Prohibition, stigma and violence against men who have sex with men: effects on HIV in Central Asia

Conscious of a paucity of evidence, and drawing upon a combination of historical documentary material, research literature and surveillance data, this paper offers a commentary on the social, historical and HIV contexts affecting men who have sex with men in Central Asia. The authors describe the history of men who have sex with men in the five Central Asian republics, before, during and after the Soviet-imposed legal prohibition, which continues in Turkmenistan and Uzbekistan, the only nations in the World Health Organization Europe region where sex between men remains illegal. This historical context frames contemporary responses to men who have sex with men. Despite long-established homoerotic traditions, modern attitudes to men who have sex with men are marked by great hostility, generating stigmatization of sex between men and discrimination against men suspected of it. The losses following public exposure can be severe: loss of employment; limited/lack of health-care access; and safety from physical and sexual assault. Such hostility creates an environment of increased HIV risk, and constrains the production of reliable HIV evidence. The authors argue that the generation of HIV risk, HIV-prevention responses and HIV evidence are products of their historical and social contexts, and call attention to the urgent need for HIV prevention and structural reforms to protect the health of men who have sex with men in Central Asia.