While the health sector has been

While the health sector has been providing MSM-dedicated services since 1997 (starting with an explicit priority to
provide condoms to MSM), a number of barriers to service provision have been identified. These include: other HIV
interventions taking priority over the needs of MSM; denial of the risk to MSM among some individuals and lack of
health service capacity to address the issue of MSM. Overlying these barriers is a culture of machismo in Mexico,
which may impede both provision of and equitable access to services. Mexico held an anti-machismo campaign
in 2004, but the problems remain. Nonetheless, there is a high degree of political support for equitable policies
and provision of services for MSM. In 2000, the President of Mexico stated that discrimination on the grounds of
sexual orientation is wrong, and in 2001 the national constitution was amended to outlaw discrimination on the
grounds of sexual orientation.
5.1.4 The Netherlands
The Netherlands has been addressing HIV prevention and treatment for the past 25 years, and has had MSMfocused
programmes since then. From an early position of wishing to avoid potential discrimination against MSM
(thus initially avoiding undertaking prevalence studies among MSM), to the current position of openly recognizing
and addressing the higher risks faced by MSM, the programme in the Netherlands has evolved alongside the
evolution of the epidemic itself.
Current priorities for HIV programmes recognize that MSM are disproportionately affected by the HIV epidemic,
and are a priority group for the national programme (along with young people, sex workers and people from ethnic
minorities). From the extensive experience of the Dutch programme, several important lessons emerge:
• Civil society engagement is crucial to programme response, but one should be wary of equating civil society
engagement with involvement of the whole community.
• A multisectoral approach is important.
• Prevention is most effective when behavioural prevention is linked to access to testing, with a guarantee that
treatment will be available to all who are HIV-positive.
• Research is important as it helps to “know your epidemic”.
• The epidemic is constantly changing, and responses should be innovative to keep pace with the epidemic.
• Linkage of HIV interventions and programmes with the general health system is important.
• Adequate resources for programme implementation are vital.