HIV risk? It’s in the programming…

‘On the fast track to end AIDS’.

That’s the UNAIDS slogan for today’s World AIDS Day; and beneath the inevitable soundbites lie some clear principles of approach, one of which is ‘deliver results that leave no one behind’ (UNAIDS, 2015).

In Asia and the Pacific, as elsewhere in the world, the HIV epidemic continues to take its heaviest toll among communities and groups that are marginalised and discriminated against. Men who have sex with men, and transgender people, are heavily affected.

(I use these terms reluctantly, given that they are English terms that often serve to mask widely diverse and often highly culturally specific gender and sexual identities, both within the English-speaking world and outside of it. Nonetheless, descriptive terms are required and these are the best we have right now.)

So what’s stopping us from addressing this?

The HIV response is now more than 30 years old, right? We have known for all of that time that MSM and transgender people are heavily affected, right?

In a new analysis tool, written for the Asia-Pacific Coalition on Male Sexual Health (known as APCOM), I outline a set of assumptions, facts and risks that affect HIV programming for MSM and transgender people.

The risks can be summarised as:

  • Unfounded assumptions on risks faced by all those who fall under the umbrella term of MSM and transgender people, without knowing about the realities of people’s lives; this in turn contributes to program activities that do not actually contribute to the desired changes because of lack of coherence between what is known and what is actually done;
  • ‘One-size-fits all’ programming that relies on the false vision of homogenised communities presented in national- or regional-level epidemiological surveys and involves activities unsupported by a clear program logic;
  • Organisations inadvertently adopting ‘power over’ community members, rather than exercising ‘power with’, thereby reinforcing the socio-cultural and power inequalities that contribute to HIV risk for many MSM and transgender people;
  • Missed opportunities because existence of repressive laws is taken as proof that there is no space for HIV programming directed to MSM and transgender people;
  • National level ‘partnerships’ effectively masking a lack of appropriate investment in, and prioritisation of, MSM and transgender people in terms of the HIV response.

The analysis tool offers a set of nine ‘risk avoidance’ activities, intended to help organisations ‘look inwards’ and ‘look outwards’.

Each activity contains a series of questions that are intended to help an organisation think through where it is now, what it knows, what its limitations are in terms of HIV programming for MSM and transgender people, and how those limitations might be addressed.

APCOM recommends that these activities be used in all organisations that are involved in HIV programming for MSM and transgender people, whether that organisation functions at global (e.g., UN), regional (e.g. APCOM itself), national (e.g. national networks) or local level (e.g. civil society organisation).

This tool does not claim to be THE answer; but I and APCOM believe it asks important questions. And for those who are not sure that we need yet another tool, as I state in the document: ‘MSM and transgender people deserve better HIV programming than they get at the moment’.


Dr Gillian Fletcher
Research Fellow
Developmental Leadership Program/Institute for Human Security and Social Change

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