In early August, on the eve of the XVII International AIDS Conference (AIDS 2008), thousands of activists marched through Mexico City to rally against homophobia, stigma and discrimination.

Following a year when UNAIDS announced that HIV rates outside Southern Africa were far lower – and more concentrated – than previously believed, AIDS 2008 focused more than ever before on the HIV-related needs and risk factors of marginalized populations, including men who have sex with men (MSM).

Notably, a pre-conference satellite organized organized by the Global Forum on MSM and HIV attracted more than 450 participants from 82 countries for a two-day series of presentations and meetings about this topic.

Evidence shows that MSM transmission may account for a substantial portion of annual HIV infections in many countries. More than half of all new HIV infections are among MSM in many countries of North America and Western Europe, but MSM also account for a substantial portion of the HIV epidemic in parts of Central and South America, the Caribbean, Eastern Europe, Asia, and the Pacific. “

"Today in Asia, in about every single major city that we have looked at, in China, Malaysia, Indonesia, Thailand, Vietnam, and elsewhere, there are epidemics of HIV among men who have sex with men, epidemics that remind me of what we’ve been seeing here in North America, in Western Europe, in Australia, in the 1980s.” – Peter Piot, Executive Director, UNAIDS

Prevention needs of MSM
Efforts are underway to address the HIV prevention needs of MSM in many places. Sex workers and MSM are now described as beneficiaries of national HIV programmes throughout Latin America and in selected countries of Africa, Asia, Eastern Europe, and the Caribbean. The Global Fund to Fight AIDS, Tuberculosis and Malaria is now exploring ways to better address the vulnerabilities of gender and sexual minorities. Several international donors, including foundations such as amfAR, Hivos, and the Open Society Institute, are stepping forward with increased funding for community programmes working with MSM on HIV. The Office of the High Commissioner on Human Rights has increased its efforts related to sexual orientation and gender identity. And at an international level, UNAIDS and its ten co-sponsors, including UNDP, WHO, UNODC, UNFPA, UNESCO, UNICEF, and ILO, are newly committed to working with national governments at the highest level to support policies and programmes to address HIV among MSM and other sexual minorities.

Behavioural research
Behavioural research on HIV among MSM was a major theme at AIDS 2008. Many researchers are calling for improved national epidemiological and behavioural surveillance to better assess the extent and characteristics of male-to-male sexual behaviour.

“Given the importance of cultural context in prevention strategies, we need not only better bio-behavioural surveillance, but also better ways of eliciting information about sexual behaviour in large-scale surveys, and we need to invest in targeted socio-behavioural studies, including ethnographic studies.” – David Wilson, Senior Monitoring and Evaluation Specialist, Global HIV/AIDS Monitoring and Evaluation Team, World Bank

National HIV expenditures are not matching national epidemics or the prevention or treatment needs of MSM. In countries with low-level or concentrated epidemics, rational funding should focus primarily on HIV interventions for most-at-risk populations, including MSM, sex workers, injection drug users, and other marginalized groups. In July 2008, UNAIDS reported that across all the countries with concentrated epidemics in 2007, the bulk of HIV expenditures were geared to the general population, and only 10 per cent of overall HIV prevention spending targeted most-at-risk populations.

Human rights
Human rights approaches are described as essential to address the stigmatization of homosexuality, and the need to support national leaders to catalyze honest conversations and programming about gender, sex, and sexuality. Laws in more than 85 countries criminalize private consensual sex between persons of the same gender.

In the 2008 Country Progress Reports to UNAIDS, nearly two-thirds (63 per cent) of the countries were reported to have laws, regulations or policies presenting obstacles to effective HIV interventions for most-atrisk populations. More than half of the countries in Africa and Asia lack mechanisms to report, document, and address cases of discrimination against people living with HIV and/or most-at-risk populations.

A chorus of calls are coming from MSM populations in the global south and from international leaders to develop effective policy and programming on these issues. As noted by an African participant at AIDS 2008 in Mexico City: “In all my years of working in AIDS, I have been frightened to be identified as gay and have argued that AIDS is not a gay disease. Now there is this great awakening of interest in existence and needs of MSM. We are hearing all these calls to action. How will we respond?”

Direct link: http://www.iasociety.org/Web/WebContent/File/2008_11_IAS_Newsletter.pdf