Introduction

Around the world, men who have sex with men (MSM)¹ are facing an HIV/AIDS crisis of enormous proportions. Available epidemiological data depict rates of infection that are universally higher than the general population and in many cases substantially so. But how severe is the situation exactly and why is it that, more than 25 years into the epidemic, HIV infection rates among MSM remain shockingly high and may even be worsening?

The first UN General Assembly Special Session (UNGASS) on HIV/AIDS in 2001 culminated in the unanimous adoption by UN member states of a landmark Declaration of Commitment on HIV/AIDS. The Declaration paved the way for a subsequent commitment in 2006 to achieve universal access to HIV/AIDS programs by 2010. For MSM, universal access is a matter of the utmost urgency. The next question, then, is how far have we traveled? And how much further do we still have to go?

amfAR set out to address these questions by compiling in a single document the best available data on the extent of the global HIV/AIDS epidemic among MSM, on the human rights factors that influence and exacerbate the epidemic, and on worldwide progress toward preventing the further spread of HIV infection among MSM.

The UNGASS commitment of 2006 required member states to report periodically on their progress against a series of specific indicators. A total of 23 indicators were identified for the 2008 reports and five of them were directly relevant to MSM:

• What percentage of MSM are living with HIV?

• What percentage of MSM have taken an HIV test in the last year?

• What percentage of MSM know how to prevent HIV?

• What percentage of MSM used a condom the last time they had sex?

• What percentage of MSM are being reached by HIV prevention programs?

Countries made a heroic effort to generate and submit their country progress reports, in many cases through intense consultations and participatory workshops to ensure the inclusion of the most up-to-date and detailed information. In March 2008, 147 out of 192 countries submitted reports to the UN. This response represents the most concerted worldwide effort to document progress against HIV/AIDS to date: 100% of Caribbean nations, 95% of Eastern Europe and Central Asia, 95% of Latin America, and 94% of sub-Saharan African countries filed reports. Indeed, the UN Secretary General described the country reports as "the most comprehensive body of evidence ever assembled regarding the response to HIV in low-, middle- and high-income countries."

But these reports reveal a disturbing lack of attention to MSM. To assess the extent of global progress on HIV/AIDS among MSM, amfAR reviewed the five indicators relevant to MSM for the 128 UNGASS country progress reports for Latin America, the Caribbean, Eastern Europe, Asia and the Pacific, the Middle East, and Africa. The review, detailed in this publication, shows that many countries have made little effort and minimal progress in preventing the spread of HIV among MSM. Indeed, when paired with the epidemiological and human rights reports, the review of country progress reports paints a dismal picture of denial, indifference, and inaction.

But there are some reasons to be hopeful. Certain nations are beginning to take a stand against the rampant discrimination against MSM that prevails in many countries. And the solutions already exist. What is required is the foresight to understand that neglect of MSM will serve only to undermine the global effort to fight HIV/AIDS among all populations, and the political will to cast prejudice aside and scale up the HIV prevention, treatment, care, and support programs that are so urgently needed.

1. The term men who have sex with men (MSM) is a cumbersome and somewhat contentious term that is used to encompass all who engage in male-male sexual behavior. It includes gay men, bisexual men, MSM who do not identify as gay or bisexual, male sex workers, transgendered people, and a range of culture- and country-specific populations of MSM.