HIV in men who have sex with men in sub-Saharan Africa

Published: June 29, 2012

The Declaration of Commitment on HIV/AIDS for monitoring progress was reaffirmed during the UN General Assembly in June, 2011, with a goal of reducing sexual transmission of HIV by 50% by 2015. For the first time, it specifically referred to men who have sex with men (MSM), sex workers, and people who inject drugs, an achievement serving to draw attention to the importance of their inclusion in the declaration’s goals.1 In 2009, The Lancet published a review of MSM and HIV/AIDS in sub-Saharan Africa in which the authors called for improvements in the provision of strategic information about MSM to accurately assess and address the needs of these men in sub-Saharan Africa.2 Owing to the work of dedicated researchers, funders, and non-governmental organisations, a high prevalence of HIV in sub-Saharan Africa and an increased risk of HIV transmission among MSM have been consistently recorded during surveys of behavioural serological surveillance and other studies in the region.3–5

Most recently, Michel Sidibé, the Executive Director of UNAIDS, emphasised these concerns and reiterated support for those fighting for equality of access to HIV services for MSM on the continent before the 16th annual International Conference on AIDS and Sexually Transmitted Infections in December, 2011. If the imperative did not seem to exist before, a need exists for donors and governments in the region to assess the extent to which HIV is affecting MSM and to improve the monitoring of progress towards reduction of HIV transmission.

The US Centers for Disease Control and Prevention (through the President’s Emergency Plan for AIDS Relief) in Kenya6 and Uganda7 and the Global Fund to Fight AIDS, Tuberculosis and Malaria are examples of organisations that have provided funding to improve surveillance in key populations at higher risk of HIV. Such funding has also lent support to the need for improvements in the legal environment for MSM and in South Africa8 to justify the incorporation of key populations in the national strategic planning for HIV.

Reporting of data for HIV in MSM has been improving slowly. Among 45 sub-Saharan Africa countries, 32 reported that indicators for MSM were relevant to their epidemic in 2010, but no data were available.9Only 15 countries have ever reported to UNAIDS or WHO about at least one indicator by 2011 (table). This country-identified need for data, coupled with low levels of indicator reporting since the first MSM-related data report in 2006, and high survey prevalence, is a call to action. Prevalence data were reported in 2010 from only 16% of 45 countries in sub-Saharan Africa and 36% of the countries in this part of the continent had ever reported about any MSM indicator. Huge monitoring and surveillance gaps exist for MSM, with only six countries ever reporting about this important indicator and only four countries reporting about the coverage of the HIV prevention programme. Further, among the 33 countries in sub-Saharan Africa reporting to UN General Assembly Special Session (UNGASS) in2010 about funding sources for prevention, only 1% of spending is earmarked for key populations and of that only 8% goes towards prevention activities for MSM.10

HIV surveillance, including addressing the representativeness and assessment of the size of MSM populations, is improving.11 However, countries need to do studies to estimate the size to ensure that programmes reach a substantial portion of the key populations. In some cases, little is known about the data gathering and recruitment strategies of some surveys, making UNGASS data for MSM in sub-Saharan Africa not representative in countries as a whole. Strengthening the representativeness of samples and estimations of size are important challenges for future surveillance and monitoring among MSM. The current 2012 UNAIDS reporting cycle will, for the first time, request detailed information about survey methods, which will help to improve knowledge of the quality of  these activities.12

January, 2012, marked a new biennium re porting cycle to the UN General Assembly. Countries were encouraged to report progress data for MSM-related indicators as part of this process. Challenges notwithstanding, now is the time to take advantage of the reporting process to address the HIV-related needs of MSM in the entire region by the declaration’s 2015 deadline.

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