Text of a speech given by Neil McKenna to the Amnesty International -HIVOS (Humanist Institute for Cooperation with Developing Countries) Lesbian and Gay Human Rights Programme for the Amsterdam Gay Games.

Delivered Wednesday, 5th August at the University of Amsterdam

I'd like to begin by saying how delighted I am to have been invited here to talk to you about my work. I am particularly happy to be here in Amsterdam because in the long dark years of homophobia and intolerance in Britain, the Netherlands has served as a beacon of enlightenment and tolerance to British gay men and lesbians.

Perhaps all of us are all too familiar with the endless degradation of the human rights of lesbians and gay men. Those of us who are old enough well remember the time before AIDS when our human rights were abused and denied.

We have lived through the long dark nights of the Aids epidemic to witness yet further assaults on our right to love who we choose, our right to be free from persecution, and our right to health.

Today, I want to talk to you about a project I began in 1993, almost by accident. In 1992, I was a newspaper journalist writing for the British national press. I had just come back from Amsterdam and had written a feature on the cannabis cafes of Amsterdam for the Independent. I was short of cash and rather bored with what I was doing when I saw an advert to edit WorldAIDS magazine, a bimonthly magazine published by the Panos Institute.

To cut a long story short, I got the job and set about learning and writing about Aids in the developing world. A year or so later, I started asking what I thought was a perfectly simple and straightforward question. I wanted to find out what role sex between men played in the pandemic of Aids in the third world.

I have to say that I was unprepared for the response. My question was met with denial, hostility, aggression and dishonesty.

Most of the answers I got were variations on the same theme which was 'male-to-male sex plays no role in Aids in the developing world,'...or, 'sex between men plays a minor role,'...or 'there are no homosexuals in our country'.

On the face of it, there was little to work on. But more significantly, no-one I spoke to wanted to find out the answers.

Indeed, I was told by a number of national and international agencies and organisations that my questions were, in some way, damaging the cause of Aids prevention in the developing world.

Somehow, some way, simply wanting to find out about men who have sex with men and HIV constituted a threat to Aids prevention. And this, all before I had begun my research or even put pen to paper.

I was shocked, surprised and upset by the violently hostile reactions that my seemingly simple question elicited. Even my colleagues at Panos were opposed to the idea. They thought it would damage relations with partners and with funders.

But because I am a stubborn and obstinate person when it comes to the pursuit of truth, I determined to carry on. It was funding from the Norwegian Red Cross which enabled to undertake the project.

I set about assembling as much material as I could on men who have sex with men, making use of the excellent HOMODOK archive here in Amsterdam, ploughing through endless books on anthropology, and huge piles of reports from around the world, looking for scraps of information.

There were some difficult moments along the way like the dinner I had in London with a doctor from the Global Programme on Aids. We were talking in a friendly fashion and I started to tell him about my research. The change was sudden and unpleasant. 'I spent 10 years in Africa,' he declared, 'and never once did I see a case of rectal gonorrhoea in a man'. When I asked him if he had ever looked for rectal gonorrhoea, he turned away and spoke to someone else.

And then there were the half dozen very unpleasant and aggressive conversations with the woman in charge of Aids prevention for a leading British NGO. I wanted to find out how much, if any, money this NGO spent on Aids prevention targeted at men who have sex with men, and what percentage this represented of their total Aids prevention budget. The hostility of this person was palpable. The answer, when it finally came, was rather less than 1%.

You can read the results of my research for yourselves in On the Margins. I called the report On the Margins because I concluded that virtually every aspect of the lives of men who have sex with men are marginalised.

They are marginalised socially, religiously, legally, and in terms of human rights. They are marginalised when their sexuality is denied, dismissed, derided and punished, and they are marginalised when the spaces they use, the spaces they own, become spaces of danger, of violence.

Men who have sex with men are, more often than not, marginalised by an Aids and HIV epidemiology which usually ignores male-to-male sexual transmission, which pretends it doesn't exist.

And they are marginalised by the failure of those in the 'international donor community' - governments, NGOs and international agencies - whose business it should be to know about the epidemic of HIV among men who have sex with men and whose business it should be to ensure that the issue is addressed.

And finally they are marginalised again by those in the international donor community whose business it should be to protest about the legal persecutions and human rights violations of men who have sex with men.

And it is about this failure in the donor community that I want to talk to you about in a little more detail today.

For what I discovered in undertaking this work was that there was, and I think, still is, a vast amount of denial, hostility, prejudice, and homophobia, within national and international organisations working to prevent the spread of HIV in the developing world.

I had expected to experience prejudice and hostility from those I spoke to and wrote to in the developing world, and I did, but nothing like on the scale I experienced it within the international Aids prevention community -from Panos right through to the Global Programme on Aids.

I think it's crucially important to ask why this situation came about. Why, almost 15 years into a global pandemic was - and more or less still is -there so little willingness to look at sex between men and HIV in the developing world honestly and rationally . Why has so little been done? Why has so little money been spent? Why has so little research been undertaken?

Why are men who have sex with men the forgotten people?

I think to understand the reasons for this neglect we must go back to the very beginning of Aids, to the early international response to the pandemic.

The Global Programme on Aids, under the leadership of Dr Jonathan Mann, set about constructing Aids in moral, political and development terms. Their aim was worthy. They wanted to remove the stigma that surrounded Aids, to prevent its spread and to care for those already sick.

A ideology of HIV and Aids quickly grew up. It was a ideology of moral rectitude, of political correctness. It embodied the new thinking that had developed in the 1970s around sustainability, partnership, justice, human rights, health rights and empowerment. Aids was, rightly or wrongly (and I still can't decide which), constructed as a development issue.

The challenge of Aids became an opportunity to put into practice a new way of thinking and working around development. The only problem was that this new thinking failed to include any consideration of the rights of men who have sex with men.

In fifteen years of often worthy rhetoric about human rights and health rights, about empowerment, about development, barely a word was said about gay men, bisexual men or men who have sex with men in developing countries.

History will judge the success or otherwise of the first years of Aids prevention under the leadership of the Global Programme of Aids, and now under UNAIDS. I believe that the GPA did much to establish and underline the nexus of poverty, disempowerment, abuses of health and human rights which facilitated the explosive spread of HIV in the developing world. It achieved much with the establishment of National Aids Programmes in developing countries with clear agendas and clear goals.

Where it failed, and failed massively in my opinion, was its reluctance to grasp the nettle of male-to-male transmission of HIV. It consistent, simplistic public statements that HIV in the developing world was almost invariably the result of heterosexual sex, contrasted uneasily with its private knowledge of the significance of male-to-male sex as a means of HIV transmission.

Some in the GPA were aware in the late 1980s that sex between men was almost certainly a major transmission route in some developing countries -not just in Latin America where the evidence was crystal clear that sex between men was, and may still be, the single most important means of spreading HIV - but also in other countries, like India, China, and Thailand. There was clear evidence that sex between men was likely to be an important transmission route in these countries.

Why did the GPA fail to act? Well, to be fair, it did act. It commissioned some research into HIV and sex between men in parts of the developing world. It commissioned guidelines for Aids prevention among men who have sex with men in developing countries, and then refused to publish them. It even funded a very few Aids prevention projects for men who have sex with men.

But the Global Programme on Aids failed at the level of policy, it failed at the level of strategic planning and decision-making to tackle the issue.

But most of all it was a failure to give leadership.

It's not just the Global Programme on Aids. There is no global leadership which fights for the human rights and health rights of men who have sex with men. Whenever human rights abuses of men who have sex with men are mentioned, the international community throws its hands up in horror and says 'well, we understand the situation but we can do nothing, we must be culturally sensitive.'

Being culturally sensitive excuses a multitude of sins.

Of course, cultural sensitivity is a two-edged sword. Let's look, for a moment at our attitude to female genital mutilation. We can express our distaste and disgust for the practice of female genital mutilation; we can ignore and override centuries of religious and cultural traditions, and we can collectively through the agencies of the United Nations seek an end to the practice. Is this being culturally sensitive? Clearly not. Quite rightly, female genital mutilation is seen as a fundamental and innate transgression of human rights.

But when it comes to men who have sex with men, cultural sensitivity counts for everything. We can't interfere, we can't seek to change the situation for men who have sex with men because we must be culturally sensitive. Clearly, there are double standards here.

Cultural sensitivity is a way of legitimising the torture, murder, imprisonment and myriad other abuses of men who have sex with men. Why is it that the human rights abuses of men who have sex with men count for so little, seem so worthless?

Even Amnesty International, the organisation that had done so much to push forward the case for human rights as an essential part of the development agenda - only adopted the human rights of homosexuals in 1991, after a period of sustained protests by gay men, culminating in a massive demonstration outside Amnesty's headquarters in London. And although I am delighted that this conference on human rights has been co-sponsored by the Dutch chapter of Amnesty International, I have to say that I have yet to be convinced about the scale of Amnesty's commitment to the human rights of lesbians and gay men.

I believe that underneath all the rhetoric of development, behind all the morally correct, politically correct statements lurk some unresolved feelings about men who have sex with men in developing countries. I believe that many people working in the field of Aids prevention and development are unhappy and uncomfortable with the idea of sex between men. I believe that the day-to-day realities of sex between men in many parts of the developing world stretch and test the very limits of liberalism.

Sometimes it's a dark, strange, covert, promiscuous, often unpleasant world. It's about a male sexuality which is unrestrained, lustful, often involving the sexual exploitation of boys, often involving prostitution, coercion, and violence. It's a world where most of the protagonists are married and their sexual activities with men can damage the wife and the family, especially when it comes to the transmission of sexually transmitted diseases.

For many people working in development, this world is not one they want to know. But the issue is not whether people working in AIDS prevention want to know this world, it is why they have failed, are failing, and will fail to address the HIV prevention needs of men who have sex with men in the developing world.

Since the publication of the On the Margins in 1996, there have been some changes of attitude. UNAIDS has taken over from the Global Programme on AIDS. Last year, after nine months of internal wrangling, UNAIDS published its short technical update on men who have sex with men and Aids, a paper which, however brief, at least for the first time acknowledges the problem of male-to-male transmission of HIV in the developing world. This is an important change but in itself it is not enough. A change of attitude on the part of UNAIDS will not change global attitudes fast enough to bring about real and enduring AIDS prevention for men who have sex with men.

Let us not mince words. AIDS has been with us for the best part of two decades and will be with us for decades to come. For men who have sex with men in the developing world, there has been a virtual famine of Aids prevention, and a drought of funding. In human terms, this means that many hundreds of thousands of men who have sex with men - gay men, bisexual men, prisoners, streetchildren and transgendered people - have been exposed to HIV, are living with the virus, or have already died. The human waste is appalling.

Were this happening to any other group of human beings, there would be an international outcry. As it is, there are just a few, faint voices of protest. The great international agencies, the United Nations, UNAIDS, WHO, UNDP are virtually silent. Governments, in both the developing world and in the Western world have not spoken out. And gay men and lesbians in our privileged Western world have not chosen to see this as an issue of international solidarity. There is something quite frightening about the indifference, the seemingly callous indifference, of wealthy, privileged gay men and lesbians in the West towards the terrible suffering and deprivation of gay men and lesbians in the developing world.

So, we come to the question of what is to be done? Well, the situation is not entirely bleak. All over the developing world there are small, innovative projects offering counselling, advice, information and crucially, condoms and lube, for men who have sex with men, very often run on a shoestring by the men themselves. They are cost-effective because they have to be. But for every project working with men who have sex with men, another ten or more fail - most often because of an absence of funding.

Some Western governments - notably the Dutch, the Norwegians and the Swedes have funded AIDS prevention projects for men who have sex with men in developing countries. Even Britain's Department for International Development have funded one or two projects. But despite written submissions made to DFID about establishing appropriate funding strategies for the sexual health of men who have sex with men, DFID have so far failed to come up with a clear policy.

Is this because DFID doesn't believe that there is a problem? I think not.

Is it because DFID doesn't get requests for funding this kind of work?

Again, I think not. We are left with the depressing conclusion that the health and human rights of men who have sex with men in the developing world are not deemed to be a priority by our government. It's a scandalous, shameful state of affairs.

And the response from British NGOs is no better. My research for On the Margins revealed that British NGOs in 1994/5 spent less than 0.1% of their Aids prevention budgets on men who have sex with men. I very much doubt if the situation has improved. Indeed, it may have worsened.

Today I am calling for the formation of an international task force to tackle years of neglect of the sexual health needs of men who have sex with men in the developing world. We need to stop asking and start demanding that governments, international agencies, and NGOs engage with the crying needs of men who have sex with men Such an international task force cannot be entrusted to the bureaucracies of UNAIDS. The sad fact is that we cannot trust heterosexuals to undertake this vital work. We must undertake the task ourselves. We must not only raise and distribute money, we must raise awareness globally. We must lobby our governments to address their criminal neglect and insist that the health and human rights of men who have sex with men are respected in developing countries.

Unless and until the health and human rights of all men who have sex with men are assured, are enshrined, are respected, we cannot cease our struggle.

Neil McKenna is a writer and journalist and the author of 'On the Margins:

Men Who Have Sex With Men and HIV in the Developing World' (1996 Panos).

Neil McKenna

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" Neil McKenna 1998