Intensifying HIV prevention and impact mitigation among MSM

Colourful Sky - MSM based in Kunming, China, attending a workshop © 2005 International HIV/AIDS Alliance

An overview of the Joint UNAIDS and International HIV/AIDS Alliance Roundtable Meeting, Geneva 14 November 2005

In recognition of the need to encourage stakeholders in the fight against AIDS to increase and reinforce existing HIV prevention efforts among gay and other men who have sex with men, the International HIV/AIDS Alliance and UNAIDS jointly organised a stakeholders meeting to explore the issue.

The meeting, held in Geneva, Switzerland on Monday November 14, was aimed at increasing donor and policy maker interest in, and commitment to, HIV prevention and impact mitigation among men who have sex with men in developing countries.

Attended by 35 key players from civil society, government and the international donor and policy making community the meeting helped situate MSM programming within the global epidemic, shared some of the latest thinking on issues which are critical to the success of programming with gay and other men who have sex with men, and profiled some of the work being carried out by civil society organisations with the support of international donors in developing countries with these groups.

Participants from community organisations in Latin America and the Caribbean, Africa and South and South East Asia shared their experiences and insights with donors and policy makers.

In recognition of the implications of many of the issues raised for the Alliance’s own programming and policy a number of the participants visited the Alliance Secretariat in Brighton to share their experiences with staff here.

The roundtable and think tank are the beginning of a process of exploring how we can better support increased resourcing for HIV prevention and impact mitigation among gay and other men who have sex with men in developing countries. An overview of critical issues and case studies from the field is being developed and will be launched at the World AIDS Conference in Canada in 2006.

In the meantime, copies of the PowerPoint presentations made at the meetings in Geneva and Brighton, together with brief overviews of the overarching themes, and key documents are available below.

The initiative forms part of the Alliance’s Frontiers Prevention Project policy and communications strategy, which includes local, national and global policy development and advocacy aimed at applying the learning from the project to enhance the impact of HIV prevention among key populations.

During the meetings, presentations were focused on the latest international developments and debates on the global AIDS pandemic, including the available evidence base, community organising, service provision and vulnerability reduction .

The extent of male sexual behaviour, identity, HIV risk and impact in developing countries

We don’t know enough about male to male sexual behaviour, identity, HIV risk and impact in developing countries. In fact, the lack of authoritative information on all these issues is seriously undermining interest in, commitment to, programming on and resource allocation aimed at responding to the HIV-related needs of men who have sex with men in low income countries and needs to be addressed as a matter of urgency.

Dr Carlos Caceres from Cayetano Heredia University, Lima presented the results of his data collection and analysis of the globally available evidence on MSM sexual behaviour and risk.

Dr Caceres’ presentation was based on a comparative study of the globally available epidemiological and behavioural evidence on MSM in low and middle income countries which was commissioned by UNAIDS. A copy of the report can be downloaded here.

Efforts to support community based organizing for HIV prevention and impact mitigation by men who have sex with men

Some level of community based organising is necessary for almost all programming aimed at reaching men who have sex with men. However, supporting gay men and men who have sex with men to network, build social capital and in turn respond to the challenge posed by HIV in developing countries is often very challenging.

This part of the meeting provided an overview of some of some of the work of organisations working to support community based organising of men who have sex with men in response to HIV.

Speakers included Kim Muji of the Naz Foundation International who spoke about the Foundations work with males who have sex with males in India. A copy of his presentation is available by clicking here.

Baba Goumbala formerly of ANCS in Senegal and currently the International HIV/AIDS Alliance’s representative in West Africa spoke about efforts to organise men who have sex with men in Senegal for HIV prevention. Download his presentation here.

More information on the sexual health needs of men who have sex with men in Senegal was provided by Dr Placide Tapsoba of the Horizons Program. A copy of their research report is available by clicking here.

Dr Tapsoba also made available a research report on the HIV/STI risks and prevention needs of men who have sex with men in Nairobi, Kenya. A copy of the report is available by clicking here.

Don Baxter, Executive Director of the Australian Federation of AIDS Organisations provided an overview of that organisation's support to emerging gay groups throughout the Asia Pacific Region.

At ICAAP in Kobe, Japan earlier this year AFAO organized a half day satellite meeting which looked at some of the challenges experienced by organisations developing gay-MSM HIV prevention programs in Asia-Pacific. The satellite provided a forum for those directly involved in initiating, developing and implementing HIV prevention and advocacy programs for gay men and men who have sex with men in Asian countries to share experiences and lessons learned.

More information on the meeting is available by clicking here.

Efforts to provide services for men who have sex with men in developing countries

 Effective HIV prevention and impact mitigation requires comprehensive approaches to the epidemic. As a result there is a need to identify what such approaches will look like for men who have sex with men in developing countries, how they will work and to monitor and evaluate their impact.

This part of the day looked at attempts to provide a continuum of programming responses for MSM and to identify some of the challenges encountered.

Presentations and discussion looked at site specific approaches, attempts to mainstream men’s sexual health needs into existing HIV and sexual health programming and the growing recognition in a number of national strategies, including India and Cambodia, where MSM have been recognised as a priority for HIV prevention work.

Shumon Sengupta, the Director of the Alliance’s office in the state of Andhra Pradesh in India presented on the work of the Frontiers Prevention Project with men who have sex with men, including the results of participatory site assessments and behavioural studies, an overview of the subgroups of men who have sex with men that the project works with, details of the structural and other interventions undertaking including the establishment of MSM friendly sexual health clinics.

To view Shumon Sengupta's presentation, click here.

Choub Sok Chamreun from the Khmer HIV/AIDS NGO Alliance in Cambodia presented on the specific ways in which, once again through the Frontiers Prevention Project, Khana was reaching rural men who have sex with men. The presentation includes details of the situation for rural msm in Cambodia, how the project is trying to reach them, the services it is providing and promoting and efforts to improve the enabling environment for MSM in Cambodia.

Toni Reis the Deputy Co-ordinator of ASICAL, the Assoication for Integrated Health and Citizenship in Latin American and Caribbean provided a community view point on prevention, care and support in HIV and human rights among gay men and other men who have sex with men acorss the region. Click here to view this presentation.

Efforts to reduce the vulnerability of gay and other men who have sex with men

 Comprehensive approaches to HIV prevention must not only address risk reduction but also systemic causes of vulnerability which limit the ability of individuals and communities to protect themselves and others from infection. Human rights violations make men who have sex with men more vulnerable to the disease and violations also exacerbate the impact of HIV on positive MSM.

The discussion during this session identified some of most significant features of MSM’s vulnerability to HIV, together with how some programmers are trying to protect and promote the rights and interests of MSM in support of HIV prevention and impact mitigation. It also tried to situate these efforts in a variety of contexts to demonstrate that different types of work can and is being undertaken in both supportive and hostile political and social environments.

Robert Carr’s presentation, ‘From Breakdown to Breakthrough’ looked at some of the challenges and positive developments associated with rights based programming for men who have sex with men in the Caribbean with a focus on both Jamaica and the Eastern Caribbean.

Cary Alan Johnson of the International Gay and Lesbian Human Rights Commission provided a general overview of some of the key human rights issues facing sexual minorities and how they relate to HIV prevention and impact mitigation efforts.

Significant policy and programming developments among funders

The discussion during this session identified some of policy and funding implications arising out of the day for funders and how they related to significant policy developments occurring among funders.

The discussion included a presentation by Erik Wagberg a consultant with Swedish Sida who co-authored Sexual Orientation and Gender Identity Issues in Development. The report is a study of Swedish policy and administration of Lesbian, Gay, Bisexual and Transgender issues in international development cooperation. A copy of the Sida report is available by clicking here.

Other resources

A range of other resources were cited over the course of the meeting or made available on the day including:

Male Sexuality, Diversity and Culture: Implications for HIV Prevention and Care by Dr Carol Jenkins for UNAIDS.

For more information about the Frontiers Prevention Project click here.