Consultations on HIV

Global and Regional Expert Consultations on HIV in MSM and TG Populations

There is an urgent need to address the emerging and re-emerging epidemics of HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender (TG) individuals around the world. This fall Eli Coleman, PhD, participated in two expert consultations to better address focused HIV/AIDS/STI assessment, prevention, and treatment for these groups.

On September 15-17, 2008, after 37 years of the HIV/AIDS epidemic, the World Health Organization (WHO) in collaboration with UNAIDS held its first international expert consultation on HIV among MSM. Coleman and representatives from around the world met in Geneva, Switzerland, to review the epidemiology of the recent trends of sharp increases in infections among MSM and to devise strategies to combat resurgence in the epidemic. As part of a comprehensive effort to ensure universal access to HIV prevention, care, and treatment, all countries and regions should consider it a priority to strengthen strategic information systems and implement interventions for the prevention and treatment of HIV and STIs for MSM and TG individuals.

As follow up to the global meeting in Geneva, the National AIDS Program in Mexico (CENSIDA) and the Pan American Health Organization (the regional office of WHO) hosted an expert consultation in Acapulco, Mexico on November 8-11, 2008. Representatives from the region of the Americas were invited to identify minimal and optimal services of health care, including prevention, for various segments of the MSM and TG population, in various settings, and using multidisciplinary approaches. Coleman was joined at this meeting by University of Minnesota professor Gary Remafedi, MD, MPH. While the emphasis was on HIV/STI prevention and comprehensive care, the agenda was to advance the sexual health and wellbeing for all through individual, community, and structural interventions.  

Resources to address HIV and STIs in MSM, TG, and their partners do not match the burden of disease. Reports from a diverse range of countries and regions highlighted that the prevalence of HIV and other STIs among MSM and TG is high when compared to men in general. Unprotected anal sex is common. Surveys show that some MSM have female partners, many are married, some engage in sex work, and some use drugs. Current HIV surveillance systems and research efforts have not adequately captured biological and behavioral data on these populations. Additionally, national HIV/AIDS and STI prevention interventions programs have not been implemented to sufficient scale.

Risk and vulnerability to infection are reinforced by societal attitudes which deny human rights and the right to health for many MSM and TG. The Secretary General of the United Nations recently called on all countries “to live up to their commitments to enact or enforce legislation outlawing discrimination against people living with HIV and members of vulnerable groups” and further called on countries to “pass laws against homophobia.”

Recommendations outlined at the global consultation in Geneva include:

• Launch massive campaigns to increase awareness of the problem.
• Develop better surveillance to determine the size of the MSM and TG populations.
• To address the urgent need to sensitize health care staff to MSM needs, define and refine a set of priority interventions for both service delivery settings and the broader health sector. This should address safe access to condoms, water-based lubricants, information and education about HIV and STIs through peer outreach, HIV counseling and testing, and STI services.
• Take a broader approach to HIV and STI prevention to include promotion of sexual health including the psycho-social and cultural aspects
• Ensure that prevention materials adequately address the needs of MSM and TG in a non-stigmatizing way.
• Address the needs of sexual partners of MSM and TG (both male and female) in programs and services.
• Address homophobia in health care settings.
• Establish regional meetings to better understand the needs among MSM and TG issues in order to develop more specific regional strategies.