Speech from George Ayala, Executive Director MSMGF, at the LINKAGES Rights in Action Conference

1. Global Men’s Health &
Rights Study (GMHR)
Overview of Preliminary Findings from 2014
George Ayala, PsyD
Executive Director
www.msmg.org

2. Global Men’s Health
& Rights Study (GMHR)

3. MSMGF Research Approach:
CBPR Principles
• Recognizes community as a unit of analysis;
• Builds on strengths & resources within community;
• Facilitates collaborative, equitable partnership in all phases;
• Fosters co-learning & capacity building;
• Integrates balance between knowledge generation & intervention
for mutual benefit of all partners;
• Focuses on local relevance of public health & ecologic perspectives
attend to the multiple determinants of health;
• Involves systems development w/ cyclical & iterative process;
• Disseminates results to all partners & involves all in process;
• Involves a long-term process & commitment to sustainability.

4. GMHR Study
GMHR Study Aims
– Represent MSM voices from around the world
– Guide policy & program implementation
– Develop evidence based MSM sexual health
framework
GMHR Study Methods
– Ecological
– Qualitative individual interviews
– Focus groups
– 3 surveys: 2010, 2012 & 2014

5. GMHR 2014 Survey
• 30-minute survey
• Baseline with 6 month & 12 month follow-up
• Arabic, Chinese, English, French, Portuguese,
Russian & Spanish
• MSMGF networks, list serves, e-mail, blasts &
website
• Open to men who have sex with men
• Baseline: July to October 2014
• 6 & 12 month follow-up surveys

6. 2014 GMHR Survey Domains
Access to | Use of:
Condoms
Lubricants
HIV-testing
Treatment
SATPs
PrEP:
Knowledge
Acceptability
Willingness
Barriers
Demographics
Sexual Stigma
Trans Stigma
Provider Stigma
MSM Violence
Trans Violence
Comfort with Provider
Discrimination
Sexual Initiation
Community Engagement

7. GMHR 2014 Preliminary
Findings

8. GMHR 2014 Demographics
Low
Middle
Slow
High Fast
Global
North
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Country Income Region Internet Speed
Global
South
N=2420

9. 2014 GMHR Demographics
18-21
HS Poorly
22-29
Unstable
Trade
Well
30-39
Stable
Colle…
40-49
Post
Grad
50-59
>60
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Living Situation Education Basic Needs
Just
Getting
By
N=2420

10. 2014 GMHR Demographics
87%
9% 0% 4%
0%
20%
40%
60%
80%
100%
Gay Bisexual Straight Other
Sexual Orientation
69%
30% 1%
0%
20%
40%
60%
80%
100%
HIV - HIV + Unknown
HIV Serostatus
(HIV+ = 655)

11. Access to Services: In your community,
how accessible is/are…
22%
47%
28%
50%
44%
0%
20%
40%
60%
80%
100%
120%
Completely Accessible
Somewhat accessible
Neither
Somewhat inaccessible
Completely Inaccessible
N=2420 (HIV+ = 655)

12. Service Utilization: In last 6 months,
how often have you used/obtained…
69%
29% 32%
48%
12%
0%
20%
40%
60%
80%
100%
120%
>10 Times
6-10 Times
3-5 Times
Once or twice
Never
N=2420 (HIV+ = 655)

13. Structural Violence

14. Structural Violence
Systematic ways in which social arrangements harm
people
“…arrangements are structural because they are embedded in
the political & economic organization of our social world;
they are violent because they cause injury to people.”
“Structural violence is visited upon all those whose social
status denies them access to the fruits of scientific &
social progress.”
Paul Farmer
Infections & Inequalities: the Modern Plagues

15. Homophobia
• Negative attitudes & feelings towards
homosexuality or people who are identified or
perceived as being homosexual; often expressed
as antipathy, contempt, prejudice, aversion, hatred
& hostile behavior such as discrimination &
violence.
• 82 countries criminalize homosexuality, with
sentences ranging from imprisonment to death.
• 20.8 percent of hate crimes across the United
States are motivated by sexual orientation bias.

16. Homophobia (α=0.86)
In your country, how many people believe that:
homosexuality is a natural expression of sexuality in men?
homosexuals are disgusting?
male homosexuality is a perversion?
male homosexuality should be honored?
homosexuality is morally acceptable?

17. Main Findings
24%
29%
26%
29%
24%
7%
0% 10%20%30%40%50%60%70%80%90%100%
male homsexuality is a natural
expression of sexuality in men
male homosexuals are disgusting
male homosexuality is a perversion
that sex between men is just plain wrong
that male homosexuality is merely a
different kind of lifestyle
that male homsexuality should be
honored
Homophobia
In your country, how many people believe that:
None A Few Some Most All

18. Perceived Access Positively
Associated with Service Utilization
(adjusting for a participant’s ability to meet basic needs)
• Risk reduction programs (OR 1.40; CI 1.30-1.52, p=0.00)
• Condoms (OR 1.21; CI 1.13-1.29; p=0.00)
• Lubricants (OR 1.34; CI 1.26-1.43; p=0.00)
• HIV testing (OR 1.19; CI 1.10-1.29; p=0.00)
• ART (OR 1.73; CI 1.52-1.98; p=0.00)

19. Accessing Services from LGBT
Org is Positively Associated with
Utilization
(adjusting for a participant’s ability to meet basic needs)
• Risk reduction programs (OR 76.72; CI 58.18-102.34, p=0.00)
• Condoms (OR 4.81; CI 4.09-5.68; p=0.00)
• Lubricants (OR 5.77 CI 4.83-6.90; p=0.00)
• HIV testing (OR 11.07; CI 8.67-14.23; p=0.00)
• ART (OR 1.92; CI; 1.19-3.10; p=0.00)

20. LGBT-led Service Points Positively
Associated with Perceived Access
(adjusting for a participant’s ability to meet basic needs)
• Risk reduction programs (OR 1.67; CI 1.40-1.984, p=0.00)
• Condoms (OR 1.34; CI 1.13-1.58; p=0.00)
• Lubricants (OR 1.74 CI 1.46-2.07; p=0.00)
• HIV Testing (OR 1.38; CI; 1.12-1.70; p=0.00)
• ART(OR 1.82; CI 1.06-3.19; p=0.03)

21. Limitations
• Convenience sample
• Selection Bias:
– Socially Connected
– Web & Email Access
– Motivated to participate
Bias likely to overestimate access &
Underestimate structural violence
• Survey Translation
• No adjustment for country effects in this
analysis

22. Strengths
• Community based
• Regional diversity
• Accessible in 7 languages
• Robust & comprehensive measures
• Consistent trends
– Within MSMGF surveys
– Across MSM surveys
– With qualitative findings

23. Conclusions

24. Policy makers, advocates, researchers, & providers must
sustainably decrease structural violence & improve
health of MSM worldwide
Tailor HIV services to needs of MSM by:
 Sexual stigma & other forms of structural violence
 Accessibility, acceptability & quality of services
 the number of LGBT-led or friendly service points
delivering these services
Work Collaboratively

25. Thank You!
Accessing services through an LGBT
organization has a dramatically large &
positive association with utilization of
HIV prevention, testing & treatment.