Achieving Universal Access for Men Who Have Sex With Men and Transgender People Progress Report of the Joint United Nations Programme on HIV/AIDS Dr Mandeep Dhaliwal, UNDP Report to the 26th Meeting of the Programme Coordinating Board Geneva – June 2010

Background (1 of 2) Available data shows that men who have sex with men and transgender people exist everywhere in the world – in both generalized and concentrated epidemics. In low and middle-income countries, men who have sex with men are 19 times more likely to be infected with HIV than the general population. In every region of the world, men who have sex with men and transgender people are experiencing extremely high HIV incidence and prevalence. Globally 25 – 86% of men who have sex with men ever had heterosexual sex during their lifetime. Given the fluidity of social and sexual networks, reducing transmission in men who have sex with men and transgender people is critical in addressing HIV in the broader population. The Global HIV Prevention Working Group estimates that HIV prevention services reach only 9% of MSM worldwide. Men who have sex with men and transgender people are in urgent need of HIV prevention, treatment and care services. Evidence from across the globe shows that stigma, discrimination, homophobia and transphobia limit the uptake of existing HIV services. There is also evidence that enabling environments can increase uptake and access to HIV services.

Background (2 of 2) The UNAIDS Outcome Framework: We can empower men who have sex with men, sex workers, and transgender people to protect themselves from HIV infection and to fully access antiretroviral therapy, by ensuring that they are empowered to both access and deliver comprehensive and appropriate packages of HIV prevention, treatment, care and support services, and by ensuring that law enforcement agencies and the judicial system protect their rights.”

UNAIDS Framework: Universal Access for Men who have Sex with Men and Transgender People May 2009

UNAIDS Action Framework: Universal Access for MSM & Transgender People Shared goals - to support Member States to: Improve human rights situation Strengthen and expand evidence base Improve and expand program and policy responses Shared responsibilities across complementary mandates: UNDP supports within context of gender, human rights, and human development; UNAIDS Secretariat provides strategic information and advocacy; UNFPA supports on sex work; UNODC supports on drug use and prisons; UNICEF supports on young people; UNESCO supports on HIV responses in the educational sector; WHO supports on health sector responses; ILO supports on HIV responses in the workplace; and the World Bank supports country capacity at all levels.

The Pillars of our Action Framework Promoting human rights Strengthening capacity for better responses Building the evidence base

Promoting human rights The Economic and Social Commission for Asia and the Pacific noted with particular concern “the high prevalence of HIV among key affected populations, including sex workers, injecting drug users and men who have sex with men, as well as the legal and policy barriers that impede progress in developing and implementing effective ways of responding to HIV and related risks among them”. The African Union’s Commission on Human and People’s Rights passed a resolution to establish a Committee on the protection of the rights of PLHIV and those most at risk, vulnerable and affected by HIV. The mandate included the recommendation to .... integrate a gender perspective and give special attention to persons belonging to vulnerable groups, including women, children, sex workers, migrants, men having sex with men, intravenous drugs users and prisoners; Organization of American States passed a resolution …. “to condemn acts of violence and human rights violations committed against persons because of their sexual orientation and gender identity; and to urge states to investigate these acts and violations and to ensure that their perpetrators are brought to justice.”

Promoting human rights    In India, UNAIDS has long supported country capacity to improve and expand HIV responses related to key populations, with recent accomplishments including a 2009 publication “Documenting the Growth of Community Action among Sexual Minority Groups”, and the first-ever national consultation on transgender people and HIV. The Delhi High Court read down IPC Section 377 which criminalized consensual adult same sex acts. The National AIDS Control Programme supported the challenge and now UNAIDS is supporting community mobilization around the judgment.   El Salvador has abolished discrimination based on sexual orientation and gender identity in the public sector. In Latin America and the Caribbean, UNAIDS Cosponsors have worked together to support country follow-up on the August 2008 Mexico Declaration on “Prevention through Education”, supporting several meetings and documents to strengthen comprehensive sexual health education and services. In Ukraine, civil society organisations worked with the Ukrainian government and UNAIDS support to initiate pilot HIV interventions, conduct population research, support anti-discrimination measures, and support networks of legal experts to support human rights interventions related to HIV among MSM.

Building the evidence In Argentina, a research study conducted in 14 localities has documented factors in HIV vulnerability and barriers to health for men who have sex with men. In Belarus, a new national evaluation of HIV prevention interventions related to men who have sex with men has identified key areas for improvement of HIV programming and documentation of outcomes.   In Burkina Faso, to build the information base about health and rights needs among MSM, a behavioural study was approved by the government and launched in April 2010 to map MSM networks and opinion leaders in Ouagadougou and Bobo-Dioulasso. The study reached out to more than 300 men, gathering baseline demographics and information about HIV risk reduction practices, and examineing how homophobia impacts access to services. In Senegal, Senegalese researchers have documented the impact of an early 2008 period of negative media and police actions on access to HIV and health services.

Building the evidence In Fiji, new research is underway to understand and map networks of MSM, their HIV-related knowledge, attitudes, practices, and behaviours, potential entry points for HIV interventions, and indicators for monitoring and evaluation, all toward developing a comprehensive HIV strategy with recommended health and rights interventions. In the Philippines, a Knowledge, Attitude, and Practices (KAP) study in four locations and qualitative analysis of 2009 national IHBSS data are helping to better define the health profile and practices of MSM and transgender people.    In Tajikistan, a national assessment of MSM social contexts, social networks, sexual networks, and HIV risks has contributed to the creation of the first-ever dedicated legal support centre for men who have sex with men, providing more than 860 men with a range of services and peer support.

Supporting capacity and partnership In eight countries of South Asia, a coalition led by Naz Foundation International and PSI-Nepal has secured new Global Fund funding for policy work, data collection and communication, and leadership and advocacy for HIV programming for men who have sex with men and transgender people. In the Caribbean, the organising, evidence, and advocacy from organisations such as COIN and the Caribbean Vulnerable Communities Coalition helped PANCAP to secure new Global Fund funding for addressing HIV among key populations, including men who have sex with men and transgender people.    In Papua New Guinea, building from an in-depth and comprehensive analysis of legal barriers to effective HIV responses, new trainings will support leadership to advocate for legal environments that support effective HIV interventions by and for men who have sex with men and sex workers. In countries as diverse as Cambodia, Lebanon, Lesotho, Panama, Peru, Philippines, and Ukraine, UNAIDS is a partner to community leaders and advocates in their informed and effective advocacy and direct provision of HIV and health services for men who have sex with men and transgender people.  

Supporting capacity and partnership At global, regional and country levels: Support for the roll-out of the Global Fund Sexual Orientation and Gender Identities Strategy in Rounds 9 and 10. Support for a global technical meeting on HIV prevention among most-at-risk adolescents and facilitation of an Interagency Working Group on Most-at-Risk Young People. Production of an International Technical Guidance on Sexuality Education, which includes recognition of the need for sexuality education to be inclusive of sexual diversity and to address homophobia. Updating of the WHO Guidance on Priority Interventions: HIV/AIDS Prevention, Treatment, and Care in the Health Sector. Updating Integrated Management of Adolescent and Adult Illness (IMAI) District Clinician Manual and Acute Care Guidelines.

Let us act now with open eyes and open minds “Our challenge is clear … our commitment to reach universal access to HIV prevention, treatment, care and support. In many countries, legal frameworks institutionalize discrimination against groups most at risk. Yet discrimination against sex workers, drug users and men who have sex with men only fuels the epidemic and prevents cost- effective interventions. We must ensure that AIDS responses are based on evidence, not ideology, and reach those most in need and most affected. Let us uphold the human rights of all people living with HIV, people at risk of infection, and children and families affected by the epidemic. Let us, especially at this time of economic crisis, use the AIDS response to generate progress towards the Millennium Development Goals. Most of all, let us act now.” Ban Ki-moon, Secretary-General of the United Nations December 2009