One evening of the consultation was devoted to a SWOT analysis to identify the strengths, weaknesses, opportunities and threats to HIV/AIDS prevention, care and support among men who have sex with men. Four subgroups were formed to carry out the analysis. A summary of their conclusions is set out below.
The strengths or positive features identified that may bolster activities targeting MSM were:
· The recognition that HIV/AIDS is a social and not solely a medical problem;
· Human resources: the existence of trained staff, technical support at the international and regional levels, networks and/or countries or organizations with a wide range of experience that are capable of assisting, training and advising others;
· Funds: these are available but still very limited;
· Infrastructure: the existence of offices and technical teams;
· Development of suitable models for intervention and educational material for the region;
· The recognition of the need to adapt and not simply adopt;
· The building of a gay identity;
· Professionalization of gay individuals and groups, a sense of commitment;
· The need to restore historical memory.
The following weaknesses or negative points were identified:
· Economic and political crises in various countries and health systems;
· Failure to define needs; inappropriate use of existing resources and failure to implement existing legislation;
· Unequal sharing of financial and human resources and of technical capacity; ideas and models suited to large cities are imposed on rural areas and smaller cities;
· Absence of local and international financial support; there are few sponsors, and community groups dispute the use of funds;
· The lack of leadership and participative planning, training and experience among human resources; overwork and exhaustion.
· The failure to define objectives and excessive professionalization that may cause workers to lose sight of the original objectives;
· Networks: there is a lot of talk but projects lack sustainability.
Problems affecting the gay community:
· Political splits and poor organization; discrimination between social classes and sexual roles;
· Low self-esteem because of the supremacy of the heterosexual culture.
Existing opportunities should be used to promote HIV/AIDS prevention, care and support among MSM.
As regards policies and the government sphere:
· Support from the ministries of health and the desire of other organizations to become involved in the area;
· Alliances and exchanges among governmental and nongovernmental organizations;
· Greater gay representation and participation in national policies;
· Implementation of existing legislation and of specific legislation on HIV/AIDS;
· The establishment of human rights in all constitutions.
· The trend towards a more progressive and open culture;
· Better acceptance within society for gay political organizations;
· Greater tolerance by the church and openness in various non-Catholic religions.
· Acceptance by society and more positive coverage of gay issues, HIV/AIDS and human rights in the mass media; expand information workshops for journalists.
· Improve support from the private sector and sponsors and apply for loans, international funding and commitment by governments.
· Improve access to information and drugs; make use of modern technology such as telecommunications.
Political and governmental:
· Adopt a more comprehensive approach to health and take advantage of decentralization;
· Improve the organization of the gay community involved in AIDS and its networks.
Political and governmental:
· Failure to respect national laws and limited use of legal mechanisms; policies fail to take existing legislation into account;
· Discriminatory legislation, such as immigration legislation in the United States of America; HIV/AIDS legislation may be a threat and/or a basis for discrimination;
· Outlawing of homosexuality and police repression;
· The prevalence of external models and demands over the activities carried out.
· Failure to classify specific subgroups in epidemiological information systems;
· Weakness in medical and hospital infrastructure;
· Privatization, decentralization and reform of the health-care system;
· Homophobia among health-care workers and fear of HIV/AIDS.
· Discrimination against MSM, stigmatization of vulnerable groups, the ghetto phenomenon;
· Fundamentalist forces; opposition by the church and religious ideas that hinder the expression of sexuality; dual moral standards and the homophobia of the Judeo-Christian tradition; machismo.
· Dehomosexualization of HIV/AIDS: funds intended for MSM have been used for the general public on the grounds that AIDS is not considered to be an exclusively gay problem. Other funds are assigned to other issues;
· The high cost of drugs;
· Impoverishment of people living with HIV/AIDS.
· Denial and invisibility of the groups active in specific human rights, gay rights, and HIV/AIDS campaigns;
· Media ignorance, sensationalism, homophobia and the association of AIDS with homosexuals. Limited, repressive and stereotyped coverage in the mass media.