Let me start by thanking and by congratulating George Ayala, the Forum co-chairs, and everyone else involved in the Global Forum on MSM & HIV. This is a timely and important and well-run meeting.

As Robert just mentioned in his introduction, fifteen years ago, in late 1993, I became the first Executive Director of a new NGO called the International HIV/AIDS Alliance. Although I was the Alliance's first chief executive, the Alliance was not my idea: it was conceptualized by a group of donors who wanted to make sure that more of their resources reached community level actors involved in AIDS work. Shortly after a selection committee offered me the ED job, they reported back to the donor group. A senior official with the United Kingdom's development assistance agency, reportedly exclaimed in distress: "The last thing that we need is for this new group to be led by a homosexual activist!"

I'm sharing this story because I want to start off my remarks today with a bit of a historical perspective.

We all know that it was gay men and trans people who invented safe sex at the beginning of the 1980s; it was gay men and trans people - and our friends and our care-givers - who set up the home care programmes and the buddy systems and the condom promotion campaigns; who invented Act-Up and AIDS activism. Looking at a history of community responses to AIDS, not just in the global North but around the world, it was gay men who established Abia in Brazil and the Library Foundation in the Philippines, and Colectivo Sol here in DF. In 1988, during my first visit to Zimbabwe, it was Dr Willy Legg - the gay man who ran Harare's City Health department - who invited me to his house to run one of Harare's earliest safer sex workshops.

What happened? With this history of pioneering leadership by gay men and trans people, not to mention the role of our friends and supporters from the lesbian community, how could it be that the AIDS world at large only just seems to have re-discovered yesterday that there is an HIV epidemic amongst MSM and trans people - in the Global South as well as the Global North?

Before we talk too much about the future, it is worthwhile to remember that there is a past. And that past includes a backlash against gay involvement and visibility in HIV work. and not just by David Nabarro. I don’t think that that the senior UK official to whom I just referred was or is particularly homophobic. My guess is that he and people like him objected to my role at the AIDS Alliance for what they themselves considered to be strategic reasons:

• They probably assumed, wrongly, that the overwhelming majority of HIV infections in the South were from heterosexual contacts within exclusively heterosexual networks.
• They probably assumed, correctly, that much of the stigma around AIDS and the reluctance of Southern leaders to respond effectively was rooted in a combination of homophobia and a perception that the AIDS agenda was being imposed on them by gay men from the North.
• They probably were happy to have the odd hard-working homosexual as a member of their own teams, as long as he or she wasn't too visible, not too likely to set back the cause.

The irony of my little anecdote is that I never really saw myself primarily as a homosexual activist, and certainly not as far as my AIDS work was concerned. I was a community activist, because I saw and understood that effective responses to this epidemic needed to be created by and owned by those who were affected. I was a human rights activist, certainly fighting for the rights of sexual minorities, but also for the rights of other marginalized populations suffering discrimination and injustice.

So I got on with my work at the Alliance, supporting community action on AIDS. That included some MSM and trans work, but in retrospect, less than it should have. Many other gay men like me were much the same - working hard on the response to AIDS, in international NGOs, in donor agencies, in UN organizations - but trying hard not to be seen as TOO gay, or to be working TOO much on gay issues.

Fortunately, for every one timid gay bureaucrat, thank goodness that there were at least half a dozen fierce queens out in the trenches. Many of you fierce queens are here in this room today - the tenacious and committed activists who kept up their work on HIV and MSM throughout the lean period of the 1990s, often in the face of hostility and with a dearth of funding: in India, in Senegal, in Mexico, in Ecuador, around the world.

David Wilson yesterday gave a great speech, but he said that he was unaware of good evidence of effective MSM projects in developing countries. Earlier this morning, I sent him some references - about your work. You revealed the diversity of male-male sexualities to which David referred, and you showed that when adequate resources are available, it is possible to reduce HIV infections amongst MSM wherever we may be and whatever language we may use to describe ourselves.

We must also thank those epidemiologists who insisted on gathering data and disseminating data - on beginning to creat the visibility we need so badly.

We must thank those smaller funders - Hivos, AmFAR, Elton John, the Ford Foundation, MacArthur - who never wavered in their support, even as the big boys were focusing elsewhere.

And certainly we must thank all of you who came together to establish and support the Global Forum on MSM and HIV - bringing together the data, the programme models, the anger and the passion into a linked-up movement to push for the attention that this issue requires.

Jorge Saavedra said it yesterday:

• Women led the fight for women's rights; who else but gay men to lead the fight for gay rights, especially in the midst of a health crisis?

Your tenacity, your courage, your successes, and your data: that's what has brought us here. That's why we're suddenly visible again.

So we are at a special moment. I met with Michel Sidibe yesterday afternoon, the Deputy Executive Director of UNAIDS. He told me that the Washington Post thinks that the Mexico conference might be the conference that puts MSM and HIV on the world stage, just as the Durban conference did for the epidemic in Southern Africa.

But remember that backlash fifteen years ago, and remember the challenges that we face ahead:

• We must dramatically increase involvement of and investment in sexual minorities as part of the HIV response. But we must ensure that understandings of concentrated epidemics don't give governments the excuse they need to walk away from AIDS leadership, funding and response.
• We must demand a seat at the table and not be afraid to sashay a little up and down a meeting room. But we need to speak for ourselves - whoever we are - while welcoming other key populations like trans people, people involved in commercial sex, people who inject, heterosexual women affected by AIDS and even heterosexual men affected by AIDS to have their own voices.
• We must link up the fights for LGBT human rights, overall LGBT health, and HIV prevention and treatment for MSM and trans people. But while promoting rights and being honest about substance use and sex work in our communities, we must avoid backlashes in the most oppressive contexts that will increase harassment, violence and killings.

So what is the role of the United Nations in all of this?

Having just drawn a contrast between the timid bureaucrats on the one hand, and the courageous grass-roots activists and front-line epidemiologists on the other, let me begin by acknowledging and thanking those UNAIDS and co-sponsor employees who have worked tirelessly and consistently to make sure that the UN system is part of the solution and not part of the problem. The board of the Global Forum knows how important the support of Michael Bartos has been. The Caribbean Vulnerable Communities coalition has worked closely with Michel DeGroulard and Nestor Arias. PAHO has supported anti-homophobia campaigns. UN officials -many in this room - have simultaneously reached out to MSM communities while trying to bring along hesitant or hostile governments, from China to India to Uganda to Guyana. Peter Piot, as shown again yesterday, has been a consistent advocate and a rare straight man in his ability to demonstrate real emotional solidarity with this cause.

But all of us agree we haven't done enough.

Across the UNAIDS family, we are working hard right now on developing a new strategy on MSM, trans populations and HIV, which we hope to be ready by the UNAIDS PCB in December.

Perhaps just as important, there is UN action beyond the UNAIDS family as well:

• The Office of the High Commissioner for Human Rights is committed to contributing.
• In UNDP's brand new strategic plan, my colleagues in the Democratic Governance programme prioritized the promotion of human rights of marginalized and excluded populations - and they are committed to ensuring that includes sexual minorities.
• As we discussed yesterday, WHO probably hasn't done enough about gay men's health in general, but I make a promise to you today to follow up next week with the Special Programme on Human Reproduction to try to convince them to launch a research effort on these issues in collaboration with UNDP.
• And by far the most important news of all of this is that Ban Ki-Moon, the Secretary General of the UN, has begun to speak out with passion and dedication to the importance of addressing HIV amongst MSM, and he may do so again this week.

Let me get back to the UNAIDS family itself. What will the new UNAIDS strategy look like?

I'm not entirely sure yet, because it is still under development. But let me share some of the main ideas that are emerging.

First, this is not to be a UNDP strategy or a UNAIDS secretariat strategy, but a strategy for all ten co-sponsors and the secretariat together. Certain agencies will be more visible:

• UNDP on law, rights, gender and community involvement;
• WHO on health services and the health system;
• UNESCO on education;
• UNODC on sex between men in prisons and the intersection of IDU and MSM issues;
• the UNAIDS secretariat on overall advocacy and coordination.
• You heard from David Wilson yesterday that the World Bank is committed to a large-scale initiative presenting evidence on MSM and HIV to policy leaders.

But it won't be just half of us:

• I am delighted that UNICEF has made a commitment to addressing young MSM in their youth work;
• UNFPA to look at issues of condom and lube availability and male sex work;
• ILO will address MSM issues in the world of work;
• Even the refugee agency and the world food programme have made a commitment to ensure that they scale up attention to MSM when they can.

Second, we must acknowledge that many of our UN colleagues either don't understand or don't support this drive for an expanded and improved focus on MSM and HIV. So a key priority to be led by UNFPA is an "in reach" programme - systematically reaching across the UN system around the world to help our colleagues understand and support not just work with MSM, but also with other marginalized communities like sex workers and drug users.

Third, we must recognize that we live not just in different cultures, but in different countries. Dr Carlos Caceres in his comment from the floor yesterday referred to a typology of countries that UNDP presented to the UNAIDS co-sponsors in our first working paper on the new strategy:

• There are the most oppressive environments, with active enforcement of anti-homosexual laws, significant risk of state-sponsored violence for visible sexual minorities, and few if any viable community-based groups of MSM or trans people. In these environments, even basic epidemiological research can provoke violence, and we need to work with the utmost care. On the service delivery side, public and private sector health professionals are probably in a better position to safely serve MSM than NGOs in these environments. On policy level, we must work discretely with Attorneys-General or similar officials, as well as doing what we can to shift dominant religious or cultural discourses towards being at least a little less hostile. For example, UNDP Arab States region has been convening Muslim theologians from Egypt and the Gulf to discuss and respond to these issues, who in turn have called for repentance by homosexuals, but they have also condemned violence and called for HIV prevention and health services.
• At the other end of the spectrum, there are countries with strong human rights protection for sexual minorities and significant history of LGBT and MSM organizing that continues to this day. We benefit from visible solidarity from national leaders like Senator Mechai in Thailand, Bishop Tutu in South Africa, and President Lula in Brazil. These countries have no serious policy or legal barriers to effective HIV prevention or treatment work amongst MSM and trans people. Of course, these countries still have homophobia, they still have health professionals who don't know how to take a sexual history of a gay man, they still have families that oppress their queer teenage children. They have other problems as well - notably the emergence or resurgence of serious HIV epidemics amongst new generations of sexually active gay men who don't see HIV as much as a threat as it was, and the challenges that us more mature folks face in maintaining safer behavior decade after decade. The priority in these settings includes using evidence and advocacy to show when governments are under-investing in MSM HIV programmes and why they must allocate more resources, more appropriately; and identifying, involving and serving the most vulnerable sexual minorities, which often include ethnic minorities and trans people. But gay men and other MSM have other work to do in these environments as well. While human rights protection is a pre-condition of strong responses, it is not enough in and of itself. We need to acknowledge that the thriving gay commercial sub-cultures that can flourish along with human rights protection can actually make us more rather than less vulnerable to HIV infection. We need to challenge ourselves to create and support a rejuvenated community and activist response; a new movement for prevention alongside access to treatment.
• Finally, in the middle, there are the large number of countries that mix tolerance and oppression; that often criminalize same-sex relations but with only rare enforcement; that have important LGBT and MSM responses to HIV in some cities, and none at all in others. Here, we need to do all of the above, while simultaneously pushing for law reform, enhanced human rights protection, and wider scale community mobilization.

This typology is of course over-simplistic, as all such typologies must be. In the end, each country, each community, needs its own strategy. We must also work on this issue in every country in the way that makes sense in that particular context. Our first priorities will likely be to focus in particular on half a dozen or so countries - a couple in each category - to test and refine programming and policy approaches that work in each environment, both to achieve immediate results in those countries themselves, but also to serve as demonstration sites for broader efforts to follow.

Fourth, there is also an opportunity and an obligation for more global level action. Many of you know about the Global Task Team on HIV and Travel Restrictions that Craig McLure spoke about yesterday. That Task Team cannot take credit for the impending repeal of US travel restrictions. Like all global efforts, its contribution to actions in specific countries is modest, although not inconsequential. However, the moment has been ripe for action in this area, and results are being achieved. As with travel restrictions in 2008, we think the moment is right for action on LGBT rights, and in particular on repealing legal barriers to health services for sexual minorities at country level. So we are considering the establishment of a new Task Team, with a time-limited mandate to identify and promote key opportunities for law reform in the countries where this is a realistic goal.

A final likely strategic thrust concerns funding. Even before this new strategy is finalized, we must work hard with all of our partners in the next six months to ensure that the Global Fund's Round 9 really starts delivering the money that the Fund has promised to evidence-based MSM and HIV projects. We must also work hard with bilateral funding agencies - including those that are moving more and more towards sector and budget support approaches that are least likely to serve the most marginalized populations.

What is your contribution to shaping this strategy, and the contribution of others?

First, we don't want to repeat global consultations for the sake of saying that we've consulted people. There have been at least half a dozen important agenda-setting meetings on these issues in the last two years already, with the involvement of UNAIDS, Gates, IAS, OSI, the AIDS Alliance and others. There have also been regional and subregional consultations. Our real priority is to take all the recommendations, insights and demands from these meetings and to figure out how the UN system can play its part in ensuring a significantly scaled up and improved response.

Nevertheless, there are some clear gaps that we need to address. I expect that we will have three relatively small meetings over the next six months with stakeholders from different types of countries to test our thinking about country typologies and appropriate response strategies. We need to make a special effort to assure the input of trans communities and others who have been under-represented in many of the MSM meetings to date. And WHO, UNAIDS and UNDP will be holding a special international consultation on the role of the health sector in responding to MSM and HIV in mid-September.

All of this said, our biggest challenge is to really focus in on how the UNAIDS family and the broader UN system can really add the most value to the response to MSM, trans populations and HIV. There are many essential actions for which we simply are not the most effective or appropriate actors. But we have an essential role to play and we must live up to those responsibilities.

At UNDP, as with a number of other co-sponsors, we certainly have budget constraints. The UNAIDS secretariat raises over $200m a year to support UN system HIV work, but that's spread over 10 cosponsors, a large secretariat, and over a hundred UNAIDS country offices. UNDP itself only receives about $7m of that funding. That's not $7m for our new mandate on HIV and MSM - that's $7m of UNAIDS funding for our entire portfolio of HIV work across 200 countries. I am delighted that UNAIDS has just increased our allocation for 2009 by half a million dollars in recognition of new responsibilities on HIV and MSM, and using that money, we will soon be starting recruitment for a leader to work on this issue full-time as part of our global HIV team in New York. I hope some of you will apply for the job!

I am also pleased that my boss - the head of UNDP - is now speaking out publicly about MSM and HIV, and is allocating UNDP core resources to supplement UNAIDS funding. Nevertheless, we must work with you to figure out how to use our moral authority, our legitimacy, and our inter-governmental structure to advance this cause: we're not now and we're not going to become a funder.

It's time for me to wrap up my remarks:

• I've shared with you this morning some thoughts on the tumultuous history of the AIDS world and MSM issues, from our pioneering work in the 1980s, to the lethargy that followed, to the extraordinary opportunity we seem to have before us right now to really improve and scale up this work.
• I've outlined some thoughts-in-progress about strategic directions for the UN system and the UNAIDS family - from new ways of thinking about different types of countries, to potential opportunities for a global task team, to the need to work with funders, to the obligation of all of us to do at least something, everywhere.
• I summarized what we're thinking about consultation and input processes, that will hopefully lead us to a reasonable strategy and road-map by year end, while in the meantime we must keep up our work.

And finally, I spoke about all of you: you've got us this far and you'll keep us going. You'll hold the UN accountable, as you should, but you'll also get on with the real work and not let us hold you back. Thanks once again.