Discussion
Findings from this large-scale global survey of MSM show
that participants had limited access to basic HIV services
that have been proven to be effective in preventing the
acquisition and transmission of HIV and treating HIV
infection, including free condoms, free lubricants, and HIV
testing, as well as HIV treatment for MSM who are living
with HIV.
Our data shows that reduced access to HIV services was
associated with lower levels of country investment in HIV
services, suggesting a need for greater investment in basic
HIV services. However, the data also suggests that structural factors, including sexual stigma and criminalization
of homosexual behavior, were also significantly associated
with reduced access to HIV services. Thus, increasing
funding for HIV services may have to be paired with
efforts to reduce sexual stigma and decriminalize homosexual behavior in order to effectively increase access to
HIV services for MSM.
The inverse relationship between sexual stigma and
access to HIV services in our study is consistent with
previous studies showing the negative impact of sexual
stigma on access to HIV services, as well as on HIV risk
[25–38]. For example, sexual stigma (also known as
homophobia) is associated with increased unprotected anal
intercourse among men not previously diagnosed with HIV
and with sexual HIV transmission risk behavior among
men who knew they were HIV-infected [35, 39]; and has