When Cesar Leon discovered he had contracted HIV from his long-term boyfriend more than a decade ago, not much information was available about the virus, even among the gay community in Bogota, Colombia's capital.
"Today, we have a lot of information [about AIDS], but people aren’t responsible, they don’t pay attention," he told IRIN/PlusNews.
HIV rates among Colombia's general population have stayed below 1 percent, but the limited data available on men who have sex with men (MSM) suggests that the infection level in this group may be at least 11 percent.
Prevalence peaked at about 17 percent in the late 1990s, but even the lower rate is still high enough to pose a significant risk to men who have unprotected sex with other men. Leon and other gay AIDS activists say complacency among gay men has become a threat.
"Before, HIV was the terror that everyone was scared of. Now it seems people are a bit too relaxed; they’re not so scared anymore," said Martin Alonso Hernandez, who works at the Weavers of Life Foundation, a community-based organisation that facilitates income-generation projects for people living with HIV in Bogota.
The organisation recently conducted a small study on condom use among gay men and found that of 69 men interviewed at various gay bars, clubs and baths in Bogota, 35 percent said they did not use condoms. Of the other 65 percent, only 30 percent always used condoms, and a minority used lubricants to prevent them from breaking.
Many said there was little condom promotion at gay clubs, and the films always featured men "barebacking" - having sex without condoms. "You enter a dark club and there's a [pornographic] video playing and you don't know anyone; you have sex and then you leave," said Edinson Aranguren, a gay AIDS activist who works for the Colombian League for the Fight Against AIDS (Liga Colombiana de Lucha Contra el SIDA).
"Some places give a condom when you enter, but most don't. There's no material about condom use or HIV." His organisation attempted to rectify this situation a few years ago by giving gay club owners boxes of condoms to hand out to clients, but many owners were hostile, and those who accepted the condoms often sold them.
The League has worked with local government to bring in a regulation forcing club owners to provide condoms, but "the government isn't interested in enforcing it; also, about 70 percent of these places are unlicensed," Aranguren said.
Hernandez said the availability of free antiretroviral (ARV) treatment through Colombia's state-regulated health insurance system was another factor in the more relaxed attitude to HIV in the gay community. "They don't view AIDS as a big problem these days because drugs are available."
In fact, not everyone is covered by the state system and the government figure of 80 percent coverage for ARVs is based only on the 25,000 people who have been tested and found to be in need of the drugs.
Hernandez delayed taking an HIV test for five years after his partner tested positive because he was out of the system at the time, and being testing in the private sector was unaffordable.
"By the time I tested, I was quite sure of the result. I had some symptoms and I only weighed 32kg," he said. "I just wanted the piece of paper so I could access treatment - by then I was covered by the health insurance system."
Hidden MSM harder to reach
Whether or not they act on it, the gay community in Bogota has reasonably good access to information about HIV and AIDS, but MSM who don't consider themselves gay are difficult to reach and tend to have a much lower level of awareness.
"They prefer to chat on the internet and arrange meetings in dark places like gay cinemas so they won't be identified," said Aranguren. "They don't think they are at risk."
In a society shaped by conservative Catholic values and a macho culture, MSM have good reason to keep their activities clandestine. "I always had an inclination towards men, but for me it was a problem because I couldn’t accept it," Leon recalled. "My family is Catholic and I grew up in the northeast, in a city called Bucaramanga where the culture is very macho."
Even today, Leon does not feel he can tell his work colleagues about his sexuality, let alone his HIV status. "At work I have to be another person," he said.
Hernandez said discrimination against gay people was common in rural areas, causing many to come to big cities like Bogota, which tended to be more anonymous, if not exactly tolerant.
Lack of official response
Colombia has no government strategy or budget for HIV prevention programmes aimed at vulnerable groups like gay men and MSM. Even condom distribution by the Ministry of Health is limited to people already living with HIV and their partners. "It's insufficient, but it's a lack of resources," said Dr Ricardo Luque, head of the National AIDS Programme.
Colombia recently submitted its fifth proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria, seeking a grant to set up prevention programmes for vulnerable groups, including MSM; four previous proposals were declined, said Luque.
The extent of HIV infection among gay men and MSM in Colombia is not known. The current figure of 11 percent prevalence is based on a survey by the Colombian League for the Fight Against AIDS in 2006 that sampled 632 men in Bogota.
"Next year we're going to do a study in four cities to get a more representative figure," said Aranguren.
ks/he
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions