You can only imagine the impact of the HIV epidemic on men who have sex with men in a country where institutionalized discrimination, bias and abuse is so extreme that sex between men is a felony that can lead to life in prison.
You can only imagine, because in such an environment the data is not there.
That is part of the vicious circle described Monday during a discussion of the findings of Achieving an AIDS-Free Generation for Gay Men and Other MSM in Southern Africa, a report from amfAR, the Foundation for AIDS Research and Johns Hopkins Bloomberg School of Public Health presented Monday at the Open Society Institute in Washington, DC.
With some African countries failing to gather any information for their demographic and health surveys on HIV incidence among men who have sex with men, the cycle begins with a lack of data.
“There’s no data, thus there’s no need to collect data, then there’s no programming,” said Owen Ryan of amfAR, a lead author of the report.
The discussion returned frequently to Zambia, a place that with success in scaling up treatment across the general population of people living with HIV, has seen HIV incidence drop in the last few years. During information gathering for this report however, no data on HIV prevalence among men who have sex with men was available, as shown in the table below.
All six countries examined in the report criminalize homosexual sex, complicating efforts to gather data, with Zambia’s laws, which include a possible penalty of 25 years to life in prison for any person consenting to anal sex, among the harshest. In Zambia recently, HIV treatment advocate Paul Kasonkomona was spent four days in jail after speaking on a television talk show about the impact of Zambia’s antihomosexuality laws, and still faces charges that could lead to prison time.
But the failures in addressing the HIV among gay men, other men who have sex with men and transgender individuals goes beyond criminalization and data, the report shows. Ryan and others at the presentation, which also was attended by representatives of the U.S. Office of the Global AIDS Coordinator, emphasized that the President’s Emergency Plan For AIDS Relief has in recent years stepped up its response to the epidemic among populations whose marginalization heightens their risk. But the report notes that funding for programs to ensure services reach gay men, men who have sex with men and transgender individuals remains a fraction of what is needed, and how the money is to be spent is poorly defined.
Similarly, while the report praises the Global Fund to Fight AIDS, Tuberculosis and Malaria for its “progressive” efforts to promote programming for men who have sex with men, just a fraction of a percent of the one and a half billion dollars provided to the six countries for HIV programs in the last decade has gone to programs for them, and those grants went to only two of the countries. The proportion there is striking as well, With just $85,000 of the $475 billion Zambia has received from the Global Fund for HIV programming aimed at services for men who have sex with men. Data on numbers of gay men, other men who have sex with men and transgender individuals, as well as data on HIV incidence among them, would help, participants in the discussion agreed. At the same time, Ryan noted toward the end of the discussion, “it’s really amazing the amount of data required to promote the need for programs [for men who have sex with men],” particularly when compared to the data required to promote programming for orphans and vulnerable children. Ryan added that he believes programs for orphans and vulnerable children are important. Still those who worked on the report cautioned, at the current pace of the response, “the face of the epidemic will change.” In a response already described as a vicious circle, the change they predict: it will be the face of a gay man.