic policies. "Eighty-six countries criminalize sex between men. More than ten of those countries have laws which punish sex between men with more than ten years in prison and seven make it punishable by death."

Frost says that kind of institutionalized homophobia makes it difficult to reach the MSM population with prevention, treatment and care.  

Armed with a systematic review of all published MSM data, epidemiologist and report co-author Chris Beyrer says the document presents a convincing case for large donors like the World Bank, the President's Emergency Plan for AIDS Relief [PEFAR] and the Global Fund for AIDS, Tuberculosis and Malaria to redirect their efforts toward helping these men. "And if they are not included in country proposals for money to go back to the countries and say, 'Why are you excluding men who have sex with men?'"

Beyrer says failure to provide health care, prevention and treatment for the MSM population amounts to nothing less than a denial of the basic human right to health care and ultimately to life itself.