At XXI International AIDS Conference (AIDS 2016), in a pre-conference meet, some of the major issues got the spotlight: Are countries doing accurate size estimates for MSM and transgender populations? Is the money coming to these countries from global donors reaching the programmes for MSM and transgender or sitting in banks? And what is the connect between criminalizing same-sex behaviour, and size estimates of MSM population and service coverage among them?
Midnight Poonkasetwattana, Executive Director, APCOM |
It is essential for key populations to have access to the full range of HIV prevention options in order to protect themselves and their sexual partners from HIV. This underscores the urgent need for the UNAIDS "90–90–90" targets to be met to realize the full potential of antiretroviral therapy (ART). The 90–90–90 targets are 90% of people knowing their HIV status, 90% of people who know their status accessing antiretroviral treatment and 90% of people on treatment having suppressed viral loads.
Are we counting properly?
Midnight Poonkasetwattana of APCOM questioned the silence on size estimates of MSM populations in Asia Pacific countries. "Countries like China, Malaysia, Indonesia, Myanmar, Thailand and Viet Nam estimates MSM population to be over 5% when prevalence in cities like Bangkok, Hanoi and Jakarta is hiking to 15-20% or even more! Why is that access to condoms still remains very low in our region and 90% of MSM in Asia Pacific do not have access to HIV prevention services that they need because of discriminatory roles. 18 out of 58 countries in our region still criminalize same sex behaviour. Since July 2012 when PrEP was approved by US-FDA and in 2014 WHO recommendations came in for PrEP as an effective HIV prevention tool for MSM, why are we not doing very well in rolling PrEP in Asia Pacific?"
"Spending on HIV prevention in Asia Pacific remains very low, especially for key populations. Funding for HIV prevention among MSM population in Asia Pacific is less than 7% of overall HIV budget. This is unacceptable for a region which is home to over 60% of world’s population and yet the funding does not match the estimated epidemic among MSM and transgender people! Critical components like advocacy, community mobilization and prevention are still getting largely funded by international donors and not domestically" added Midnight.
Criminalizing same sex behaviour leads to lower size estimates, inflated service coverage
"Second finding we had was that countries that did criminalize MSM were doing "better" in terms of HIV testing for MSM - they had reported "higher" coverage of HIV testing among MSM. This seems odd and we looked at countries that criminalized and had reported 90% to 99% HIV testing coverage among MSM (some countries reported even 100%). We found that most of these countries had no MSM size estimates, and tiny samples were used as basis to calculate the service coverage, Algeria for example, had tested 59 men and 57 of these men picked up their test results so Algerian authorities arrived at 96.6% HIV testing coverage among MSM. Hungary tested 388 men and reported a 100% HIV testing coverage. Criminalization can lead to low size estimates, and low denominators result in inflated coverage" added Meg Davis.
Is money locked up in banks or used for saving lives?
Governments of all countries in Asia Pacific, and globally, have committed to achieve Sustainable Development Goals (SDGs) by 2030, one of which is to end AIDS by 2030. If we do not want to fail in achieving SDGs by 2030 or earlier, we need to ensure that size estimates of all key populations are accurate, components of all programmes are well resourced, money is not being locked up or delayed rather getting fully utilized optimally, and HIV rates decline fast enough to keep us on track to meet the promises made for 2030.
Bobby Ramakant, CNS (Citizen News Service)
18 July 2016
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