Homosexual men and trans-gender people should get equal access to HIV/Aids programmes under the World Health Organisation's first guidelines aimed at ending stigma that denies quality care to many, the UN agency said.
WHO also reported evidence of HIV infections surging again among men who have sex with men and people who change their gender, particularly in Western countries. The two groups are already hard hit by the Aids epidemic that began 30 years ago.
"This is the first time that WHO, as a UN agency together with other partners, is putting this forward. It is sensitive but is right to the point and is really critical for the epidemic," said Dr Gottfried Hirnschall, director of the HIV/Aids department at the WHO.
The 21 recommendations form "the first global public health guidelines" to focus on homosexual men and trans-gender people, the WHO said in a statement. They are designed to help health care workers and policymakers overcome entrenched discrimination and offer them testing, counselling and life-saving treatment.
Risk 20 times higher
Homosexual men are 20 times more likely to be infected with HIV than males in the general population, and rates are even higher in Mexico, Thailand and Zambia, according to the United Nations agency. HIV infection rates among trans-gender people range from 8% to 68%, depending on the country.
An estimated 2% to 4% of males have reported having sex with another man during their lifetime, Dr Hirnschall said.
"Certainly one thing that we know is that MSM behaviour (men who have sex with men) exists in all cultures. Obviously, the level of acceptance and cultural mystification varies from culture to culture," he added.
More than 75 countries criminalise same-gender sexual activity, according to the WHO. "And trans-gender people lack legal recognition in most countries," it said.
This forces many homosexuals and trans-gender people to risk criminal sanctions if they seek help from a health care worker. Police often have authority to harass support groups, it said.
"Because of the stigma, the discrimination, they will often access services late, they may not access them at all and often if they do access them the quality of services provided to them may be inferior," Dr Hirnschall said.
"If a trans-gender, in many parts of the world, comes to a health service, she gets chased away at the door," he said. "If she ever makes it by the guy at the door, the next question is 'where do we put her, in which ward do we put her?'"
Welcoming and safe
George Ayala, executive officer of the San Francisco-based Global Forum on MSM and HIV, said that health care services should offer an environment that is "welcoming and safe."
"It is difficult to respond with even the best of interventions that we have available to us if individuals run the risk of violence, of ridicule, of other forms of humiliation on their way to accessing services," he said.
Hua Boonyapisomparn, a trans-gender activist from Thailand, said that trans-gender communities have been "invisible" in national and international health care programmes.
"HIV guidelines are an important, historic step which is a hope for trans-gender community to ensure that their voice will be heard at all levels," she told reporters in Geneva.
(Reuters Health, Stephanie Nebehay, June 2011)