New Analysis of HIV Proposals from Global Fund Rounds 8, 9 and 10 Shows Progress, Reveals Gaps
Despite significant improvements, representation of key populations on Country Coordinating Mechanisms and in grant proposals remains unacceptably low
(May 3, 2011) – A new analysis of all HIV proposals from Rounds 8, 9 and 10 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) shows improvements in funding trends for men who have sex with men (MSM), transgender people and sex workers, three populations severely impacted by the HIV epidemic worldwide. However, the analysis reveals that despite clear gains, these key populations remain gravely underrepresented on the GFATM’s Country Coordinating Mechanisms (CCMs) and in GFATM grant proposals. The report was released in advance of the upcoming GFATM Partnership Forum Meeting, the Twenty-Third GFATM Board Meeting in mid-May, and the unveiling of the GFATM’s new five-year strategy later this year.
The GFATM analysis involved reviews of all funded and unfunded HIV proposals from Rounds 8 through 10 and reports on several key issues including representation of MSM, transgender people and sex workers on CCMs. From Round 8 to Round 10, the GFATM has documented increases in:
- the proportion of CCMs with representation by organizations clearly working with these populations
(R8: 7%, R9: 38%, R10: 28%);
- the proportion of proposals providing baseline HIV prevalence data or planning data collection for these groups
(R8: 22%, R10: 34%);
- the proportion of funded proposals focusing on care and support related to these populations
(R8: 29%, R9: 50%, R10: 47%);
- the proportion of funded proposals including stigma or rights-promotion related to these groups
(R8: 13%, R9: 43%, R10: 63%); and
- the proportion of funded proposals focusing on Community Systems Strengthening related to these populations
(R8: 26%, R9: 47%, R10: 41%).
There were also a significant number of plateaus and declines from Round 8 to Round 10, including decreases in:
- the proportion of proposals including at least one prevention activity targeting these populations
(R8: 71%, R9: 80%, R10: 66%); and
- the proportion of proposals including at least one treatment tool or service targeting these populations
(R8: 57%, R9:48%, R10: 44%).
The Global Fund Strategy in Relation to Sexual Orientation and Gender Identity, approved by the GFATM Board in May 2009 before the Round 9 application deadline of June 2009, represents a key step toward enhancing the GFATM’s impact on key populations. While the overall upward trend of key population representation on CCMs and in grant proposals since the release of the new Sexual Orientation and Gender Identity (SOGI) Strategy is heartening, the figures reported for Round 10 are far below the levels necessary to adequately address the epidemic among these populations.
Research has shown that MSM, transgender people and sex workers shoulder a disproportionate HIV disease burden compared to the general population in nearly every country that reliably collects and reports surveillance data. Taking this into consideration, the fact that only 28% of CCMs report representation of these populations is unacceptable. In addition, representation of individuals belonging to key groups does not necessarily entail expertise in designing and implementing programs that target these populations. Only 32 of the 84 CCMs applying for grants in Round 10 reported any programmatic experience working with these populations. Even when CCMs include members representing the interests of key populations, numerous reports indicate that these members can be sidelined during group discussions or have their opinions discounted altogether. More must be done to ensure meaningful and effective participation of key populations in CCMs.
While improvements in data collection are a sign of progress, the Round 10 figures for research are also well below where they should be. The GFATM notes in its SOGI Strategy that less than one third of the 128 countries reporting on the UN Declaration of Commitment on HIV/AIDS in 2008 included complete data on all five indicators related to SOGI and HIV. The GFATM followed by declaring its intent to “support efforts to build the available evidence-base through [funding] support for national surveillance and operational research.” However, less than 35% of proposals in Round 10 included efforts to conduct research on population size or HIV prevalence pertaining to these groups. Data collection is especially important for MSM, transgender people and sex workers, as governments and stakeholders often use a lack of data as an excuse to avoid addressing the HIV-related needs of these populations.
Finally, recent research on programming suggests that massive scale-up is needed to meet the prevention, support, care and treatment needs of key populations. In 2010, the Global Forum on MSM & HIV (MSMGF) conducted a survey of more than 5,000 MSM worldwide and found that more than half of MSM reported that it was difficult or impossible to access HIV testing (57%), HIV education materials (66%), and HIV treatment (70%). While GFATM-supported programs for care, support and stigma-reduction are increasing, prevention and treatment are decreasing. And with so few CCMs reporting expertise in programming for these key populations, there is no guarantee that the programs supported will be high-quality or effective. The GFATM must take steps to increase both the number and quality of programs targeting key populations.
The MSMGF applauds the GFATM for its efforts to increase the impact of its grants on key populations and to keep the broader community abreast of its progress. Still, significant barriers persist. Until CCMs ensure the inclusion of qualified representatives of key populations – who are meaningfully engaged in proposal design and implementation – the GFATM’s efforts to support key populations will remain compromised. In addition, the GFATM recommends that CCMs and principle recipients work together to select which organizations become sub-recipients and receive funding. Reports from the ground indicate that discrimination against key populations can play a role in these decisions, effectively preventing organizations working with key populations from accessing GFATM funds. Organizations working with key populations also need access to more technical assistance options to aid their participation in the GFATM application process. Many such organizations are small, young and community-based; support programs could greatly enhance their involvement with the GFATM. Finally, transgender people must be explicitly mentioned as a specific population for consideration in future Proposal Guidelines. The failure to do so thus far may have played a large part in the severe underrepresentation of transgender people on all indicators across the board.
The GFATM has proven itself a leader in the field of HIV and a strong ally to MSM, transgender people and sex workers. The MSMGF supports the GFATM’s continued contributions to advancing the health and human rights of all key populations worldwide.
Read the GFATM report at: http://www.msmgf.org/files/msmgf//Advocacy/Rounds_8_9_10_MSM_TG_SW_Report_April_2011.pdf
Read the GFATM SOGI Strategy at: http://www.theglobalfund.org/documents/publications/other/SOGI/SOGI_Strategy.pdf
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