MSM in low and middle income countries are 19 times more likely to be infected with HIV than the general population.
A welcome move
The Alliance welcomes this move to better address the specific HIV prevention needs of MSM. It marks an important milestone in the US government’s leadership in the global response to HIV, and fills a longstanding and serious gap in the prevention activities supported by the US President’s Emergency Plan for AIDS Relief (PEPFAR).
The technical guidance is to be used by Country Missions who are implementing PEPFAR. It recognises that human rights, legal barriers and homophobia must be addressed as part of the effective HIV response for MSM. For too long, these factors have undermined HIV services for this highly vulnerable population.
What does it cover?
Six core elements are set out in the new guidance, to be used as a comprehensive package of HIV prevention services for MSM. This includes community-based outreach, condom and lubricant distribution, HIV counselling and testing, linkages to care and treatment, targeted information and screening and treatment for sexually transmitted infections.
James Robertson is the Country Director of India HIV/AIDS Alliance which implements Pehchan, a five-year programme funded by the Global Fund to Fight AIDS, TB and Malaria that builds the capacity of community-based organisations to provide HIV prevention programming for MSM, transgenders and hijras in 17 Indian states.
“The guidance has been long awaited and is highly appreciated,” said James. “In the context of the US government’s efforts to address HIV around the world, it recognises the particular needs of MSM. This is great progress.”
The main concern about the guidance is how the words will translate into action.
“It is not clear how success against the expectations that have been set out will be measured or who will be accountable for failure to act,” said James.
“Our fear is that we will continue to see MSM programming supported by PEPFAR only when it is already a partner country priority and where there is a champion to move these efforts forward. We need stronger and more focused leadership to change the current situation,” he added.
The guidance does acknowledge the importance of involving MSM in planning, implementation and leadership of HIV prevention efforts for MSM but the document does not explicitly recommend the use of PEPFAR funds to support MSM organisations.
“It is important that MSM-led community-based organisations are treated as full partners, and they should be supported as such. Too many countries continue to have inadequate or insufficient HIV programming for MSM and other sexual minorities with dire epidemiological consequences. The guidance is a good starting point. Now let’s see some real action,” said James.
What about other vulnerable groups?
The Alliance hopes that this important step regarding MSM is accompanied by meaningful investment to expand PEPFAR programming to meet the needs of sex workers, injecting drug users and transgender people.
Along with MSM, these population groups experience a severe and disproportionate impact of HIV/AIDS in low and middle-income countries. Although specific prevention needs vary somewhat, the obstacles are quite similar – including lack of access to properly resourced prevention programmes, marginalisation and hostile social environments, as well as legal barriers and abuses of human rights.