Johannesburg - Stigma, discrimination and underfinancing.
These have been found to be the widespread causes in governmental and donor neglect in the fight against HIV among gay men, men who have sex with men (MSM) and transgender people (GMT) in southern Africa.
A report titled “Achieving an Aids-Free Generation for Gay Men and other MSM in Southern Africa” was released by the Foundation for Aids Research and the Centre for Public Health and Human Rights at Johns Hopkins University in the US on Thursday.
It focuses specifically on six countries - Botswana, Malawi, Namibia, Swaziland, Zambia and Zimbabwe - and their financing, as well as the implementation of HIV programmes for gay men, men who have sex with other men and transgender people.
Civil society members in each country were contracted for a period of six to eight months to conduct consultations with people involved in the national HIV response, review funding agreements and national strategies, and report on their findings.
“While the global conversation focuses on novel approaches to HIV treatment and prevention, GMT struggle to obtain the most basic health services,” the report states.
Laws criminalising same-sex sexual practices persist in all these countries despite nearly a decade’s worth of investment in HIV programmes, the report asserts.
Furthermore, widespread homophobia among government officials and religious figures remains a formidable barrier to the implementation of HIV programmes.
In Swaziland, where HIV prevalence is the highest in the world at 26 percent, the Swazi government’s reluctance to address the needs of gay men, MSM and transgender people creates a challenging environment for tracking available HIV programmes.
And in Malawi, where about 910 000 people have HIV, many are unwilling to disclose their sexual orientation for fear of harassment, denial of health care, and arrest.
The report also revealed big gaps in data.
“Large gaps in epidemiological surveillance of MSM persist. By the end of 2011, more than 47 percent of countries had not reported on HIV prevalence in MSM in the previous five years. For this analysis, data was available for only three countries: Malawi, Namibia and Swaziland,” it states.
It found that the top two funders of HIV/Aids programmes globally - the US President’s Emergency Plan for Aids Relief (Pepfar) and the Global Fund to Fight Aids - have policy commitments to addressing the rising HIV epidemic among GMT.
But despite clear policy commitments, the report shows most Pepfar budgets contained no funding for these groups, and only 0.07 percent of all Global Fund resources for HIV were targeted to them.