GRASSROOTS: The GMT Initiative Blog

Posted by Jirair Ratevosian, November 23, 2010

A list of challenges facing those fighting HIV among MSM in Eastern Europe and Central Asia.

There is something electrifying about this gathering of some 100 HIV and LGBT rights leaders, government officials, and regional stakeholders from across 15 countries of Eastern Europe and Central Asia. Many of amfAR’s MSM Initiative grantees are also here in Kiev, including representatives from community-based groups in Armenia, Belarus, Tajikistan, Kazakhstan, Ukraine, and Russia. But the topic is somber: MSM and transgender people in the region are at a dangerously elevated risk of contracting HIV.

Ukraine, which is playing host to this regional consultation, organized by WHO and UNDP, is also host to some of the region’s most alarming trends. According to Natalya Nizova, director of Ukraine’s National AIDS Centre, half of all HIV cases in Ukraine last year were diagnosed among MSM. Although the country was the first post-Soviet state to decriminalize male-male sexual activity (in 1991), HIV among MSM remains “invincible, hard to reach, and hard to control,” said Nizova.

In some of countries in the region, concentrated epidemics of HIV among MSM are spreading to other populations—including women, injecting drug users, and sex workers. The extent of this phenomenon is unknown but WHO data presented today shows that the population of MSM who report having sex with woman ranges from 14 percent in Poland to 45 percent in Russia.

Unbelievably, HIV prevention programs for MSM in the region really only took off ten years ago. Efforts since then have been largely fragmented and have confronted a plethora of barriers, including lack of sufficient data needed to inform their development, human rights violations, and insufficient resources.

While social and political factors vary considerably from one country to the next across the region, many participants here agree that for all countries, significant investments are needed to strengthen the knowledge base and to scale up interventions targeting MSM and transgender people.

Posted by Jirair Ratevosian, November 19, 2010

This week, the Global Fund released a report analyzing funding for HIV activities targeting most-at-risk populations. 

The results are deeply troubling. With an HIV budget of more than U.S.$903 million in Round 8,  the Global Fund allocated a mere 8.8 percent specifically for men who have sex with men (MSM), sex workers, and people who inject drugs. The amount allocated for activities specifically targeting MSM is even more sobering: U.S.$19 million—just 2.1 percent of the total signed HIV budgets.

The Global Fund says that these numbers are likely an underestimate, but many MSM and LGBT community-based groups on the frontlines of the epidemic receive little or no support from multilateral or bilateral donors—let alone governments that support policies fueling stigma, violence, and discrimination.

HIV prevalence among MSM is very high in all part of the world where estimates are available—often significantly higher than general population rates. This is true even in generalized epidemic settings, which makes some of the findings in this report even more worrisome: In 14 countries reporting both generalized and concentrated HIV epidemics, only 7 percent of the Global Fund budget has targeted most-at-risk populations. This figure falls to less than 3 percent when the estimate excludes Thailand, which allocated 75 percent of its Round 8 budget to most-at-risk populations. 

Civil society, however, continues to be the most persistent driving force to address HIV among MSM and protect human rights. With a deep understanding of their communities, grassroots organizations like those supported by amfAR’s MSM Initiative are leading efforts to develop and implement innovative programs that effectively target MSM, even as they navigate adverse social, political, and legal climes.

These Global Fund findings come as no surprise. The numbers are consistent with a series of reports released by amfAR this past July analyzing the failure of the global response to reach MSM and others populations at greatest risk of infection. Together, these reports underscore the need for governments and donors to get serious about increasing long-term investment in these populations. The Global Fund and PEPFAR must recognize the need for significantly increased, sustained, multi-year funding commitments that provide project-specific resources, as well as core support for operations and organizational development for community-based initiatives.

The Global Fund should be commended for the transparency and accountability of its work with most-at-risk populations. But new resources will be required at a time when HIV programs are facing major financial pressures. Research is also needed to develop a better understanding of funding disbursements and what is happening on the ground. Much more effort lies ahead, but prospects to change the trajectory of the pandemic have never looked better.