by Mike Andrew -
SGN Staff Writer
The Office of the U.S. Global AIDS Coordinator (OGAC) has released new guidelines for PEPFAR (the President's Emergency Plan for AIDS Relief), a $48 billion dollar program started by then-President George W. Bush.
While PEPFAR provides needed funding for HIV/AIDS relief programs in 15 African countries, it has been criticized for funneling millions of dollars to church-run organizations promoting abstinence as a prevention strategy.
In Uganda alone, $285 million was spent in 2009 on abstinence education.
At the same time, PEPFAR as conceived by Bush provided no assistance to programs addressing the needs of men who have sex with men (MSM).
PEPFAR has also had to operate under a congressionally mandated pledge that prohibits funding from going to organizations assisting sex workers.
In contrast, the new Technical Guidance on Combination HIV Prevention specifically addresses the MSM population and calls for measures to address human rights, legal barriers, and homophobia in HIV response for MSM.
The new guidelines define a set of six core elements to be used as part of a comprehensive package of HIV prevention services for MSM, including community-based outreach, condom and lubricant distribution, HIV counseling and testing, linkages to care and treatment, targeted information, and screening and treatment for sexually transmitted infections.
The document also includes a number of recommendations for optimizing HIV prevention for MSM, such as ensuring confidentiality, and concludes by enumerating a set of activities that PEPFAR will support through budgets in individual countries.
The new guidelines also emphasize the importance of 'involving MSM' in the planning, implementation, and leadership of HIV prevention efforts for MSM, noting that the strengths and networks of local MSM are an indispensable resource for HIV prevention.
The new PEPFAR guidelines more accurately reflect HIV/AIDS incidence and the actual needs of affected communities.
MSM in the global south are, on average, 19 times more likely to be infected with HIV than the general population, with infection rates among MSM now surpassing 30% in countries like Jamaica and Thailand.
More than half of MSM around the world are without access to life-saving services like HIV education, testing, and treatment.
MSM are considered by national AIDS officials in countries such as Kenya, Uganda, Tanzania, and Zimbabwe to be a 'most at-risk population' because, as same-sex sexual acts are illegal there, no policies or services targeting MSM for HIV interventions are in place.
In some countries, provision of services for MSM populations have been specifically ruled out by governments, whereas in others they are only covertly supported as part of national HIV/AIDS programs.
'We are very happy to see that OGAC has finally issued a guidance document for MSM,' said Dr. George Ayala, executive officer of the Global Forum on MSM & HIV (MSMGF).
Ayala said the MSMGF has been advocating for updated guidelines since 2009, bringing a delegation of MSMGF Steering Committee members from Africa to Washington to discuss the necessity of technical guidance as recently as May 17.
'With the guidance now available, we will be looking closely at its implementation and how MSM prevention programs are funded,' Ayala added.
Ayala was also critical of some aspects of the new guidelines, however, suggesting they don't go far enough in supporting local MSM organizations.
'If PEPFAR is serious about addressing barriers like stigma and criminalization, a clear set of steps must be offered for Country Missions to tackle these difficult challenges,' said Dr. Ayala. 'Any such strategy must include a plan to train front-line service providers and implementers about these issues.'
However, the new document focuses on 'building the capacity' of local MSM organizations rather than explicitly recommending the use of PEPFAR funds to support them, Ayala said.
In many PEPFAR countries, these groups have been the only organizations implementing programs for this population since the epidemic began.
The new guidelines may also face opposition from conservative Republicans in Congress, who could balk at funding MSM programs when they review PEPFAR's budget.
In 2008, Democrats seeking to expand PEPFAR funding had to agree to allocate at least half the PEPFAR budget to treatment of existing cases - as opposed to prevention of future infections, which would have involved distribution of condoms and safer sex education.