Män som har sex med män ? utmaningar och strategier i svenskt utvecklingsarbete
MSMHIV-preventionUtvecklingssamarbeteMänskliga rättigheterHBTMSMHIV preventionDevelopment co-operationHuman rightsLGBT
Introduction: Men who have sex with men (MSM) is a vulnerable group with regard to HIVbecause of biological factors, lifestyle, discrimination and, in some parts of the world,criminalization. From a public health perspective it is important to include MSM in order to securea high-quality HIV prevention but also to safeguard human rights (HR) for this group. However, itis only recently that the Swedish development cooperation agencies have begun to integrate MSMin HIV prevention. Objective: To examine how employees of Swedish institutions responsible fordevelopment cooperation manage the vulnerable group MSM when providing support for HIVprevention programs and human rights programs. Topics relate to challenges and strategies tointegrate MSM in HIV prevention, which achievements have been obtained, and how to practicallydeal with the criminalization of the group. Method: Qualitative semi-structured interviews withfive respondents with work tasks that could be linked to the focus of the paper. The material wasanalyzed in two ways: the domain named challenges was categorized according to manifest contentanalysis, while the strategies and successes were described according to case study methodology.Efforts to include MSM in HIV prevention were by the respondents linked to efforts to securehuman rights for lesbian, gay, bisexual and transgender (LGBT) groups. Therefore, the concept ofLGBT, encompassing MSM, has been used in the analysis. Results: Respondents expressed anumber of challenges that are linked to four different groups: LGBT organizations andorganizations with LGBT projects (legitimacy and financing, risks and anonymity, opposition);partner countries and organizations without LGBT projects (denial and delusion, resistance,legislation); the employer organization (uncertainty, conflict, discomfort and fatigue, enthusiasts)as well as overall factors (statistics, stigma). The strategies have been divided into externalstrategies (dialogue, visibility and networking, mapping, regional activities) and tools (LGBT actionplan and task force, the ITP course, the Yogyakarta Principles). Successes mentioned are recentsignals that attitudes towards same-sex sex and/or homosexuality are slowly beginning to changein some partner countries, and that Sweden is regarded internationally as leading in LGBT withindevelopment cooperation. Discussion: The challenges mentioned can be divided into practicalversus emotional- and knowledge-based. The strategies listed correspond to the practicalchallenges but not quite to the emotional and knowledge-based ditto. The concept of MSM inrelation to the concept of LGBT may need to be questioned in HIV prevention efforts to clarifywhich group is in focus and what suitable measures are required. The field is in great need offurther research about how different sexual groups included in the MSM category are affected byHIV; about how other important actors in development cooperation (field staff and nongovernmentalorganizations) work with MSM; about the role of social, cultural and economicfactors; and ? most important ? to directly interview MSM in partner countries about their viewsand needs.