Limited Data Available on MSM, Sex Workers and Transgenders
Global Fund releases report on analysis of Rounds 8, 9 and 10 proposals
Relatively little epidemiological data exist on men who have sex with men (MSM), transgender persons, and male, female and transgender sex workers. This is one of the conclusions of a study conducted by the Global Fund on to what extent Rounds 8, 9 and 10 proposals addressed the needs of these populations.
The study analysed 247 HIV proposals submitted in the three rounds combined. This includes proposals screened out by the Global Fund Secretariat (i.e., deemed ineligible), proposed not recommended for funding, and proposals approved for funding.
The study found that only 24% of Round 8 proposals contained estimates on the size of these population groups, a proportion which grew to 32% in Round 10. Even smaller proportions of the proposals included activities to establish population size.
Only 22% of Round 8 proposals contained any prevalence data for these groups, although the proportion rose to 25% and 34% in Rounds 9 and 10, respectively. Only 7.7% of all 247 proposals contained prevalence data for the transgender population.
The Global Fund adopted the Sexual Orientation and Gender Identities (SOGI) strategy two years ago to improve access to programmes for these populations.
The study found that more than three-quarters of the proposals included at least one "element" related to the SOGI populations. However, the term "element" was very broadly defined; it included epidemiological data, service provision, and participation and representation. Thus, if proposal said that a CCM member had academic or programming experience related to one of the SOGI population groups, this would be counted as an element.
Most proposals contained some activities to address the needs of MSM and sex workers. Very few contained activities for transgender persons. For example, In Round 8, 67% of proposals included at least one activity targeting at least one of the SOGI populations. Sixty-one percent targeted sex workers, and 51% MSM, but only 10% transgenders. The numbers for Round 10 were as follows: 56% targeting at least one of the SOGI populations; 48% sex workers, 44% MSM, and 11% transgenders.
(The study noted, however, that the proportion of funded proposals that included at least one prevention activity aimed at the transgender population grew from 6% in Round 8, to 20% in Round 9 and 22% in Round 10.)
Generally, the trend between Round 8 and Round 10 varied, depending on the data element being analysed. For example:
- The proportion of proposals that included at least one treatment activity declined over time, from 39% of all proposals in Round 8, to 33% in Round 9, and to 32% in Round 10.
- The proportion of proposals with at least one activity to reduce stigma and promote the rights of people living with HIV rose from 25% in Round 8, to 33% in Round 9, and to 39% in Round 10.
The study also compared proposals received in Round 10 through the regular funding channel and those that were submitted through a dedicated funding reserve for most-at-risk populations (the so-called MARPs reserve). Proposals approved through the MARPs reserve channel contained 11% more prevention, care, support and anti-stigma activities than the general HIV proposals. In addition, the activities in the MARPs proposals were described in greater detail.
The authors of the study stated that grant applicants in all three rounds demonstrated a commitment to addressing the needs of the population groups identified in the SOGI strategy. The authors also stated that their findings "suggest" that applicants are broadly aware that the HIV epidemic disproportionately affects marginalised populations and that the responses must reflect this.
Finally, the study recommends that the Secretariat give applicants more specific guidance on devising programs for the target populations, help the Technical Review Panel better understand programmes targeted to the population groups, share models of good practice, and proactively address the gaps in data and programmes.
A study of this kind may reveal some broad trends, but the findings have to be interpreted with caution. The authors of the study acknowledge that there were many limitations. Some of the data are not particularly useful. For example, how useful is it to know how many proposals contained an "element" related to the SOGI populations, when "element" is defined so broadly? How useful is it to know how many proposals contained at least one activity targeting, say, sex workers, with knowing anything about the nature of the activity (or activities)? A study that analysed the extent and quality of the activities targeting SOGI populations would have been more useful, even if the study had been conducted only for a limited number of proposals. Admittedly, such a study would have been much more complicated to design.
The report, entitled "Analysis of Rounds 8, 9 and 10 Global Fund HIV Proposals in Relation to Men Who Have Sex with Men, Transgender People and Sex Workers," is available on the website of the Global Forum on MSM and HIV here. The report has not been posted on the Global Fund website.