New Analysis of World’s Premier AIDS Conference Finds Poor Coverage of Populations Most-at-Risk for HIV
Hundreds of Organizations Worldwide Call on Conference Organizers to Increase Meaningful Coverage of Gay Men, Transgender People, People Who Inject Drugs, and Sex Workers
A new report produced by a coalition of global advocacy organizations shows that the International AIDS Conference (IAC) program continues to lack meaningful coverage of populations most-at-risk for HIV, including men who have sex with men (MSM), transgender people, people who inject drugs (PWID), and sex workers. Over 220 organizations from more than 70 countries around the world have called on the organizers of the IAC to take concrete measures to increase coverage of HIV-related issues concerning the health and human rights of these populations worldwide.
The report features a systematic quantitative audit and qualitative analysis of the topics and countries covered by abstracts on most-at-risk populations at the 2012 IAC, also known as AIDS 2012. These populations are also called “key populations,” because they are both key to the epidemic’s dynamics and key to the response. As an in-depth examination of research presented at the world’s premier AIDS conference, the report also offers a glimpse into the current state of research on these key populations globally.
The quantitative audit of the AIDS 2012 program showed that only 17% of all abstracts presented at the conference were exclusively focused on MSM, transgender people, PWID, or sex workers. Some key populations were better represented than others. The percent of all abstracts exclusively dedicated to each key population was 8% for MSM, less than 1% for transgender people, 5% for PWID, and 4% for sex workers.
The qualitative analysis of abstracts on these populations was even more revealing, indicating that more abstracts on key populations focused on individual risk factors (40%) than any other topic, including structural factors [e.g. policy, stigma, violence] (26%); primary prevention (19%); testing, care, and treatment (15%); and surveillance (10%). Only 29% of abstracts on key populations focused on describing interventions, while 71% described vulnerabilities without offering any detailed solutions.
“This meager level of coverage on issues concerning our communities at the International AIDS Conference is unacceptable,” said Dr. George Ayala, Executive Director of the Global Forum on MSM & HIV (MSMGF) and co-author of the report. “Not only was there a comparatively low number of abstracts on key populations at the conference, but the content of these abstracts was largely divorced from the most urgent needs of key populations as identified by members of the populations themselves.”
The report cites the body of abstracts at AIDS 2012 focused on MSM as an example of the gap between the kind of research prioritized by key population stakeholders and the kind of research ultimately presented at the conference. Ahead of AIDS 2012, the MSMGF conducted a global survey of nearly 300 MSM advocates and service providers around the world to identify the topics they felt would be most important to address at the conference. The top three themes were “Prevention,” “Stigma and Discrimination,” and “Law and Criminalization.” Of all abstracts presented at AIDS 2012, the percentage dedicated to these themes in relation to MSM was 1.6%, 0.5%, and 0.3%, respectively.
“After thirty years of AIDS, we know key populations are at much greater risk than the general population in nearly every country around the world,” said Allan Clear, Executive Director of the Harm Reduction Coalition and co-author of the report. “Our communities deserve proper attention, and mounting evidence argues that addressing HIV among key populations is central to ending the global AIDS crisis. It is time for the IAC and the broader AIDS response to start addressing HIV among key populations in a more equitable, more appropriate, and ultimately more effective way.”
In addition to examining the number and focus topics of abstracts on key populations, the report also assessed geographic coverage. Of all abstracts on key populations, nearly 40% focused on North America and Western Europe. A country-level analysis revealed that nearly two-thirds of all key population abstracts were concentrated in 10 countries alone. Of the remaining 79 countries represented in these abstracts, 32 had only 1 abstract on 1 key population. Numerous regions and countries with concentrated epidemics among key populations were either underrepresented or entirely absent.
“The poor coverage of topics concerning key populations, especially from lower-income countries, may reflect inequitable global funding for research on key populations as much as it reflects the IAC’s processes that reinforce these inequities,” said JoAnne Keatley, Director of the Center of Excellence for Transgender Health at the University of California, San Francisco and co-author of the report. “The IAC’s organizers must update the conference’s processes to ensure the event is as valuable as possible for addressing the urgent HIV epidemics among key populations. As the premier platform for sharing the latest research on HIV and AIDS, it must lead the global AIDS research field to do the same.”
“The IAC represents a unique and powerful opportunity to impact the global AIDS epidemic,” said Anastacia Ryan, Global Policy Officer on HIV and Sex Work at the Global Network of Sex Work Projects (NSWP). “The conference offers unparalleled potential to shape the industry’s discourse, funding priorities, and locus of scientific inquiry, giving key affected populations the recognition they deserve as partners in fighting the epidemic. By updating its processes to increase meaningful engagement with and coverage of key populations, the IAC will not only support the development of more effective strategies to address the needs of key populations, it will bring the global AIDS response closer to developing the comprehensive solutions we need to end the epidemic.”
The report concluded with a set of 5 recommendations for measures that can be taken by conference organizers to increase meaningful coverage of key populations at future IACs. The recommendations include conducting community consultations, issuing targeted calls for abstracts, and advocating with large funders and research institutions for more appropriate funding and support for research on key populations. A total of 221 organizations from 73 countries endorsed the recommendations for action.
The full report, entitled “Coverage of Key Populations at the 2012 International AIDS Conference,” is available online at http://www.msmgf.org/files/msmgf//Advocacy/AIDS2012_KeyPopulations.pdf The report was jointly produced by the Global Forum on MSM & HIV (MSMGF), Global Action for Trans* Equality (GATE) , the Center of Excellence for Transgender Health (CoE), the Harm Reduction Coalition, the International Network of People Who Use Drugs (INPUD), Different Avenues, and the Global Network of Sex Work Projects (NSWP).
The full list of recommendations and endorsements can be found online at http://www.msmgf.org/files/msmgf//Advocacy/Action_Alerts/AIDS2014_CCC_Signatures.pdf.
- Coverage of Key Populations at the 2012 International AIDS Conference (sexworkresearch.wordpress.com)
- Anti-AIDS programs ignore LGBTs in Africa (76crimes.com)
Some disturbing news. From Reuters:
The CDC reported that the number of new cases of HIV among black women declined 21 percent between 2008 and 2010, while the incidence of HIV among young gay and bisexual men rose by 22 percent in the same time frame. The rate of HIV infections among black women remains 20 times higher than the number of new cases in white women, and HIV-infected black women account for 70 percent of HIV incidence among all women. Men who have sex with men comprised almost two-thirds of all new HIV infections in 2010.
Joseph Prejean, chief of the Behavioral and Clinical Surveillance Branch in CDC’s Division of HIV/AIDS Prevention, attributed the decline in new HIV cases among black women to HIV testing and the success of HIV
awareness campaigns. “Treatment advances” for AIDS may have caused young men to underestimate their risk and the health threat posed by HIV”, said Prejean. Although anti-retroviral treatment prolongs life, HIV-infected individuals can expect to take medicine for the rest of their lives, at an estimated lifetime cost of $400,000. (emphasis mine)
Young black men who have sex with men have the highest HIV incidence of any population group within the United States. An earlier CDC report stated that 26 percent of new HIV cases occurred among young people age 13 to 24. Half of HIV-infected young people do not know their HIV status, reported CDC Director Thomas Frieden, MD.
Read the full article here.
- HIV Patients Lose More Years To Smoking Than HIV (dgsmith.org)
- CDC: Half of young people with HIV don’t know it (thechart.blogs.cnn.com)
- Breaking News: Young Gay, Bisexual Black Males Hit Hardest By HIV Infection (thebuzzcincy.com)
- CDC Reports Troubling Rise in HIV Infections Among Young People (pbs.org)
Call the Bozeman Public Library for free tickets: 406.582.2426
National Gay Men’s HIV/AIDS Awareness Day – NGMHAAD – is coming September 27, three months to the day after National HIV Testing Day, and hard on the heels of July’s landmark International AIDS Conference (IAC) in Washington, D.C. We have two messages this year: Be aware, know your risk, and, Let’s end this epidemic! Because we matter – and we can.
Speaker after speaker at IAC returned to this year’s good but challenging news: yes, we still need more science to stamp out HIV – more and better antivirals, an effective vaccine, and a functional cure - but we already have all the biomedical tools we need to make new HIV infections a thing of the past. The hard part is reaching “key populations” – groups with high rates of existing infections and new infections because they have been marginalized, stigmatized, denied civil rights, and excluded from health care.
NGMHAAD is for one of those “key populations:” this country’s men who have sex with men (MSM). NAPWA founded NGMHAAD in 2008 because we want them to know the epidemic isn’t over. We want them to know how high their HIV risk really is – because so many are already infected, and too many don’t know it. And we want them to know that we’ve come a long way since AIDS was first reported in 1981, and even further since Stonewall, but stigma is still driving this epidemic and gay men don’t have to take it anymore.
So let’s look at some numbers and see what that the gay men’s HIV epidemic looks like in the U.S.
The July 28 issue of The Lancet opened an admirable series of articles on HIV among gay men worldwide with a look at epidemiology, and reported that HIV prevalence among men who have sex with men in its North American region is a jaw-dropping 15.4% - almost one in six. The real prevalence may be a little lower - The Lancet assumes that only 3.7% of American men are MSM, a number we think is too low, and raising the estimated number of MSM would reduce the calculated prevalence a little – but it’s still clear that prevalence is breathtakingly higher among MSM than in the rest of the population.
Let’s calculate just how much higher.
About 251 million Americans are 15 or older. If 5 percent of the men are MSM, we have 6.3 million MSM and 245 million “others” 15-and-older in this country. We’re all familiar with the CDC’s estimates that 1.2 million Americans are living with HIV, and 60% of them are MSM. That gives us 480,000 infections in 245 million “others,” for a prevalence of 0.2% – one in five hundred. It also gives us 720,000 infections in 6.3 million American MSM, for a prevalence of 11.5% – just shy of one in eight. HIV prevalence among American MSM is almost 60 times what it is in the rest of the population.
That means HIV-negative MSM who are active with partners whose status they don’t know are at much higher risk than many realize. So the first and most important message of National Gay Men’s Awareness Day is – simply - be aware. Know your status. Know your risk. If you aren’t absolutely sure you know your own and your partner’s status, keep your condoms handy.
In September 10′s Positive Voice, we’ll write about how we got to where we are and what’s needed to deal with the MSM epidemic on the ground. Why near-universal testing is so important when prevalence is already so high. The need to confront stigma and talk frankly about sex in communities where this is deeply uncomfortable. The need for pride and love. The need to have culturally competent and welcoming health care for MSM.
And in the September 24 issue, just three days before NGMHAAD, we’ll remember the quarter-million (at least) American MSM who have died of AIDS and examine our responsibility as their survivors to demand action to end this epidemic once and for all. Now that we can, we must.
- Gay Men’s Wives, Homophobia and HIV (dgsmith.org)
- The Ongoing HIV/AIDS Epidemic Among Active ‘Gay’ Men (illuminati360.wordpress.com)
- Gay, bisexual black men at high risk for HIV (thechart.blogs.cnn.com)
- Anti-Gay Stigma And Criminalization Help Maintain HIV Epidemic (thinkprogress.org)
When: September 14 – 16, 2012
Where: Helena, MT
Registration Deadline: September 7, 2012
• Experienced facilitators and educators • Great workshops on accessing resources • Safe and confidential space
To Register, CLICK HERE, or if you have Questions, call:
FDH & Associates ● 406.829.8075 Or email: firstname.lastname@example.org
Also published on Bilerico.com
Yesterday, I posted an article about a press release by the Journal Of The American Medical Association:
“…all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article in the July 25 issue of JAMA, a theme issue on HIV/AIDS. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.”
This follows the “treatment as prevention” model, based on the scientific research that people with HIV on antiretroviral therapy- with an undetectable viral load- are 96% less likely to pass on the virus.
This seems to be very good news. If you have HIV, you should find out early, get on meds and you’ll have a better chance of living a longer healthier life.
So what’s the problem? The problem is twofold:
- People at risk aren’t being tested: 20-25% of all HIV-infected people don’t know they have it.
- People at risk are still not being tested: Gay and Bisexual men of all races are the most severely affected by HIV
That’s not a typo- they’re basically the same reason, but there’s a difference. Any guesses?
Hint: It’s probably why most gay men won’t even read this article.
20-25% of all people with HIV don’t know they have it. Why not?
Here’s my take: Denial is one of the strongest mechanisms in the human psyche. It is fed by lack of information, by avoidance and by a strong desire for an alternative reality. If you’ve had unprotected sex, you’ve probably engaged in the process of denial. You’ve probably downplayed the risk, probably lied to yourself a little. You may have even gone over and over it in your mind, seizing every opportunity to deny the possibility of trouble.
“He looked okay”; “He didn’t seem sick”; “He pulled out”; “He would have told me if he had HIV”, etc, etc, and etc.
Well, we all know where that goes…. As individuals, we’re not facing facts. If we were, we’d be getting tested.
Again, denial applies. Gay and Bi men aren’t talking about HIV anymore. Our friends aren’t dying, so there’s no reason to be concerned. People with HIV aren’t out- aren’t well-known in our communities. Why? I was once told “You don’t need to harp about HIV all the time- it’s not that big of a deal.” Except that it is.
HIV has complicated my life in ways many people can’t believe. I am on catastrophic health insurance through the state- almost three times as expensive as my partner’s insurance. I get assistance for my meds- which cost about $25,000 a year- but (crazily), I can’t make more than $30,300 and still qualify for the program. I have joint pain, sleep issues, battles with depression, fatigue and a body that is aging at several times the normal rate- most probably due to inflammation- the hallmark of HIV disease. And yet, if I talk about this to friends or family, I’m seen as a whiner or someone trying unnecessarily to worry people I care about. It’s the “shut up- at least you’re not dying” defense. I know several HIV+ people who haven’t told anyone of their status, mostly because it’s “uncomfortable”.
As a community, we’re not facing facts. If we were, we’d be talking to our friends about the importance of maintaining our health. We’d be talking about the hard reality of HIV.
But we’re not. Denial still holds sway, both individually and as a community. We’re lying to ourselves- we’re lying to each other- and infection rates stay the same.
We have a chance to change this trend. But only if everyone with HIV starts treatment, gets into care. This recommendation of the AMA may help with that. But it’s not up to doctors, nurses and social workers, it’s up to us.
We’re being tested, both as individuals and as a community. The problem is, we’re flunking.
Because we’re not showing up.
The second video in the Montana social marketing campaign for HIV Awareness:
This HIV prevention animation targeting the MSM population is a playful look at a young bull elk that is looking for a relationship in Montana. As the party music plays he searches the herd for another bull who has been “Checked” (tested) for HIV. This is a creative project that was created by Laura Dybdal and Amber Bushnell as a part of Montana’s HIV Prevention Social Marketing Campaign. It also directs viewers to getcheckedmt.org, a resource to find the nearest HIV testing location in Montana.
The first one was posted yesterday….
One of two new Montana public service message targeting men who have sex with men- check back tomorrow for the second:
This short point of view video targeting Montana’s MSM population looks at the Classified Personal ads and points out some HIV facts that should not be classified and offers some excellent reasons to get tested (checked) for HIV. It also directs viewers to getcheckedmt.org , a resource to find the nearest HIV testing location in Montana.
This creative project was created by Laura Dybdal and Jason Gutzmer as part of Montana’s HIV Social Marketing Campaign.
- Chronicle Reports on HIV In Gallatin County (dgsmith.org)
- HIV+ and Partners Retreat (dgsmith.org)
- Health care debate: high stakes for those with HIV (seattlepi.com)
- Missoula County Sees Spike In HIV Infection (dgsmith.org)
- My Hiv Test Results (thegayjohntucker.wordpress.com)
- Montana Gay-Friendly Health and Mental Health Providers (dgsma.wordpress.com)
- Missoula County Sees Spike In HIV Infection (dgsmith.org)
- My Hiv Test Results (thegayjohntucker.wordpress.com)
- Montana Gay-Friendly Health and Mental Health Providers (dgsma.wordpress.com)
This hasn’t taken that long.
I’m blaming Hillary Clinton and Barack Obama.
The news that HIV treatment is prevention has taken a remarkably short time to hit the mainstream media, and it’s due to Secretary Clinton’s address to the NIH last month, and the President of The United States.
Important new findings show that very early treatment of people infected with H.I.V. enhances their health and greatly lessens the likelihood that they will spread the virus that causes AIDS. We welcome the Obama administration’s announcement of a farsighted effort to treat millions more infected people abroad, especially in sub-Saharan Africa.
The administration expects that the expanded treatments can be paid for with existing resources, by pushing for greater efficiencies and more financing from recipient nations. But if that effort stalls, the administration should re-evaluate quickly whether to ask Congress for money.
… Mr. Obama also announced that he would commit an additional $50 million in this country in fiscal year 2012 to help pay for treatments at AIDS clinics and in-state programs that provide AIDS drugs to people who can’t afford them. The money may be drawn from $1 billion available through the health care reform law.
Working to get these changes made legislatively have proven impossible in a Republican-owned House and a Republican-bullied Senate- especially when it involves the health of gay and bisexual men- so policy and administrative action were required. And by beginning to make testing and immediate treatment for HIV routine, medical practices are established that will be hard to take back.
An estimated 1.2 million Americans were infected with the virus at latest count, of whom 240,000 people are unaware. The Centers for Disease Control and Prevention started a campaign last week to increase testing with special emphasis on warning black gay and bisexual men, whose infection rates have been soaring, to get tested and treated.
Meanwhile, the New York City Health Department became the second (after San Francisco’s) to recommend doctors offer drug therapy immediately to every person diagnosed as infected, instead of waiting for the virus to damage their immune systems. The city has made enormous strides in testing, treating and cutting the number of new infections. Some 110,000 infected residents are under treatment; aggressive testing might find another 2,500 immediately and perhaps 500 a year thereafter.
The investments here and abroad should pay off in the long run by reducing the number of people infected and easing the severity of illnesses.
Thanks to you both.
- Few Americans with HIV have virus under control – msnbc.com (today.msnbc.msn.com)
- Obama to Up Funding for AIDS Treatment, Expand Access to Drugs (foxnews.com)
- Obama on AIDS: ‘We can beat this disease’ (mercurynews.com)
- Secretary Clinton Calls To “Embrace Treatment As Prevention” (dgsma.wordpress.com)