GUEST BLOG: Uncounted: MSM, Stigma and HIV Financing

Published: April 24, 2012

At a community meeting in Atlanta, Georgia on March 20th, Kevin Fenton, director of Centers for Disease Control & Prevention’s (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention said, “Our own stigma, our own homophobia, cascades down in our funding and allocations…” Dr. Fenton was recognizing a reality in the United States that has become increasingly apparent to health policymakers throughout the world: that despite high prevalence rates of HIV among gay men and other MSM, funding for HIV prevention, treatment and care consistently neglects these populations, often due to stigma and discrimination.

Our own research at amfAR, the Foundation for AIDS Research, in partnership with the Center for Public Health and Human Rights at Johns Hopkins University has drawn similar conclusions. In our report, “Achieving an AIDS-Free Generation for Gay Men and Other MSM”, we found that MSM are neglected and marginalized by national HIV responses throughout the world, even in countries where MSM are a significant proportion of all HIV infections. For example, in Guyana where MSM account for a large majority of infections, funding to this population was as little as .05% of overall HIV funding from the Global Fund (a major donor in that country).

However there is an even larger reality that is more pernicious than budget cuts. In many settings, MSM are completely neglected by epidemiological surveillance, the data that informs funding flows. In countries like Ethiopia and Mozambique, which have received billions of dollars in aid for their HIV response, epidemiological surveillance of HIV deliberately excludes MSM and other key populations leading to a dearth of programming; this despite several reports that have shown significant epidemics among gay men throughout Africa. Our data reflect a simple truth: if MSM aren’t counted, they aren’t funded.

Dr. Fenton’s remarks suggest a reality that our findings support: HIV funding decisions are not made solely on the basis of epidemiological data. Instead, they are impacted by a variety of forces including politics and homophobia, and these forces are having a negative impact on the efficiency and effectiveness of the HIV response.

The news is not all grim, however. Dr. Fenton’s remarks come at a time when the CDC, and the Obama Administration as a whole, is making a calculated effort to prioritize an evidence-based response to HIV, one that includes gay men and MSM in the US and abroad.

In the past year we have seen a historic speech by Secretary Clinton on the interconnectedness of LGBT rights and health, the adoption of a new five-year strategy for the Global Fund which for the first time directly links human rights and health outcomes, the release of US government guidance on HIV programs for MSM, and prioritization by the CDC of HIV programs for gay men of color in the US.
Still, there is a big difference between strong policy and strong practice. Recent news on the persecution of MSM underscores the need for quickly implementing these advances.

This is where private funders come in.

The philanthropic sector is known for its ability to be flexible and innovative, and importantly, for supporting issues and populations that governments are often unable, or unwilling, to fund. In fact, private funders have been at the forefront of efforts to reduce the burden of HIV among MSM for decades. The Levi Strauss Foundation, The MAC AIDS Fund, The Elton John AIDS Foundation, and my own organization, amfAR, have been working with gay men and other MSM for decades, both in the US and internationally. More recently, organizations such as ViiV Healthcare’s Positive Action and the Bill & Melinda Gates Foundation have contributed their resources to MSM and HIV as well.
However, in FCAA’s most recent resource tracking report, only 15% of top international AIDS funders noted they prioritize funding for MSM in 2010. In the US only 28% of funders prioritized MSM – the same population that accounted for 61% of new HIV infections in 2009.

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