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The Global Forum on MSM & HIV
MSM and the Global Fund: Where Do We Go From Here?
 
(December 1, 2011) - Last week, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it will cancel its eleventh round of funding due to the failure of donor governments to live up to their commitments.  The Global Fund has been central to the global AIDS response since its inception, and the collapse of sustained commitment would deal a catastrophic blow to those affected by HIV around the world.  For communities of men who have sex with men (MSM), the loss of a fully-functional Global Fund would be especially devastating.
 
HIV has taken a brutal toll on MSM from the time the epidemic was first identified among gay men living in the United States.  After 30 years and the loss of countless lives worldwide, the virus continues to ravage our communities, with infection rates surpassing 20% among MSM in urban centers from Bangkok to Mexico City.  Despite the clear need for intervention, recent research suggests that fewer than 50% of MSM worldwide can easily access HIV testing or free condoms, and only one third can easily access HIV treatment.  Scale up of tailored services for MSM is urgently needed if we are to have any chance of heading off this crisis.
 
Most governments have done little to address these issues.  Only 25% of countries made an effort to report levels of HIV prevention spending for MSM to the United Nations in 2010.  In the few countries that did track this spending, an average of less than 2% of national HIV prevention budgets was dedicated to MSM.  Making matters worse, more than 70 governments around the world have laws that criminalize homosexuality, forcing MSM underground and away from lifesaving services.

Amid a global response bogged down by stigma, discrimination, and lack of political will, the Global Fund has been at the forefront of developing effective funding responses to fight HIV among MSM and other key affected populations.  In 2009, the Global Fund Board approved a new landmark Strategy in Relation to Sexual Orientation and Gender Identity.  The adoption of the “SOGI Strategy” was followed by important increases in key population representation on Country Coordinating Mechanisms, the proportion of funded proposals focusing on care and support related to these populations, and the proportion of funded proposals focusing on Community Systems Strengthening related to these populations. 
 
Central to the success of the Global Fund’s work with MSM and other key populations has been the creation of a funding pool dedicated exclusively to most-at-risk populations (MARPs).  Established in Round 10, the MARPs funding pool awarded $47 million to programs for MSM, people who use drugs, sex workers and transgender people.  With so many national responses intent on underfunding programs for local MSM – indeed, many are actively sabotaging them – dedicated financial support from a multilateral like the Global Fund is fundamental to an effective MSM response.
 
The cancellation of Round Eleven not only means fewer people living with HIV receiving treatment and care services, it means a weakened global mandate to take a targeted, evidence-informed and rights-based approach to fighting AIDS.  Said more bluntly, the failure of donor governments to honor their funding commitment in the fight against AIDS is equivalent to insisting that a three-legged table can stand just fine with only two legs.  There is absolutely no question that a focus on key populations and human rights is essential to any effective AIDS response – a truth recently reiterated by institutions such as the World Bank and Johns Hopkins University – yet so few leaders have the political courage to act on this knowledge.  This must be the focus of our advocacy, now more than ever.
 
We are now at a crucial moment in the AIDS response.  We have new evidence that the end of the global pandemic may be within reach, if only we make the right decisions about funding and implementation.  U.S. President Barack Obama today exercised bold leadership in his commitment to “end the pandemic, once and for all,” announcing a new commitment to reaching 6 million people with anti-retroviral treatment by the end of 2013. Now we must push for him and other leaders to honor their commitments, and in doing so, to recognize that targeted, evidence-informed, rights-based approaches to the epidemic are non-negotiable.  
 
Call to Action:
 
As we move forward at this critical juncture, there are a number of steps MSM advocates in all countries can take to help ensure that the response for MSM is fully and appropriately funded. 
 
Mere months ago, in June 2011, all UN Member States pledged to uphold the 2011 Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS.  Hold your governments accountable to fulfilling their promises as enshrined in the Political Declaration, including:
  1. Fully funding the Global Fund to Fight AIDS, Tuberculosis and Malaria: Member states have affirmed UNAIDS’ estimate that $24 billion is required in annual global expenditure on HIV in low- and middle-income countries [88]; have committed to providing funds in a sustained a predictable manner to the Global Fund [92]; have recognized  the Global Fund as a pivotal mechanism for achieving universal access and encouraged all Member States to provide “the highest level of support for the Global Fund” [95];
     
  2. Effectively reaching key populations, including men who have sex with men: Member States have recognized that HIV prevention strategies inadequately focus on populations that epidemiological evidence shows are at higher risk, specifically men who have sex with men [29]: and have committed to ensuring that national HIV prevention strategies comprehensively target key affected populations, to ensuring data collection on these populations are strengthened, and to ensuring that services are accessible [61];
     
  3. Respecting, protecting and fulfilling human rights in the HIV response: Member States have committed to creating enabling legal, social and policy frameworks in each national context to reduce stigma and promote access to services [77]; have committed to reviewing laws and policies that adversely affect successful and equitable delivery of HIV services [78]; and committed to having national HIV and AIDS strategies that promote and protect human rights [80].
In addition to advocating for your government to follow through on its commitments to the Political Declaration, advocate for the Global Fund to hold an emergency donor conference – as soon as possible, and certainly before the next International AIDS Conference taking place July 2012 – and work to ensure that donor governments use this meeting as a clear venue to re-commit their pledges. 
 
Now is the time to get serious about matching the response to the epidemic; we can no longer allow squeamish and bigoted bureaucrats to use all manner of excuses to continue to ignore us.  None of this will change if we allow ourselves to be convinced that “it just isn’t the right time” for us to fight for our health and our human rights.  Now is exactly the right time.  We must work together to re-open the door to changing the course of the HIV pandemic, putting the world back on a path toward ending AIDS.

The Global Forum on MSM & HIV (MSMGF) is an expanding network of AIDS organizations, MSM networks, and advocates committed to ensuring robust coverage of and equitable access to effective HIV prevention, care, treatment, and support services tailored to the needs of gay men and other MSM. Guided by a Steering Committee of 20 members from 18 countries situated mainly in the Global South, and with administrative and fiscal support from AIDS Project Los Angeles (APLA), the MSMGF works to promote MSM health and human rights worldwide through advocacy, information exchange, knowledge production, networking, and capacity building.

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