Meeting the needs of MSM in the Middle East and North Africa

By Manuel Couffignal

Manuel Couffignal is a Senior Advisor: Funding and Influence at the Alliance.

In the Middle East and North Africa (MENA), men who have sex with men (MSM) are a particularly vulnerable and highly stigmatised community, and their burden of HIV infection is significantly higher than the general population.

From 2005 to 2015, the Alliance worked with eight civil society organisations (CSOs) in Algeria, Lebanon, Morocco and Tunisia to respond to the sexual health and HIV/STI prevention needs of MSM in an exceptionally hostile environment. 

The Alliance started from scratch, setting up community-led health initiatives designed by and for MSM, where there were previously virtually no services. The CSOs that were part of the programme distributed condoms and lubricant, and provided HIV counselling and testing and STI diagnosis and treatment in various cities in the four countries. They also provided psychosocial support and legal advice, and undertook a range of activities aiming to raise awareness of HIV prevention, the importance of knowing your status, individuals’ right to health, services and non-discrimination, and where to go for support.

The fact that the services were aimed for MSM was usually concealed from any signs and printed material, and the address of the MSM community spaces was communicated by word of mouth only.

Given the sensitive context, the work was largely done under the radar. The fact that the services were aimed for MSM was usually concealed from any signs and printed material, and the address of the MSM community spaces was communicated by word of mouth only. The sexual orientation of peer educators was kept confidential, and there was limited communication about and visibility of the reach or results of the programme to avoid being attacked as “NGOs promoting homosexuality”.

In parallel, they advocated for a more positive environment for MSM and CSOs working with MSM. They spoke up for the inclusion of MSM as a target in the national AIDS programs, and they challenged stigma and discrimination through sensitization workshops with health service providers, policemen, journalists, lawyers, and religious leaders.

The program leaves behind an important legacy as the first and only MSM program in the MENA region providing critical services for a continuous period of ten years, empowering MSM communities and strengthening civil society’s capacity to respond to HIV and the needs of key populations. MSM in these countries now have better access to appropriate and friendly services, and several of the CSOs have become respected actors in the national HIV response and in the region.

Many MSM peer educators have become activists, carving the way forward towards a more positive future for MSM and LGBT in their respective countries. The program lives on today thanks to the people participating in it, whether as people accessing services or as MSM and LGBT activists, and thanks to the wealth of MSM friendly tools and other material created as part of the programme.

The program leaves behind an important legacy as the first and only MSM program in the MENA region providing critical services for a continuous period of ten years

One of these tools is the training toolkit on MSM programming for the MENA region developed jointly by the Alliance, UNAIDS and the CSO partners of the Alliance MENA programme. It is intended for training and guiding community outreach workers, peer educators and managers of organisations that want to start MSM programs in their country or town. It incorporates the experience from the pioneer MSM programme in MENA, but also builds on international good practices on MSM programming.

The Alliance’s programme represents a part of the few HIV focussed interventions targeting MSM in MENA, and while their achievements are significant, the needs of MSM in the region remain largely unmet. In every country of the MENA region they shoulder a disproportionate burden of HIV infection rates, they lack equitable access to HIV services, they are criminalized, and they face unrelenting stigma, discrimination and violence.

These countries will not be able to stop the progression of the HIV epidemic unless they effectively address HIV in this diverse population. Gay men, bisexual men, other men who have sex with men and transgender people living in MENA need more safe spaces, more empowerment, more friendly services, increased access to treatment, and a more enabling environment.