Achieving Universal Access for Men Who Have Sex With Men and Transgender People Progress Report of the Joint United Nations Programme on HIV/AIDS

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Achieving Universal Access for Men Who Have
Sex With Men and Transgender PeopleProgress
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

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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.

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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.

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

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The Pillars of our Action Framework
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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 Unions Commission on Human and
  Peoples 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.

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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.
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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.  
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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.
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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.  
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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.

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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