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AIDS: PEPFAR seeks to include gay, bi men in programs
by Bob Roehr

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The US government has taken a step to ensure that gay and bisexual men are included in programs supported by the international HIV/AIDS program known as PEPFAR ( President's Emergency Plan for AIDS Relief ) . A technical guidance report on men who have sex with men ( MSM ) was quietly released on May 19.

"Multiple epidemics exist within diverse populations and social networks, including concentrated epidemics within larger generalized epidemics," it said. The guidance cites a systematic review of data from 38 low- and middle-income countries, which "found that MSM were, on average, 19 times more likely to have HIV than the general population."

"The negative effects of homophobia, stigma, and discrimination are obstacles to implementing effective programs for MSM and also put MSM at increased risk for HIV infection and limit the availability of appropriate HIV prevention, care and treatment services for this population"

PEPFAR calls the document "a direct response to the urgent need to strengthen and expand HIV prevention for MSM and their partners and to improve MSM's ability to access HIV care and treatment."

The 21-page document proposes changing laws to decriminalize homosexual activity, tackling social stigma, and building up community-based organizations that have the trust of gay and bisexual men.

Most countries in sub-Saharan Africa still have strong legal and social prohibitions on same sex activity, which are stoutly defended by religious zealots. Uganda has been debating whether to strengthen its antigay laws.

A senior PEPFAR official, speaking on background, said the guidance is part of the agency's second five-year strategic plan, which focuses on most at risk populations based on "incidence surveys and mapping the epidemic at the country level."

The official said the agency has been funding activities focusing on MSM "for some time; we wanted to aggregate and collect it all in one place, and provide technical resources to meet the need" as countries update their HIV/AIDS plans.

The PEPFAR recommendations are compatible with similar guidance developed by UNAIDS and other global agencies. The United Nations General Assembly will hold a special meeting on HIV/AIDS June 8-10.

The nonprofit Global Forum on MSM & HIV was formed to support gay and AIDS groups around the world. It has been advocating for these changes since 2009.

Executive director George Ayala said the document "shows strong leadership in recognizing that human rights, legal barriers, and homophobia must be addressed" as part of an effective response.

But Ayala also criticized it for lack of specificity on how to address those issues, for not specifically earmarking funds to support groups helping MSMs, and for not having measures of accountability when the concerns of MSM are not adequately addressed.

The PEPFAR official acknowledged the criticism and said, "We are in discussion about a lot of the things that George brings up." The agency does not want to impose a boilerplate formula but rather allow each country the flexibility to create plans tailored to "hotspots of new infections."

Country plans for PEPFAR funding will be submitted in October and if a plan does not adequately address the needs of MSM, the official said, "Then the funding doesn't get approved."

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