Conclusions and Recommendations: Universal Access for MSM to HIV Prevention, Treatment, Care and Support Programs

Ninety-one countries (71%) did not report on access for MSM to HIV prevention programs. Only 10 of 128 countries (7%) were able to report that at least 60% of MSM have access to HIV prevention programs. Some MSM experts note that the calculations of coverage of HIV prevention programs are often overestimated, based either on estimations of MSM population size not performed with scientific rigor or on research studies of time-limited projects as opposed to sustained programmatic interventions.

While these findings on HIV prevention programs for MSM are incomplete, no reporting whatsoever is required in the areas of treatment, care, and support programs for MSM. This absence of data is compounded by a lack of experience in successfully scaling up these programs to ensure universal access to HIV/AIDS prevention, treatment, care, and support programs for men who have sex with men.

Recommendations for Action

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• Countries should urgently scale up access to culturally appropriate, evidence-based HIV prevention, treatment, care, and support programs in consultation with affected populations using proven assessment, response, and monitoring and evaluation tools such as:

  • Rapid Assessment and Response Adaptation Guide on HIV and Men Who Have Sex with Men (WHO)

  • Practical Guidelines for Intensifying HIV Prevention (UNAIDS)

  • Framework for Monitoring and Evaluating HIV Prevention Programs with Most at Risk Populations (UNAIDS)

• Countries should urgently develop indicators for reporting progress in HIV treatment, care, and support programs for MSM and should develop costed work plans for scaling up these programs

• Best practice models and approaches to ensuring universal access to HIV/AIDS prevention, care, treatment and support programs with MSM should be identified, and should include relevant regional, national and local planning, costing, resource mobilization, implementation, monitoring and evaluation strategies.

• International and bilateral donor and technical cooperation agencies should develop strategies and commit adequate human and financial resources to assist countries in their efforts to ensure universal access to HIV treatment, care, and support programs for MSM including adequate technical assistance and support to MSM organizations.

• UNAIDS, in collaboration with key stakeholders, should organize regional consultations on pathways to scaling up access for MSM to HIV/AIDS prevention, care, treatment, and support programs.

MSM and Human Rights

Criminalization of consensual same-sex sexual activity, along with pervasive stigma and discrimination, continue to heavily constrain efforts to ensure or expand access to HIV prevention, treatment, care, and support services for MSM.

Recommendation for Action

• Countries should take steps to decriminalize same-sex sexual behavior and to eliminate the stigma surrounding MSM. They should adopt international human rights guidelines such as:

  • International Guidelines on HIV/AIDS and Human Rights, Office of the United Nations High Commissioner for Human Rights and UNAIDS

  • Yogyakarta Principles: Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity

Country Reporting on MSM and HIV

Almost half (44%) of the countries reviewed failed to submit data on any of the five UNGASS indicators pertaining to HIV/AIDS among MSM. It is safe to assume that in the majority of countries that did not submit data, HIV/AIDS interventions targeting MSM are scant or nonexistent. Among those countries that did supply data, almost half (45%) reported on three or less of the five indicators relevant to MSM.

Recommendation for Action

• Countries should immediately take steps necessary to address the issue of MSM and HIV/AIDS in consultation with affected populations using proven monitoring and evaluation tools such as UNAIDS Framework for Monitoring and Evaluating HIV Prevention Programs with Most at Risk Populations

HIV Testing and Seroprevalence Among MSM

Seventy-seven countries (70%) did not report on HIV testing among MSM. In less than a quarter of the countries that submitted UNGASS reports (21%) did at least 40% of MSM have access to HIV testing. 79 countries (62%) did not report on HIV seroprevalence among MSM. Where information has been gathered and reported, MSM are in all instances disproportionately affected by HIV relative to the general population, in most cases by a wide margin.

Recommendations for Action

• Countries should urgently scale up access for MSM to culturally appropriate voluntary counseling and testing services that are nondiscriminatory and respect confidentiality.

• Countries should take the necessary steps to measure HIV prevalence among MSM in close consultation with affected populations and respecting ethical research practices and confidentiality by applying tools such as the Bio-Behavioral Assessment Surveys (FHI).

Knowledge About HIV and Condom Use Among MSM

Eighty-nine countries (70%) did not report on knowledge of HIV among MSM. Only 20% of the countries that submitted UNGASS reports reported adequate levels of knowledge about HIV among at least 40% of MSM. Sixty-nine countries (54%) did not report on condom use among MSM during their last anal intercourse. Only 27 countries (21%) reported the use of a condom by at least 60% of MSM the last time they had anal intercourse.

Recommendation for Action

• Countries should urgently scale up access for MSM to culturally appropriate information, education and communication activities on condom use. Additionally, much greater efforts should be made to ensure access to condoms and waterbased lubricants.