Op-ed: To The Most Vulnerable, The Least Reward

More than a decade ago, as countless millions succumbed to the worst pandemic of our time, the world finally said: Enough. What followed was a historically unprecedented response. In a few short years, billions of dollars were dedicated to ending the HIV epidemic and saving the lives of men, women and children throughout the world. This has had a dramatic impact, especially in Southern Africa where the virus has taken an enormous toll.

According to UNAIDS, the rate of new HIV infections occurring annually has dropped by 73% in Malawi, 71% in Botswana, 68% in Namibia, 58% in Zambia and 50% in Zimbabwe over the last 10 years. In Swaziland, which has the highest HIV prevalence in the world, new infections dropped by 37%. This is a staggering accomplishment.  To date, there have been only a handful of public health campaigns that have shown the same scale of success as the response to HIV. Much of this is due to the efforts of national governments in each of these countries and international donor programs like the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

However, in recent years, there has been growing evidence that not everyone has benefited equally. Thanks to the work of researchers at the Center for Public Health and Human Rights  at Johns Hopkins University and elsewhere, it has become increasingly clear that gay men and transgender individuals experience significantly higher rates of HIV infection  than other adults throughout the world.

At amfAR, we sought to understand better why this might be happening, and what we found was surprising. In a year-long examination of financing for HIV programs in the six countries listed above, we discovered that institutional neglect of these men and women was pervasive. Major donors, national governments, researchers, and public health officials intentionally left the most vulnerable groups out of their programs, in many cases under the false assumption that they simply didn’t exist.

The myth that gay and transgender people don’t exist or are “unnatural” in Africa has long been proven false. Yet the impact of these beliefs has been dramatic. In each of these countries, gay and lesbian men and women are criminalized  and can be sentenced to as much as life in prison in some settings. These laws are not only a serious violation of human rights, but have also been shown to significantly undermine the effectiveness of HIV programs. Our research shows that donors have invested negligible amounts of funding to address these impediments.

This inaction has consequences. In Swaziland, more than one in six gay men studied tested positive for HIV, but in the last six years, PEPFAR has only provided funding to prevent new infections among them once, and even then the amount totaled less than 10 percent of all HIV prevention funding for that year.

In Zambia, a country where gay men have been jailed and beaten, the Global Fund has dedicated only $85,000 of the nearly half billion dollars in funding over the last 10 years to reach these men. In total, of the $1.5 billion in funding allocated by the Global Fund since 2001 to the six countries studied, only 0.07 percent was for programs specifically targeting gay and transgender people.

Though our research looked primarily at hard numbers – budgets spreadsheets, funding agreements, and national planning documents – our conclusions point to the more subtle effects of stigma and discrimination. The violence and intimidation that deter these men and women from accessing basic health services stem from the same root cause that prevents donors from fully addressing the public health crisis in these countries: homophobia.

Friday, May 17th is the International Day Against Homophobia, a day dedicated to recognizing and addressing the inequalities that exist because of fear and hatred. Thankfully, several African leaders are doing just that. Festus Mogae, the former President of Botswana, has spoken out publicly on the need to decriminalize homosexuality. Michele Sidibé, the Malian executive director of UNAIDS, has been unequivocal in asserting the need for greater attention to the human rights of gay and transgender men and women in the fight against AIDS. And Malawian President Joyce Banda has been clear about her support  for gay rights, despite later moderating her view.

It’s not just political leaders. Across the continent men and women have stepped out publicly, risking their lives to provide much needed HIV care programs to their friends, neighbors and partners. We could not have accomplished this analysis without the men and women who partnered with us in each of these countries. They have been harassed and threatened for courageously speaking out on the reality of life for gay, lesbian and transgender African men and women and the HIV epidemic among them. They are demanding greater attention from their governments and from donors. As members of the international community, we should pay them their due.  

OWEN RYAN is the deputy director of public policy for amfAR, and one of the lead authors of a new report, “Achieving an AIDS-Free Generation among Gay Men and Other Men who have sex with Men in Southern Africa.”