AIDS in Togo and Cameroon: Empty promises kill

Colin Stewart is a 45-year journalism veteran living in Southern…

AIDS fighters have long recognized that the goal of halting the spread of HIV cannot be achieved without making extra efforts to reach high-risk groups, including gay men.
But often that realization has led to nothing beyond words on paper.
National anti-AIDS plans too often do nothing beyond listing the country’s most-at-risk populations, with little or no follow-up to ensure that high-risk people — many of them social outcasts — are actually served instead of being ignored.
The examples of two African countries — Cameroon and Togo — show how poorly the system works for gays and other men who have sex with men (MSM).
Because they are neglected and shunned, a disproportionately high number of gay men and other MSM are dead or dying because of HIV/AIDS, particularly in sub-Saharan Africa.
This is true even though, a few years ago, UNAIDS (the Joint United Nations Programme on HIV/AIDS) identified several key populations including gay men and other MSM, transsexuals and sex workers, as deserving of strong targeted prevention programs and equitable access to medical services if the pandemic were ever to be brought under control. The Global Fund (Global Fund to fight AIDS, Tuberculosis and Malaria), which finances most AIDS prevention programs in poor countries, accepted this analysis and agreed to provide funds for programs to these key populations on a priority basis.
On paper, countries seem to be coming around to including key populations in their national HIV/AIDS plans and funding proposals. But not so at the next level, where Global Fund grants often are implemented by a non-governmental organization (NGO) designated as a Principal Recipient. Although this method of routing the money through an NGO allows governments to avoid directly funding stigmatized groups, in Cameroon and Togo the targeted key population groups still receive almost no substantial prevention funds or funding for access to needed medical services.

Togo

A small sub-Saharan country in Western Africa of about 7 million people, Togo is sandwiched between Ghana and Benin. In this French-speaking country, homosexual acts are punishable by up to three years in prison and fines of up to about US $1,000. The Togo government reported an HIV prevalence rate of 6.9% for gays and MSM, compared to 2.9% for the general population.
On paper, Togo has an HIV prevention program for gay men that includes free distribution of condoms and lubricant. In reality, it doesn’t.
Under its current grant to Togo (Grant TGO-809-G09-H), the Global Fund budgeted $7.8 million for 2013 for Population Services International — Togo (PSI), the country’s Principal Recipient. It budgeted $12.7 million for this year.

Un panier de condoms (photo de cbc-ca) — A basket fulf of condoms (photo CBC-ca)

Among other programs, the grant provides that PSI is to distribute condoms and lubricant free of charge as part of its anti-HIV work among gay men and MSM in Togo. But three gay and MSM groups, including the local group “Men’s,” receive neither sufficient condoms or lubricants nor any direct funding to purchase them.
At the “Men’s” office, the group is allowed to give out one condom at a time to people who come in for an appointment. “Men’s” is the only group to distribute free condoms and lubricants to gay and other MSM in Lomé, the capital of Togo.
Neither the PSI nor the Global Fund responded to email requests for further information. Questions that they should answer include:

Do the authorities at PSI believe one condom per office visit is sufficient for gay men and other MSM?
Do they expect gay men in Togo to practice abstinence?
Are gay men expected to re-use their one condom until their next office visit?

According to the Global Fund website, a prevention program exists and is funded for gay men in Togo.
Global Fund managers’ assessment of PSI’s performance for 2013 was “UNACCEPTABLE”. In addition, PSI failed to spend nearly $2 million of last year’s $7.8 million grant. This year, the website shows no expenditures from the $12.7 million grant.
More than half the population of Togo subsists on less than $1.25 per day. They cannot afford to purchase supplies of condoms and lube. But millions of dollars in available funding remains unspent.

Cameroon

The situation is similar in Cameroon, a French-speaking country of about 23 million people. Among the Cameroonian population overall, HIV prevalence is estimated at 5.4%. But the rate is at least five to nearly ten times greater among gay men and other MSM, according to the Cameroonian government — 28.8% for those under 25 years of age, 47.8% for those 25 years and up.
As in Togo, homosexual activity in Cameroon is illegal — the penal code provides a maximum penalty of 5 years’ imprisonment and a fine of roughly $40 to $400. Unlike in Togo, LGBT people in Cameroon are often arrested and imprisoned.
As in Togo, the latest performance assessment of the Principal Recipient in Cameroon is rated “UNACCEPTABLE” by Global Fund managers.
On paper, the Global Fund grant (project CMR-011-G10-H) covers HIV prevention work and access to medical care for gay men and other MSM, channeled through the Cameroon National Association for Family Welfare (CAMNAFAW).
But last year CAMNAFAW failed to spend about $2 million allocated for that work. In 2013, it recorded expenditures of only $900,000 out of $2.9 million budgeted to it. It has not yet recorded any expenditures this year, out of a budget of $3.2 million.

In addition, the Global Fund reported in January that it found that CAMNAFAW spent an extra, unauthorized $43,500 for human resources.
That $43,500 was almost double the amount shared by all 50 key population groups funded by CAMNAFAW for six months last year, including gay and MSM groups.

Key groups in Cameroon had to share a total of just $25,000 for the six months ending in December 2013 — an average of about $19 per week per group — an amount so meager as to be almost meaningless.
The 50 key population groups together received only 0.02% of the overall 2013 grant allocated to CAMNAFAW by the Global Fund.

Many of those groups are reluctant to complain about this tiny level of funding, for fear of being cut off entirely. Neither CAMNAFAW nor the Global Fund responded to email requests for further information.

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Hope?

On July 3, the Global Fund announced a new co-chair for its Human Rights Reference Group, which “was created to help guide the Global Fund through all matters relating to human rights and HIV, TB and malaria, both at the policy and at the operational level.”
That new leader is Michaela Clayton, an activist-lawyer from Namibia, who said of her work: “The people we need to reach now are the key populations who are facing human rights violations.”
Clayton is now in a position to look into this type of life-threatening injustice that has proliferated in Togo and Cameroon, and to demand a change.

A plea from the author

I find the situations in these countries not unlike the disastrous state of affairs suffered in most of the West back in the early and mid-1980’s, in the early days of the AIDS epidemic, when LGBT groups and emerging AIDS groups were struggling with our respective governments for funding to combat and to prevent AIDS, but were left to our own resources to help our community.
We cared and we fought while our friends and colleagues died by the thousands.
I had the impression we had come a long way since then, thanks to the work of the UNAIDS and the Global Fund, but clearly we have not made enough progress to significantly reduce the spread of HIV and deaths for key populations living in the Global South, particularly where those populations are criminalized. Empty promises kill.