Sexual minorities, including men who have sex with men (MSM) and transgender people, face high rates of
HIV prevalence. However, many lack basic human rights protections and access to HIV services that would
help reduce HIV incidence and meet the 2006 commitment of member states to “ensure the full enjoyment of
all human rights and fundamental freedoms by people living with HIV and members of vulnerable groups.”
Key Messages
▪
Criminalization of homosexual acts and social and economic marginalization of sexual minorities cause
social dislocation, fuel human rights abuses, and increase the risk for HIV transmission for this vulnerable
group.
▪
Even in countries without legal prohibitions against same-sex behaviour, widespread stigma and discrimination
often prevent MSM and transgender individuals from seeking or receiving essential HIV prevention,
care and treatment services.
▪
Because many countries have not established appropriate health messages, support, and services for
sexual minorities, HIV infection rates and prevalence remain disproportionately high among MSM and
transgender individuals in both developed and developing countries, undermining progress on universal
access targets.
Background: Myths vs. Realities – The Road to Universal Access
There is strong evidence linking the social oppression of sexual minorities with increased risk for HIV.
▪
Although MSM are recognized as a group that is at elevated risk for HIV, the reality is that only 1 in 20
MSM worldwide has access to HIV prevention, care or treatment. Even less is known about the impact of
HIV and access to HIV services for transgender individuals.
▪
A recent meta-analysis of HIV studies of MSM in low and middle-income countries revealed substantially
higher rates of HIV among this population group than in the general population in both generalized and
concentrated epidemics, and suggests that this population is both understudied and underserved in the
planning and delivery of HIV services.
▪
MSM and transgender people are inadequately represented in country and regional level planning processes,
their needs are often explicitly excluded in HIV priority-setting, and the result is a widening and
unacceptable disparity in resources devoted to programs targeting sexual minorities.
▪
MSM remains the group most affected by HIV in many regions. In 2000, HIV prevalence among MSM in
Latin America was estimated at 25 percent. In Asia, Australia, Africa, the Caribbean, Europe, and North
America, HIV prevalence studies yield higher than average estimates that range between 7 percent and
46 percent.
▪
In 2008, MSM face arrest in 85 countries if they openly state their sexual orientation; the penalties for
which can include lengthy imprisonment or death sentences. In Central American countries, there is
widespread harassment by police and discrimination by healthcare providers. Sexual minorities are also
persecuted in India, China, Egypt and other countries in the Middle East. Two-thirds of African countries
prohibit male-to-male sex.
▪
Current HIV prevention efforts are not effective in reaching MSM. Research in Kenya and Ghana has
shown that MSM in Africa do not consider themselves at risk of HIV, because prevention messages focus
solely on heterosexual couples. Even in countries where homosexuality is not illegal, social oppression
can be extremely harmful, particularly for sexual minorities who also belong to indigenous, migrant or
ethnic minority groups.
The Role of Civil Society
Civil society organizations are often uniquely positioned to reach, serve, and advocate on behalf of sexual minority
communities. They should be directly involved in working with national authorities and UN agencies in
establishing priorities and programmes to address the needs of MSM and transgender individuals.
For more information, contact: Media contact:
Kieran Daly:
+ 1 416 275 8413 •
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Callie Long: +1 647 267 9813 •
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Recommendations
▪
All member states must decriminalize homosexual acts and establish a legal
and policy environment that protects the human rights of MSM and transgender
people, consistent with the 2001 and 2006 commitments to protect
the human rights of vulnerable groups.
▪
UN agencies must expand their leadership and advocacy with member
states on human rights abuses of sexual minorities.
▪
All organizations engaged in HIV or human rights advocacy should adopt
decriminalization of homosexual acts as part of their advocacy agenda.
▪
National coordinating authorities must ensure that HIV services address the
needs of MSM and other sexual minorities and that funds dedicated to these
services at the national level are proportional to the impact of HIV on the
population in that country.
▪
National AIDS authorities should ensure MSM and transgender people are
involved in decision making processes on HIV at the national level, and that
programme spending is monitored to ensure they are included in national
HIV surveillance and independent epidemiological, behavioural, and social
research studies.
▪
Donors must require implementing agencies to expand access to HIV prevention,
treatment and care for sexual minorities, and incorporate it into
accountability mechanisms.
This paper was prepared under the auspices of the Civil Society Task Force for the 2008 UN High Level Meeting on AIDS.
Background
The Proposed Global Fund Debt Conversion Mechanism - Debt2Health
RESULTS Educational Fund, March 2007
Background
The Global Fund to Fight AIDS, TB and Malaria (GFATM)’s Innovative Financing Unit is working to develop a debt conversion mechanism that would allow creditor countries to cancel a portion of beneficiaries’ debt which would then be converted and invested (at an agreed discount) by the beneficiary in a GFATM-approved program.
Once a deal is reached, the beneficiary country can factor in this support into its program proposals submitted (through the Country Coordinating Mechanism) to the Global Fund. Proposals can be submitted through the Phase 2 renewal process, a regular round or new rolling continuation channel (RCC), rather than through a separate or new process, and is subject to the same approval process through the Technical Review Panel and Global Fund Board.
The benefits for creditors include a resolution of old loans and increased contribution to the Global Fund, and beneficiaries receive partial debt relief allowing for an increase in health spending and country ownership. Challenges could include the risks that debtors renege on their agreements, donors could reduce their other contributions to the Global Fund and Official Development Assistance, reluctance of some creditors, effective monitoring and oversight of agreement deal and implementation, etc.
The GFATM is working with UNAIDS, the German government and civil society organizations, Make Poverty History and Global AIDS Alliance on a pilot project with support from The Bill & Melinda Gates Foundation. The pilot project would be focused in four beneficiary countries, Indonesia, Kenya, Pakistan and Peru, with possible expansion to additional countries.
Status of “Debt2Health”
The GFATM Board will be deciding on this scheme at their upcoming meeting in April in Geneva.
Germany has committed to providing $200 million EUR to Indonesia over five years and will formally begin negotiations with the Indonesian government in March 2007. A deal is expected to be announced in September 2007 at a conference in Berlin with implementation beginning in 2008.
Italy has also signaled its interest, and the Debt2Health partnership will be reaching out to other potential creditors.
Potential Opportunity for Kenya
Kenya, given its non-HIPC status and high-burden of disease, is included in the pilot phase of this project. A Debt2Health deal for Kenya could yield additional resources for GFATM grants, with significant impact for TB and TB-HIV. A Debt2Health team is hoping to visit Kenya in the next few months to explore this opportunity.
Sources: The Global Fund to Fight AIDS, TB and Malaria, Global AIDS Alliance
Debt2health Background
The Proposed Global Fund Debt Conversion Mechanism - Debt2Health
RESULTS Educational Fund, March 2007
Background
The Global Fund to Fight AIDS, TB and Malaria (GFATM)’s Innovative Financing Unit is working to develop a debt conversion mechanism that would allow creditor countries to cancel a portion of beneficiaries’ debt which would then be converted and invested (at an agreed discount) by the beneficiary in a GFATM-approved program.
Once a deal is reached, the beneficiary country can factor in this support into its program proposals submitted (through the Country Coordinating Mechanism) to the Global Fund. Proposals can be submitted through the Phase 2 renewal process, a regular round or new rolling continuation channel (RCC), rather than through a separate or new process, and is subject to the same approval process through the Technical Review Panel and Global Fund Board.
The benefits for creditors include a resolution of old loans and increased contribution to the Global Fund, and beneficiaries receive partial debt relief allowing for an increase in health spending and country ownership. Challenges could include the risks that debtors renege on their agreements, donors could reduce their other contributions to the Global Fund and Official Development Assistance, reluctance of some creditors, effective monitoring and oversight of agreement deal and implementation, etc.
The GFATM is working with UNAIDS, the German government and civil society organizations, Make Poverty History and Global AIDS Alliance on a pilot project with support from The Bill & Melinda Gates Foundation. The pilot project would be focused in four beneficiary countries, Indonesia, Kenya, Pakistan and Peru, with possible expansion to additional countries.
Status of “Debt2Health”
The GFATM Board will be deciding on this scheme at their upcoming meeting in April in Geneva.
Germany has committed to providing $200 million EUR to Indonesia over five years and will formally begin negotiations with the Indonesian government in March 2007. A deal is expected to be announced in September 2007 at a conference in Berlin with implementation beginning in 2008.
Italy has also signaled its interest, and the Debt2Health partnership will be reaching out to other potential creditors.
Potential Opportunity for Kenya
Kenya, given its non-HIPC status and high-burden of disease, is included in the pilot phase of this project. A Debt2Health deal for Kenya could yield additional resources for GFATM grants, with significant impact for TB and TB-HIV. A Debt2Health team is hoping to visit Kenya in the next few months to explore this opportunity.
Sources: The Global Fund to Fight AIDS, TB and Malaria, Global AIDS Alliance
