I thought I would post a letter that I would write to Hillary Clinton about her recent remarks at NIH this week, the video of which can be found below. I love the woman, but I am sad about her lack of any reference to MSM. The speech was discussing how the US can lead the world in establishing an “AIDS Free generation”. Sorry Secretary Clinton, but in most areas, even in areas with generalized epidemics like subSaharan Africa, MSM transmission and infection rates are on the rise, and an AIDS free generation won’t magically appear without targeted aid and prevention efforts directed towards these groups.
Dear Secretary Clinton,
While I applaud the United States’ efforts in leading the world to fight AIDS, and its strong commitment to ensuring an AIDS free generation through programs such as PEPFAR, I am extremely disappointed by your complete lack of any mention of men who have sex with men in your global prevention strategies.
You mention microbicides which “give women the power to protect themselves.” Yes this is true, but there is also a robust (and largely underfunded and underpublicized) movement to develop a rectal microbicide to give MSM (and heterosexuals) the opportunity to protect themselves. You talk about “combination prevention” that the US will lead including: ending mother to child transmission, expanding voluntary medical male circumcision and scaling up medical treatment for people living with HIV/AIDS. There is no mention in this three pronged “AIDS Free generation plan” of addressing the prevention needs among vulnerable communities such as men who have sex with men, intravenous drug users and transgendered populations. While I applaud the State Department’s efforts, targeting male circumcision and mother to child transmission, while not addressing prevention among men who have sex with men will not lead to an AIDS Free Generation.
Dr. Frits van Griesvan of the CDC, in his article , along with numerous other studies, detail the balooning rates of HIV among men who have sex with men with India, China, and several areas of Latin America and subSaharan Africa. PEPFAR II, has a specific directive targeting HIV prevention at MSM, and it is time for our government and your department to take action and put this plan into action – studies show that current prevention efforts only reach 10% of MSM around the world who would benefit from prevention education and programs. You discuss a story about the Tanzanian mother infected with HIV concerned about passing it to her child. What about the man in Botswana who has anal intercourse with another man without condoms because homosexuality is illegal in his country, and he has no education on how to maintain his health since the subject is never spoken about? You briefly mention the presence of such laws making homosexuality illegal, but never further discuss this topic in the 30 minute speech.
You do mention “embracing treatment as prevention.” While this prong is not directed toward MSM specifically, it obviously can help MSM currently living with HIV and prevent the spread of the virus among their communities. For this I applaud you. However, be aware that many MSM who present at clinic for such treatment will be stigmatized due to their sexual orientation if it is disclosed, and may not feel comfortable obtaining treatment at traditional treatment clinics due to barriers to care that exist for MSM populations including providers who are homophobic, stigma against MSM and laws criminalizing homosexuality.
Full text of article available at link below –