Funding and Other Trends Imperil Global Response to HIV/AIDS
amfAR Reports Find Men Who Have Sex With Men Especially Are at Risk
For Immediate Release
Media Contact: Cub Barrett, Program Communications Manager
Int’l Cell: (646) 387-4603
VIENNA and NEW YORK, July 16, 2010—On the eve of the 18th International AIDS Conference, amfAR, The Foundation for AIDS Research, issued a series of reports warning that a confluence of decreased funding and other trends is jeopardizing the global response to the HIV/AIDS epidemic, especially in populations of men who have sex with men (MSM) and others at greatest risk of infection.
Faced with the global economic downturn and competing priorities, donors are increasingly turning away from HIV-specific programs and focusing more on broader health systems. At the same time, donors are empowering recipient governments to set HIV priorities. With same-sex sexual behavior criminalized in nearly 80 countries and stigmatized in many more, these well-meaning decisions could contribute to a public health disaster.
“Once again, MSM—and, by extension, other marginalized groups such as injecting drug users, sex workers, and transgendered individuals—are being left behind,” said amfAR CEO Kevin Frost. “These reports make a clear case for investing in programs and services that directly address vulnerable populations and fight stigma and discrimination. By simply reassessing and scaling back their commitments to HIV/AIDS in favor of health systems strengthening, donors are jeopardizing years of hard-fought progress, not to mention countless lives.”
The first of amfAR’s reports, “The Shifting Global Health Landscape: Implications for HIV/AIDS and Vulnerable Populations,” highlights how current funding mechanisms fail to address the needs of vulnerable groups, including MSM and injecting drug users—and how health systems strengthening can reinforce these limitations. In developing countries, MSM are 19 times more likely to be infected with HIV than the general population.
Yet in countries where HIV infections are clustered among vulnerable populations, only 10% of prevention funding is focused on those groups. In countries where national HIV prevalence is high, that funding number is almost zero. Discrimination also plays a role in the funding and services dedicated to MSM: globally, 76 countries, including many with the highest rates of HIV infection, consider same-sex sexual activity a crime.
The above podcast features an interview with Chris Collins, amfAR's vice president and director of public policy, conducted by the Kaiser Foundation during the International AIDS Conference. Collins discusses global funding concerns, the U.S. government's National AIDS Strategy, and more.
The report demonstrates how, unless these factors are addressed, health systems strengthening can dilute already limited funding and sustain systems that discriminate against MSM. This could discourage MSM from going to clinics and affect the care they receive there. The report makes clear that a focus on health systems strengthening can have some benefits for HIV programs by integrating HIV care into related health services such as TB, malaria, and family planning; by reducing stigma around the disease; and by expediting scale-up of treatment. However, increased funding for targeted, HIV-specific programs that address the needs of MSM is an essential component of any effort to address the global epidemic.
“We can and should strengthen health systems, but in doing so we cannot ignore the needs of those at greatest risk for HIV infection,” Frost said. “Because these groups are already marginalized, we must go out of our way to make sure they have access to care. We must create environments that are safe, accessible, and equitable, and we must develop targeted interventions designed specifically for these communities.”
The second report released today, “MSM and the Global HIV/AIDS Epidemic: Assessing PEPFAR and Looking Forward,” underscores the failure of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to meet its own goals for serving vulnerable populations. In 2009, PEPFAR’s new five-year strategy recognized the vulnerability of MSM and highlighted the need to invest in targeted HIV services. Yet among the eight countries examined in the report, the amount of funding dedicated to MSM is indeterminate. Despite $2.2 billion spent on HIV/AIDS interventions in these countries, there is very little country-level information about MSM in general. At the same time, more than half of the 88 countries that have received PEPFAR funding continue to criminalize homosexual behavior—a critical barrier to services.
“All PEPFAR has to do to save the lives of MSM and other vulnerable populations is to live up to its own promises,” said Chris Collins, amfAR’s vice president and director of public policy. “It is terrific to see that PEPFAR has recognized the importance of addressing HIV among these groups. But we need more action. We must ensure governments funded through PEPFAR meet their commitments, promote and fund interventions targeted specifically towards these communities, direct funding to community groups already making a difference on the ground, and recognize and address the social and legal barriers that are undermining our own efforts to fight AIDS.”
Many of those potential solutions are highlighted in amfAR’s third report, “Lessons from the Front Lines: Effective Community-Led Responses to HIV and AIDS Among MSM and Transgender Populations,” which stresses the impact that small community-based programs are having on the HIV epidemic among MSM around the world. (The report was developed in collaboration with the Global Forum on MSM and HIV.) The report demonstrates that these groups have a deep understanding of their communities and have developed innovative and effective programs specifically targeting MSM. In the face of violence and discrimination, they are often the sole providers in their communities.
“The ways to address HIV among MSM are not a mystery,” Frost said. “We have hundreds of examples of small organizations that effectively and efficiently deliver prevention and treatment services. We can and must invest in these organizations and model larger programs off this focused, community-specific approach. It will require that donor governments live up to their commitments to address HIV/AIDS in developing countries. And it will require the political courage to stand up for the health and rights of vulnerable groups instead of forcing them into the shadows.”
amfAR, The Foundation for AIDS Research, is one of the world’s leading nonprofit organizations dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy. Since 1985, amfAR has invested more than $307 million in its programs and has awarded grants to more than 2,000 research teams worldwide.