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GRASSROOTS: The GMT Initiative Blog

Grassroots reports on the work of amfAR-supported research teams and advocates responding to the devastating impact of HIV among gay men, other men who have sex with men, and transgender individuals (collectively, GMT).

GMT and the New “Truths” in HIV Prevention

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Posted by Kent Klindera, November 13, 2012  

In July 2012, coinciding with the XIX International AIDS Conference in Washington, DC, scientific journal The Lancet launched a special issue focused on HIV among men who have sex with men (MSM).  I read this 30-year summary of success and failure with much hope, as it solidified what many researchers and community activists have been saying for the past year—that we can achieve an AIDS-Free Generation among gay men, other men who have sex with men (MSM), and transgender individuals—what we at amfAR collectively refer to as “GMT.”   

You may have noticed over the past few months that amfAR has been using the term “GMT” more often. Now, after five successful years of activity, we have formally re-branded our MSM Initiative to become the GMT Initiative.  Following the lead of our brothers and sisters in Latin America, we made the switch to better capture the diversity of populations served through our initiative and to emphasize the connection between rights-based policy and advocacy and successful service delivery to improve the health and well-being of GMT.  

In addition to the brand change, amfAR has expanded the scope of the initiative, focusing more on larger, systemic changes that are achieved through empowering local communities.

The GMT Initiative will focus on several core areas:

  • Funding and more formally evaluating combination HIV program models that can be scaled up
  • Emphasizing the connection between rights-based advocacy and successful service delivery
  • Supporting targeted advocacy to influence government and donor policies
  • Strengthening the capacity of GMT-led organizations to collaborate with and expand access to appropriate government-funded HIV programs
  • Supporting epidemiological, resource tracking, and other research to advocate for GMT-related health services


As a research-focused foundation, amfAR has made this shift in order to recognize the potential of science-based efforts.  My colleague at The Center for Public Health and Human Rights (CPHHR) at Johns Hopkins, Dr. Stefan Baral, speaks of “truths” that The Lancet studies have indicated must be integrated into the next generation of HIV prevention programming. 

To me, these truths can be summarized as the following:

  1. Behavior Interventions work...BUT NOT ALONE!  As we have seen, interventions that focus on reducing individual HIV/STI-related risk behavior and increasing health-seeking behavior are powerful.  These programs, grounded in behavioral science, led the way to reductions in incidence among GMT in the early years of the HIV epidemic.  However, we have known for years that they are not necessarily effective in reducing HIV incidence for all GMT communities.  We will not achieve an AIDS-Free Generation if we focus solely on behavioral interventions.  We need to combine these strategies with new (and old) biomedical interventions, and address structural issues.  
  1. Biomedical Interventions work!  
  • Test and Treat:  New studies have confirmed that motivating individuals to get tested is still vital.  However, testing needs to be closely linked to treatment and care.  We have learned that lowering ”community viral load” means those GMT who are living with HIV need to know their status and actively seek treatment to lower their infectiousness.  The challenge is to motivate people living with HIV to take action, and to adhere to their medications.  And sexually active GMT need to regularly seek clinical services for STI diagnosis and treatment, as STIs are often a co-factor in the spread of HIV. 
  • Condoms and Lubricant:  An old intervention in our playbook, we need to continue condom promotion and increase access to quality condom-compatible lubricant—especially in the global south.  This includes advocating for lubricant to be part of national strategic plans, as well as creating sustainable channels to supply lubricant to community organizations.    
  • PrEP, Microbicides, Vaccines:  These newer science-based approaches are showing promise.  Pre-exposure prophylaxis (PrEP)—taking HIV medication to prevent an individual from contracting HIV—has already proven effective among GMT populations throughout the world.  Although the roll-out is challenging in many parts of the global south, we need to advocate for an increase in PrEP.  Down the road, we expect to have microbicides and vaccines that are effective as well.   
  1. Structural interventions are needed! The latest epidemiologic studies indicate that homophobia and transphobia play a significant role in increasing GMT individuals’ vulnerability to HIV.  We suspected this before, but now we have scientific models to prove the effects.  

A shortage of comprehensive, culturally competent health services for GMT is attributed to the stigma and discrimination associated with same-sex behavior.  Many GMT do not feel worthy of receiving health services that meet their needs, since they have been treated as second-class citizens by their families, communities, faith traditions, and health care providers.  Added to this victimization are other issues such as racism, classism, and sexism (especially for transgender individuals), which inflate these vulnerabilities.  The Lancet series refers to “political homophobia,” legal and economic frameworks that deny GMT basic human rights, including economic opportunities, which further increases their vulnerability to HIV.   

The structures that inhibit GMT from getting proper health care must be addressed.  We must challenge legal structures that violate human rights and challenge stigma and discrimination in the family, community, and health care setting through the empowerment of GMT community-led organizations. 

  1. Sexual and Romantic Relationships matter! Finally, one study from The Lancet that resonated with me was about relationships, and the importance of increasing GMT individuals’ abilities to communicate about HIV issues.  Notably, discussing one’s HIV status with sexual partners reduces risk.  Other factors that reduce risks include partner negotiation, “sero-sorting” (using condoms and lubricant when having intercourse with someone of another serostatus), and recognition of role reversal (not always being a top or a bottom).  

However, what stands out for me is the recognition that casual partners are associated with an increase in incidence rates, suggesting that the more long-term sexual relationships individuals have, the lower their risk.  I’m not sure that I needed to see the data on this one to know it is true. However, it represents an issue so often discussed among GMT.  So many GMT want boyfriends (or girlfriends), to be loved, and to be in a long-term health romantic relationship.  We need to help GMT individuals develop the skills to find and keep long-term romantic relationships. 

So, please join us in using the more inclusive term “GMT” as we work to achieve an AIDS-Free Generation among gay men, other MSM, and transgender individuals!