MSM

President William Clinton at Closing Session of AIDS 2012. {Photo credit: © IAS/Steve Shapiro - Commercialimage.net.}Photo credit: © IAS/Steve Shapiro - Commercialimage.net.

It's been nearly two weeks since former President William J. Clinton closed the last session of the XIX International AIDS Conference (AIDS 2012) and delegates returned home.

This year's conference featured commitment and calls for an AIDS-free generation, a growing interest in Option B+, and new research towards a cure.  Here are some reflections from what we learned at AIDS 2012, where we truly started "turning the tide together".

Clinton calls for a blueprint toward an AIDS-free generation

Secretary Hilary Rodham Clinton announced significant funding towards preventing mother-to-child transmission (PMTCT) of HIV, South Africa’s plan for voluntary medical male circumcision, and money for “implementation research,” civil society, and country-led plans. Sec. Clinton also called on Ambassador Eric Goosby to provide a blueprint for achieving an AIDS-free generation during her plenary address. Numerous other stakeholders echoed her commitment. But, if we really want to achieve an AIDS-free generation, the $7 billion funding gap that stands between where we are now, and where we should be, will need to be erased

The results from the first Pre-exposure Prophylaxis (PrEP) clinical trial, the iPrEx Study, were just made public and published in today’s issue of the New England Journal of Medicine. In short, the trial showed an overall 44% efficacy in preventing HIV infection in gay, bisexual and transgender subjects who took the daily fixed dose combination antiretroviral pill Truvada (tenofovir [TDF] and emtracitabine [FTC]), compared with participants receiving a placebo. This is the first evidence that oral antiretroviral medications, taken by HIV-negative people before exposure to HIV can reduce the risk of HIV infection. iPrEx is also the first trial showing effectiveness of a new biomedical prevention tool in gay men and other men who have sex with men.

The iPrEx trial enrolled 2,499 participants across 11 sites in six countries---Brazil, Ecuador, Peru, South Africa, Thailand and the United States. It is the first PrEP effectiveness trial to report results. This trial was one of a suite of PrEP trials currently ongoing in a range of populations around the world.

The AIDS 2010 conference theme “Rights Now, Right Here” was delivered loudly, clearly, and passionately throughout the week in Vienna as delegates discussed the practical and urgent implications for truly gaining universal access to HIV treatment, prevention, and care. Over 10 million HIV positive people are without access to treatment, without universal access, the MDGs will not be achieved by 2015.

Human rights violations are a barrier to learning about the epidemic or receiving critical prevention information. Some HIV positive people are subject to unethical surveillance. Human rights violations contribute to transmission of HIV (such as from rape in prisons or domestic violence) and, in too many countries, being HIV positive is a criminal offense. Stigma, discrimination, and persecution are all huge barriers to HIV testing, care, and support. Universal access to human rights by all is what will lead to universal treatment, prevention, and care, not the reverse. Realizing the full protection of human rights is the first step to enhancing efficiency in these programs. The right to live life free of stigma and discrimination and the right to health care including treatment, prevention, care, and needle exchange and substitution treatment are essential.

Originally appeared in GLOBAL HEALTH magazine.

Men who have sex with men (MSM) bear a disproportionate share of the HIV/AIDS burden in Eastern Europe and Central Asia, but data on and services for this population are woefully inadequate. With a better understanding of this marginalized community's needs, donors and implementers can help support effective policies and programs for MSM infected and affected by HIV.

In Eastern Europe and Central Asia, as in many parts of the world, the HIV epidemic among MSM is underreported and under”acknowledged. The lack of official reports on HIV among men who have sex with men might enable governments to avoid prioritizing or even offering interventions, and HIV programmers can fail to reach those most in need.

Without the data and analysis of MSM issues it is easy for governments and HIV/AIDS programmers to not develop MSM programs and interventions as: (a) no data means it can look like MSM is not a problem and therefore not a priority and (b) lack of recognition of the issue means that it is easy for governments'/programmers' own homophobia to get in the way of developing programming.

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