Regional Consensus Meeting on Developing a Comprehensive Package of Services to Reduce HIV among Men who have sex with Men (MSM) and Transgender (TG)

A Team from the Philippines* participated in the Regional Consensus Meeting on Developing a Comprehensive Package of Services to Reduce HIV among Men who have sex with Men (MSM) and Transgender (TG) Populations in Asia and the Pacific from 29 June – 1 July 2009, Bangkok, Thailand


Background
In 2008, the Independent Commission on AIDS in Asia released a report entitled “Redefining AIDS in Asia – Crafting an effective response” which made several policy recommendations intended to reduce the impact of the HIV epidemic among key affected populations, including men who have sex with men (MSM). The report calls for the urgent scale up of prevention interventions that are known or agreed to prevent infection with HIV and include access to treatment, care, and support for those already living with HIV. In addition, it noted that countries need to understand what is driving their epidemics and how to reach populations most at risk of HIV infection in order for their HIV responses to be effective.

The Operational Work Plan (2007-2008) for the Third ASEAN Work Programme on HIV and AIDS (AWP III) together with the ASEAN Commitments on HIV and AIDS was adopted by the Heads of State and Government of ASEAN during the 12th ASEAN Summit Special Session on HIV and AIDS on 13 January 2007 in Cebu, Philippines.

On 7-9 May 2008, ASEAN, UNDP and APN+ co-organized the ASEAN Regional Consultation Plan of Action for Greater Involvement and Empowerment of People Living with HIV in Vientiane, Lao PDR. In this Regional Consultation, a suggestion was made to convene a regional consultation to address HIV among men who have sex with men and TG in the region.

In line with these commitments, the ASEAN Secretariat recognises the urgent need to work with member states, the UN system, donors, civil society and government partners throughout the Asia Pacific region to scale up access to comprehensive services for men who have sex with men and transgender populations in the Region, and in general recommend advocacy for changing or amending restrictive legal and social environments. Furthermore, mobilizing resources is a priority, data collection and analysis need to be harmonized, and the capacity of health-care workers strengthened.

Highly concentrated and severe HIV epidemics among men who have sex with men (MSM) in urban areas across the region are already well documented. For example, the estimated HIV prevalence rate in Bangkok is 30.7%; Phnom Penh – 8.7%; Mumbai – 9.6%; and Beijing – 5.8%. Yet, investments in HIV programming for MSM remains limited, ranging from 0% to 4% of the total spending for HIV programming in countries region-wide. Most other major Asian cities still have a window of opportunity to avoid serious epidemics among MSM – but that opportunity will close soon unless investment and programming are put in place rapidly.

In the majority of the countries in the Asia Pacific region, there is a lack of HIV interventions for MSM which comprehensively focus on prevention, treatment, care and support. A 2006 survey of the coverage of HIV interventions in 15 Asia-Pacific countries estimated that targeted prevention programs reached less than 8% of MSM, far short of the 80% coverage that epidemiological models indicate is needed to turn the HIV epidemic around.

Due to the increased availability of epidemiological data on HIV among MSM in recent years, there is a better understanding of the magnitude of these epidemics, of the rapidity with which they can develop, and of the relative importance of male to male transmission within the HIV epidemics in the region. In some countries this has led to increased political will to address HIV among this behavioural population. Despite this, there is still inadequate information on what its defined as a ‘comprehensive package of interventions for MSM and TG’, which includes priority evidence-based interventions activities and its cost. This data is critical for governments and donors in the development, implementation and scale up of HIV programs for men who have sex with men.

In recent years, several initiatives have begun to support countries address HIV issues among MSM and TG in the region. In 2004, the U.S. government (USAID and US CDC), along with Family Health International (FHI), UNESCO, and others organized two consultation meetings of government and MSM community representatives and technical experts that ended with six country action plans built around the concept of a comprehensive package of services (labelled a “minimum package of services” at that time). These meetings were the beginning of a MSM initiative in the greater Mekong sub region.

In 2008, the USAID/Health Policy Initiative, Greater Mekong and China (HPI/GMR-C), in partnership with Burnet Institute, undertook a survey to map donor expenditures for HIV prevention programs for MSM in the Mekong sub region. The survey found that only USAID was making significant funding contributions throughout the GMS subregion, although there is a range of other donors supporting various activities; and that in principle other aid agencies, international NGOs, the UN system and donors are very supportive of interventions targeting MSM. Some countries in the region have started to implement MSM and HIV programming funded through GFATM grants.

In 2009, USAID, in partnership with UNDP, WPRO and APCOM is supporting two complementary projects in the region to advocate and assist national governments to prioritize the response to HIV among MSM and TG populations. These projects aim to assess the effectiveness of a comprehensive package of services being implemented throughout the GMS region, and provide an advocacy and resource estimation tool for initiating or scaling up this package of services.

Finally, in February 2009, WHO (WPRO), UNDP, UNAIDS and the Hong Kong Health Department co-hosted a regional consultation aiming to strengthen the health sector response to HIV among MSM throughout the region. This broad-based conference was attended by over 100 participants from the health sector, international NGOs, regional and national civil society networks, academia, bilateral donors and the UN system. As part of the outcomes of the meeting, the participants “recognised the need for a widely endorsed, single, comprehensive regional reference package to better inform national responses”; and “the implementation of a ‘highly active’ range of interventions was recommended for settings with high HIV prevalence and incidence among MSM and TG”.

Furthermore, other bi later donors and foundations have recently expanded their commitments to address HIV among MSM and TG in Asia Pacific. The Foundation for AIDS Research (amfAR) has been supporting community- based responses to MSM and HIV in Asia Pacific since late 2007 through a small grants program and capacity-building assistance. AmfAR recently submitted a call for proposals for another round of funding, aimed to further promoting innovative HIV services (prevention, treatment care), research and partnership building in local responses.

An expanded area of work under Australia's new international development strategy for HIV is a focus on HIV prevention among MSM. AusAID has recently commissioned a scoping exercise to consider how it will support comprehensive approaches to address HIV infection among MSM in the Asia Pacific region. This scoping exercise will form the basis for further planning by AusAID on how it will implement the focus on MSM in its new strategy, building on the investments it has made in conjunction with AFAO in Indonesia, in the Pacific and in Papua New Guinea.

To increase the effectiveness of all of these initiatives, the proposed Comprehensive Package of Services for MSM and TG Consensus Meeting with government and civil society representatives, and the Advocacy/Costing Tool Workshop, aims to build on collective efforts and experiences of national AIDS responses, INGO and community experiences and will be convened to achieve the following objectives:

· National government decision-makers, multi- and bilateral donors, international NGOs and community advocates review, identify priorities and endorse the components of a comprehensive package of services.

· Produce an advocacy product that will allow users to identify gaps in baseline information, test assumptions and produce local costing estimates for a scale-up of the comprehensive response to HIV among MSM.

· Understand the data sources and means of collection, costing calculations and estimation methods so a comprehensive package of services can be adopted in other countries and sub-regions.
Comprehensive Package of Services for MSM Consensus Meeting, 29 June - 1 July 2009
Meeting Partners include UNDP, ASEAN Secretariat, WHO-WPRO, UNAIDS, UNESCO, USAID-RDMA, APCOM

Directly responding to the recommendations from the Health Sector and MSM regional consultation, which was recently held in Hong Kong SAR, China (February 2009), this meeting aims to come to a consensus about the basic components of a comprehensive package of services to prevent HIV and provide treatment, care and support for MSM in the region. The meeting aims to be a platform for discussion to reach consensus between government and civil society partners on the components of a “Comprehensive Package of Services” to reduce HIV incidence among MSM and TG. By reviewing existing interventions implemented in the region over the past several years, this process will include an overview of key evidence-based interventions and strategies for preventing HIV and providing treatment, care and support to MSM . The meeting aims to achieve a consensus from national stakeholders on the components, as well as intervention priorities to prevent HIV transmission among MSM behavioural populations, including TG populations.

A key challenge when reviewing past experiences in responding to HIV among MSM is that most of the current interventions among MSM in Asia Pacific have not benefited from rigorous outcome evaluations using behavioral and/or biological outcomes to analyze their effectiveness in Asia. However, acknowledging that a recommendation of the Consensus Meeting may well be that outcome evaluations of MSM HIV interventions should be conducted, many countries in the region do have a set of interventions that can justifiably serve as the basis for discussion and on which to reach consensus. Below is a graph depicting the conceptualization of a possible Comprehensive Package of Services for MSM, including suggested components, which can serve as the basis for discussion at the meeting.

Participants:
Dr. Ferchito Avelino, PNAC Director
Noemi D. Bayoneta-Leis, HAIN, Implementing Partner, MSM Project
Mr. Anastacio Marasigan, TLF Share Collective, Responsible Partner