Guidance must be followed with clear steps toward implementation and accountability
OAKLAND, Calif., May 19, 2011 /PRNewswire-USNewswire/ -- The Global Forum on MSM & HIV (MSMGF) is encouraged by the release of new Technical Guidance on Combination HIV Prevention for men who have sex with men (MSM) from the Office of the U.S. Global AIDS Coordinator (OGAC). Designed to be used by Country Missions executing the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the guidance document shows strong leadership in recognizing that human rights, legal barriers and homophobia must be addressed as part of an effective HIV response for MSM. Following the release of the guidance, OGAC, which administers PEPFAR, must now clarify how it intends to ensure that Country Missions are held accountable for the proper implementation of these recommendations.
The PEPFAR MSM guidance comes at a time when MSM in low- and middle-income countries are on average 19 times more likely to be infected with HIV than the general population, with infection rates among MSM now surpassing 30% in countries like Jamaica and Thailand. With a budget of $48 billion over the next five years to support HIV programming in low- and middle-income countries, PEPFAR offers an enormously powerful tool to address this worsening global crisis.
"We are very happy to see that OGAC has finally issued a guidance document for MSM," said Dr. George Ayala, Executive Officer of the MSMGF. "We have been advocating for the development of technical guidance since 2009, bringing a delegation of MSMGF Steering Committee members from Africa to Washington to discuss the necessity of technical guidance as recently as last Tuesday. With the guidance now available, we will be looking closely at its implementation and how MSM prevention programs are funded."
Released earlier this morning with no formal announcement, the guidance defines a set of six core elements to be used as part of a comprehensive package of HIV prevention services for MSM, including community-based outreach, condom and lubricant distribution, HIV counseling and testing, linkages to care and treatment, targeted information, and screening and treatment for sexually transmitted infections. The document also includes a number of recommendations for optimizing HIV prevention for MSM, such as ensuring confidentiality, and concludes by enumerating a set of activities that PEPFAR will support through country budgets.
While the document is quite clear on its recommendations for essential interventions, the guidance leaves vague a number of elements that are crucial to the document's success.
The guidance rightly highlights the importance of addressing key barriers like stigma, discrimination, human rights abuses and criminalization of same-sex activity, but it offers no specific recommendations on how to do so. These factors have undermined HIV services for MSM since the beginning of the epidemic, leaving more than half of MSM around the world without access life-saving services like HIV education, testing and treatment.
"If PEPFAR is serious about addressing barriers like stigma and criminalization, a clear set of steps must be offered for Country Missions to tackle these difficult challenges," said Dr. Ayala. "Any such strategy must include a plan to train front-line service providers and implementers about these issues."
The guidance also emphasizes the importance of "involving MSM" in the planning, implementation and leadership of HIV prevention efforts for MSM, noting that the strengths and networks of local MSM are an indispensible resource for HIV prevention. However, the document focuses on "building the capacity" of local MSM organizations rather than explicitly recommending the use of PEPFAR funds to support them. In many PEPFAR countries, these groups have been the only organizations implementing programs for this population since the epidemic began. They have built an institutional memory and community presence that constitute two of our most powerful tools for addressing the epidemic among MSM. MSM-led community-based organizations must be treated as full partners and they must be funded as such.
With no formal statement on the guidance from OGAC, important questions remain unanswered about mechanisms for ensuring the proper implementation of its MSM guidance. While the document offers a list of MSM-related activities that countries can use PEPFAR funding to support, it seems to give Country Missions the option to choose whether or not to initiate them. There is no mention of any system to hold Country Missions accountable for implementing MSM programs, nor is there any indication of efforts to create an MSM funding pool to support the creation of MSM programs. The guidance contains no plan to track MSM funding or program effectiveness. MSM are highly stigmatized in the vast majority of PEPFAR countries, and the staff of many Country Missions may simply decide to ignore the population. The United States government must make clear how it will ensure that MSM in PEPFAR countries get the services they need.
OGAC's efforts to produce technical guidance on HIV prevention for MSM represent an extremely important step in the fight against HIV among one of the world's most affected populations. With proper execution, the new MSM guidance has the potential to make a powerful impact on the epidemic among MSM across the globe. However, many advocates around the world are concerned that a "quiet" release of the technical guidance sends the wrong message to country missions and implementers. With so much at stake, we cannot afford to leave implementation to chance. OGAC must issue a formal announcement to all PEPFAR stakeholders that this guidance has been released, and it must take clear and immediate steps to ensure that the guidance is implemented and resourced appropriately.
The Global Forum on MSM & HIV (MSMGF) is an expanding network of AIDS organizations, MSM networks, and advocates committed to ensuring robust coverage of and equitable access to effective HIV prevention, care, treatment, and support services tailored to the needs of gay men and other MSM. Guided by a Steering Committee of 20 members from 18 countries situated mainly in the Global South, and with administrative and fiscal support from AIDS Project Los Angeles (APLA), the MSMGF works to promote MSM health and human rights worldwide through advocacy, information exchange, knowledge production, networking, and capacity building.
SOURCE The Global Forum on MSM & HIV (MSMGF)