HIV, Health and Development

Published: March 14, 2012

Background

The UNAIDS Report on the Global AIDS Epidemic in
2010 noted that the Philippines was one of only seven
countries in the world where HIV incidence grew more
than 25 percent in the past 10 years. Figures show that
from 2007 to 2011, the average number of new reported
cases jumped from one per day to over six per day1. This
dramatic acceleration of new infections reflects the
many risk factors that face the country.

It is however, also driven by stunning trends in two atrisk
populations. Five of the six Filipinos being infected
with HIV each day in the country in 2011 are MSM.
MSM and transgender persons are arguably the two
most at-risk populations in the entire country. HIV in
these groups already resembles an epidemic, even if
the overall HIV and AIDS situation in the Philippines
does not yet. Transmission trends have clearly shifted
from heterosexual to male-to-male sex. In 2011, sexual
transmission through male-to-male sex represented 82
percent of all new cases reported, up from 56 percent
in 2007. More disturbing is the absolute numbers of
newly infected people identifying either as homosexual
or bisexual, growing from 37 total cases in 2001 to 1,842
in 20112.

Further, the underlying risk factors for these two
populations are worrying. The 2009 Integrated HIV
Behavioural and Serologic Surveillance (IHBSS) showed
that prevention programmes reached only 29 percent of
the estimated 690,000 MSM, while only 35 percent have
correct knowledge on HIV. In addition, only 32 percent
of the people who practice anal sex reported the use
of a condom. Given these inherent gaps between real
behaviour and preventative behaviour, the current
growth in HIV cases may very well be just the start of a
period of explosive, exponential growth in HIV amongst
MSM and transgender populations.

The potential for an epidemic to take hold within
the most-at-risk populations has not been lost on
the government, civil society organizations, or other
stakeholders. Neither has the potential to reverse the
increase in HIV through well focused and targeted
programmes. However, as TLF Sexuality, Health, and
Rights Educators (TLF-SHARE) – the MSM-sectoral
representative to the Philippine National AIDS Council
(PNAC) – noted in 2007, government budgetary backing
for HIV and AIDS was not providing the needed resources
for adequate HIV prevention, treatment, care and
support programmes at the national level. The dramatic
rise in HIV cases within the MSM and transgender
communities also raised a more fundamental concern –
were past intervention programmes that once seemed
to be helping stem the tide of HIV, like outreach activities,
learning group sessions, and condom distribution, still
effective under these changing circumstances?
Understanding and Empowering MSM
and Transgender Communities

As the convening UN agency supporting empowerment
of MSM and transgender persons, UNDP and the UN
Joint Team on AIDS determined that more effective
interventions were needed to slow the spread of the
disease in these two key populations. As discussions
progressed, it became clear that institutional knowledge
of these populations and their characteristics was low.
While MSM were acknowledged as a distinct group,
transgender persons were viewed at best, as a subset
of the MSM population, and mistakenly as MSM dressed
as women. Service providers and government officials
alike viewed MSM as a homogenous population defined
almost solely by their sexual behaviour, with very little
understanding of the complexities and variations that
exist in any community.

Thus UNDP, along with PNAC and the UN Joint Team
on AIDS, developed Component 4 of UNDP’s HIV
Programme, ‘Strategic Information and Community
Leadership among Men who have Sex with Men (MSM)
and Transgender Populations’ in order to strategically
develop, disseminate, and utilize key information and
knowledge. The programme would undertake research
to build greater understanding of the behaviours,
motivations, needs, and background of MSM and
transgender persons, and also to assess current
interventions to identify the most effective approaches.
This information could then feed into national and local
policy-making, programmatic planning, and sharing
of best practices and strengthening of South-South
cooperation through the USAID and UNDP Multi-city
MSM and HIV initiative.

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