Alex in Phnom Penh ©peripheries

In a comment published in the Phnom Penh Post, independent consultant Michael De Guzman, put forward a few reasons why interventions aiming at reducing HIV infection and transmission amongst Men who have Sex with Men (MSM) are failing in a developing country such as Cambodia where an uncovered epidemic is brewing and growing.

For Guzman, interventions are not working because MSM have been generally ignored by Behavioural Sentinel Surveillance study. Then, when working groups are finally convened they are mostly comprised of government representatives, rarely willing to hear and even less recognize sexual behaviour outside “the norm”, donor representatives and foreign consultants who are there more for the money than for the personal interest, and sometimes some representatives of MSM (“supposedly”).

For Guzman this is not the best combination one could come with to deal with the discrimination against MSM in a country like Cambodia. Despite being traditionally and religiously much more tolerant than many other countries when it come to MSM (King Norodom Sihanouk showed support for gay marriage in 2004 though this did not materialise into law) men whose family found out about their sexuality are often ostracised by their community. As a consequence, many hide their sexuality and will marry whilst continuing to be sexually active with other men. MSM also receive little attention and have little access to relevant information and prevention tools.

But for Guzman, it is the lack of personal stake that is the main obstacle to outreach programme and other interventions.

“I realised that for all the talk of programs, projects and interventions for MSM, a critical element was lacking in the MSM response to HIV/AIDS. A personal stake. I mean, we were talking about doing outreach, establishing MSM-friendly clinics and advocating for MSM. But on a personal level, what does advocacy mean to a 13-year-old boy who lives in a remote province who’s just starting to realise he’s different from the other boys because he is growing to be sexually attracted to them?”

In this context it does not matter how one is competent or how good is the intervention if there is nobody at the receiving end. Guzman therefore posits that “A personal commitment strengthens and enhances interventions tremendously. On the side of the supposed beneficiaries of these interventions, the personal commitment of a service provider will nurture the client’s own commitment towards their health, in turn making them more receptive to behaviour change messages.”

I could not agree more with Guzman. And for such commitment to grow, there is a need first to recognised the existence of MSM, then to include and involve MSM in future programme and intervention and boldly have these programme led by those who are the most concerned, no matter how much that would irritate or anger (foreign) consultants (for a similar view, read this). This goes far beyond gimmicky empowerment. It is about leadership.

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