Despite the Global Fund’s progressive policies on the inclusion of gay men, other men who have sex with men and transgender individuals (GMT) in programmes supported by the Fund, only a tiny fraction of the money spent by the Fund in six countries in Southern Africa has targeted this population.

This is one of the conclusions of a new study from the Foundation for AIDS Research (amfAR) and the Center for Public Health and Human Rights at the John Hopkins University School of Public Health.

The study examined funding from the Global Fund, the US government and national governments – and the implementation of programmes for GMT – in Botswana, Malawi, Namibia, Swaziland, Zambia and Zimbabwe. The study found that less than one tenth of one percent of the $1.5 billion spent by the Global Fund on HIV programmes in these six countries in Rounds 1–10 and in the Transitional Funding Mechanism round supported the GMT population. Moreover, the study found, the majority of this support was concentrated in just one of the six countries (Namibia).

According to the report on the study, although the HIV epidemic among gay men and other men who have sex with men (MSM) is expanding, programmes often neglect this population. “Stigma and discrimination against MSM flourish with impunity in countries that receive significant donor funding for HIV,” the report said.

Although national planning documents and donor funding agreements mention MSM, little programming actually exists, the report said. “GMT struggle to obtain the most basic health services. They are isolated, criminalized, blackmailed and beaten.”

In addition, the report said, little to no attention is paid to the needs of transgender people.

Citing UNAIDS, the report said that national governments currently spend almost no money on programs for GMT. “This leaves a patchwork of isolated interventions sponsored by international donors that is inadequate to prevent further expansion of the epidemic.”

According to the report, there were 29 HIV proposals submitted to the Global Fund by these six countries, of which 19 were approved. Of the approved proposals, 58% percent made no mention of MSM; 32% mentioned MSM but did not include any specific activities targeting MSM; and 11% – only two proposals – contained activities targeting MSM.

The report said that the Technical Review Panel has noted the exclusion of GMT from submitted proposals since at least Round 9. In its report on the Transitional Funding Mechanism, the TRP said:

“Activities for most-at-risk populations (MARPs) were often reduced in scale or removed altogether under TFM…. There were reductions in targets associated with MARPs, which for the most part are poorly monitored and absent from performance frameworks. In some cases, activities mentioned in the proposal were not included in the budget even though listed as a priority.”

The report said that the Global Fund needs to operationalize its policies and strategies on GMT. The Sexual Orientation and Gender Identity (SOGI) strategy needs a workplan, staffing, money and priority, the report said.

In addition, the report said, the needs of GMT should be embedded in the new funding model.

The title of the report on the study is “Achieving an AIDS-Free Generation for Gay Men and Other MSM in Southern Africa.” This is the second of a series of studies on GMT. The report on the first study was summarised in a GFO article here.