Gay men and other men who have sex with men (MSM) in several countries in sub-Saharan Africa have gained a potentially influential voice in decisions about how funding for HIV treatment and prevention is targeted in their local LGBTI communities.
The change from excluding gay and MSM people to involving them in decision-making was demanded by the Global Fund, which is a primary provider of funding for the fight against Aids, tuberculosis and malaria.
It’s too early to expect any hard evidence that the change has slowed the course of the HIV epidemic, but some of the first steps are promising. In Cameroon in particular, the budget for Aids prevention among gay and MSM, sex workers and other most at-risk or key populations has gone from nearly nothing to US $6.8 million.
The Global Fund last year instituted the requirement that each nation’s health oversight committee (called a Country Coordinating Mechanism, or CCM), which sets policies and allocates money for a nation’s anti-AIDS projects, must include representatives of the nation’s “key affected populations” (KAPs).
Those populations vary from country to country, but typically they include gay men and MSM, sex workers, women and girls, and laborers in socially isolated occupations such as truck driving, mining or fishing. The Global Fund defines KAPs as groups suffering high rates of infection, with limited access to health services, and facing “criminalization, marginalization or exclusion that hinders access to key services or basic human rights.”
A recent survey of 17 health policy representatives in six countries in southern Africa (Swaziland, Lesotho, South Africa, Botswana, Zimbabwe, and Zambia) found that each nation’s CCM now includes KAP representatives, as required.
But the survey, conducted by the watchdog group Aidspan, found little evidence that KAP representatives had succeeded in affecting CCMs’ policies or programs: Some of the KAP representatives have been ignored, denied information about the workings of the CCM and reduced to the role of spectators.
Still, Aidspan found signs of progress. As one survey participant observed, in the past “we were just told what to do, no orientation workshops were conducted. But we are no longer spectators now. We know our roles and are improving as we move on.”
Aidspan noted that the survey “suggests that not only are KAPs now present on the CCMs, but they are no longer quiet (even where they used to be). But just because one is vocal does not necessarily translate into meaningful engagement through getting ideas noted and interventions or programmes included to meet the needs of one’s constituency.”
“When asked if they had evidence that what they said was being taken seriously, most only spoke in general terms,” the Aidspan report said. “We tried to get specific, concrete examples of change that had occurred as a result of the KAP presence, but found few examples.”
One problem is that KAP representatives are often given the task of representing more than the KAP group to which they belong.
“Two KAP reps pointed out that they had to represent [gay men and MSM], sex workers and [drug users], but they had been elected to represent either women and girls or disabled persons,” the report said.
Another problem that limits the effectiveness of KAP representatives is government resistance to recognizing the needs of stigmatized KAP groups, such as gay men and other MSM and sex workers. The report also said that basic data have not been collected about KAP groups, such as the HIV infection rate among sex workers. The result is “a lack of cooperation from the other constituencies (on the CCM) because they feel that the key populations [representatives] are time-wasters,” one survey participant said.
The effectiveness of KAP representatives’ participation is also undercut because they are often notified late of CCM meetings and are excluded from — or simply do not attend — meetings of technical working groups “where critical planning, prioritization, discussion and debate is done,” the report said.
The Aidspan survey did not include Cameroon, which provides an encouraging example of progress in the battle against HIV among high-risk communities.
For six months in 2013/14, only €18,294 (US $20,732) in Global Fund money was allocated for the fight against Aids among key populations, and that was divided among 50 non-government agencies (NGOs).
In the current funding round, Cameroon’s recommended Global Fund budget for prevention alone totals more than €6 million (US $6.8 million) — €1,494,016 for gay and bisexual men and trans persons; €2,607,546 for sex workers and their clients; and €1,971,487 for truck drivers, according to a case study by the Global Forum on MSM and HIV (MSMGF).
It is too early to measure the outcome of this newly inclusive anti-Aids initiative, but the hope is that, with key populations engaged, trained, involved and funded, the pandemic will finally loosen its grip on Cameroon, and that much of sub-Saharan Africa could see similar progress once similar changes in their CCMs take effect.
The reform effort in Cameroon received a boost from Canadian LGBTI and HIV rights activist Denis LeBlanc, who investigated and made public in 2013 how little money from the Global Fund was actually being provided to combat HIV in the LGBTI community and other at-risk populations in Cameroon.
LeBlanc, an activist since 1971 who now is an editor for the Erasing 76 Crimes blog, sent numerous e-mails to alert officials and published articles on his own blog exposing the fact that NGOs targeting high-risk communities in Cameroon were allocated an average of barely $400 each for six months of Aids-fighting work.
That Cameroon changed its approach and has now allocated $6.8 million for Aids prevention among at-risk communities in the current round, LeBlanc said, was “I think perhaps triggered in part by the blogs and e-mails I did in 2013 exposing the Global Fund/MSM and key populations goings on in Cameroon …. The players, including the Fund, took things in hand. They and many other partners such as MSMGF and GNP+ did quite a few seminars on funding and provided other technical assistance to key population groups last year in Cameroon. This led to a successful Global Fund Country Dialogue Process and Concept Note funding proposal.”
LeBlanc predicts that similar progress will occur elsewhere in Africa:
“It’s an old story now – one that likely is being repeated in many nations in sub-Sahara.
“As the Global Fund is now serious about key populations on CCMs, national plans and funding applications, other countries will hopefully fall in line if they expect to receive funding. … The Fund doesn’t accept excuses, and will likely reject country plans that do not comply.
“With key populations and in particular gay men and other MSM engaged, trained, involved and funded, there is real hope the pandemic will finally loosen its grip on Cameroon, and that much of sub-Saharan Africa could see similar progress.”
- Praise for Malawi’s new focus on HIV among LGBTI people (April 2015, 76crimes.com)
- Finally, an LGBT voice on Uganda’s anti-HIV panel (March 2015, 76crimes.com)
- Zimbabwe inches toward battling HIV among LGBT people (January 2015, 76crimes.com)
- Ghana seeks update on high HIV rate for gays, other MSM (December 2014, 76crimes.com)
- Medical centre stripped bare in Douala, Cameroon (November 2014, 76crimes.com)
- World health agency: Fight AIDS by repealing anti-gay laws (July 2014, 76crimes.com)