[dropcap]W[/dropcap]hen you think about the global HIV/AIDS epidemic one big funding source stands out, the Global Fund to Fight AIDS, Tuberculosis and Malaria.
But there’s another important organization, albeit less known, that’s been connecting big funders and community groups on the front lines of the HIV response for almost a decade.
MSMGF (The Global Forum on MSM & HIV) is an expanding global network focused on sexual health and human rights for all men who have sex with men.
With a full-time staff of only a dozen, mostly in Oakland, California, it works with a budget under $5 million annually, much of it coming from the Dutch Ministry of Foreign Affairs. Its dollars are stretched far.
MSMGF supports programs across fifteen countries—including Nigeria, Cameroon, Ghana, Tunisia, Costa Rica, Vietnam, and Honduras, to name a few—as a middleman to help direct money from the Global Fund to community groups and NGOs that can reach gay men and MSM.
And it also helps regional LGBT and HIV/AIDS groups apply and secure funding on their own, for MSM-specific HIV prevention and treatment programs. It also encourages countries to include MSMs in their national AIDS strategy.
All of these efforts are necessary due to what MSMGF’s executive director calls the de-gaying of HIV/AIDS prevention and outreach funding over the past fifteen years. In order to circumvent homophobia and make the AIDS epidemic more palatable to the masses, the focus was aimed at women and children even when gay men bear a disproportionate HIV disease burden.
In 2014 the World Health Organization warned HIV among gay men and non-gay identifying men who have sex with men (MSM) was on the rise around the world. But in many countries, especially in the developing world, gay men or men who have sex with men are stigmatized, even criminalized, if they’re considered at all.
That means these men are less likely to receive information on safer sex, less likely to get tested, and less likely to seek treatment if they do test positive.
“Around the world it is hard to frame HIV in terms of sexuality. In the late nineties there was a deliberate effort to de-gay AIDS and that was a mistake from the global perspective, because it communicated that it didn’t matter what happened to gay men,” says executive director George Ayala.
Ayala says the needs of gay men have never been resourced well enough over the thirty-plus years of the HIV/AIDS epidemic.
“Even in the U.S., state and local officials are reluctant to fund MSM-specific prevention and outreach when you get away from the coasts,” Ayala tells A&U.
Advocacy and accountability
The Global Fund to Fight AIDS, Tuberculosis and Malaria, often called The Global Fund or GFATM, is a public-private partnership founded in 2002 and is the largest financier of anti-AIDS programs in the world. But it’s not an implementing agency. It’s overseen by Country Coordinating Mechanisms, which includes in-country stakeholders and private sector groups. The Global Fund recognizes country ownership of the HIV/AIDS epidemic and lets each country define the nature of the epidemic.
That means some countries, specifically those who don’t recognize HIV among MSM as a problem or countries openly hostile to gay men, are likely to exclude treatment, outreach, and even research focusing on MSM from their applications to the Global Fund.
In a sense the Global Fund doesn’t discriminate. If a country wants money for MSM-specific outreach, it just has to ask for it. But even if a country asks, the Global Fund doesn’t have the oversight to ensure adequate security, for example, to prevent ransacking of UNAIDS materials (this happens at clinics), or to prevent violence against gay men who seek health services (this happens too).
MSMGF wants to “re-gay” the HIV funding in several ways. One is by brokering relationships with these countries at the Geneva-level (where The Global Fund is based), according to Nadia Rafif, MSMGF’s Senior Policy Advisor.
“We are not a donor, but we help LGBT-friendly NGOs and local advocates find and apply for the money they [local organizations for MSM] need,” Rafif tells A&U.
“The money goes from the Global Fund to a country’s Ministry of Health, and is directed to local groups. Some of our work involves information sharing. We may hear of an open call for a proposal one month, and we go to the NGO and help them draft a proposal that includes programs specific to gay men and MSM.”
Or a country may say that it has no data on MSM, and therefore wouldn’t know what to ask in terms of dollars for prevention and treatment. MSMGF will broker the relationship between that country and Geneva to make sure the country has the funds for research, and that the research actually happens.
MSMGF also advocates for MSM-specific national training with a country’s Ministry of Health. Rafif points to successes, especially in Morocco, in getting a Ministry to recognize that MSMs are at high risk and that HIV among these populations is a true public health crisis.
Swimming against a current of homophobia
Any exploration of HIV/AIDS funding priorities can get a little wonky. But while MSMGF acts as a financial middleman and MSM advocate at the highest levels, it also has a substantial impact in helping gay men access testing and treatment services in regions that are either indifferent or openly hostile to gays.
Specifically, it offers training sessions for community groups, public health officials and policy leaders, and it trains local activists to advocate for services for MSMs from their governments.
It’s a tricky business doing so, due to the politics of the countries involved. That’s one of the reasons MSMGF has such a low profile. The very idea of men having sex with men is verboten in many places MSMGF operates.
Take Zimbabwe, where homosexual acts are prohibited as they are in many African nations. President Robert Mugabe has condemned LGBTs, calling them “worse than pigs and dogs.” Gay rights activists in Zimbabwe claimed to have been abused and tortured in police custody, after being accused of possessing gay porn.
In such a political and cultural environment only the bravest MSMs will access health care and be open about their sexuality with physicians.
“The number-one predictor of negative access to healthcare [for MSM] is homophobia,” says Mohan Sundararaj, the director of public health programs for MSMGF. He says his group is constantly “swimming upstream” in the face of anti-gay hostility in Zimbabwe and other countries.
The discrimination can be subtle and overt.
“Men may go to a clinic for treatment for an STI and named and ridiculed by nurses and doctors,” Sundararaj tells A&U.
But in only two days of pilot testing their healthcare-training curriculum training, coordinated with a local LGBT group and experts from Johns Hopkins University, Sundararaj saw a huge attitude shift among physicians.
“There were doctors who said they had never met a gay person before,” Sundararaj says. “But in two days of clinical and cultural sensitivity training, these same healthcare workers understood how to discuss patients’ sexual histories, what the critical issues are for gay men’s health and how to develop networks of understanding physicians and facilities across a region.
Nobody at MSMGF thinks that their organization alone can turn around the fierce antigay cultures that exist in many countries. And the organization is not taking over the role of LGBT and HIV activism in Zimbabwe and other countries it works with.
Rather, its role is helping to strengthen local networks, training trainers and facilitating intra-country networks.
“We want Kenya and Zimbabwe LGBT and HIV networks and prevention experts to exchange knowledge, for example,” Sundararaj says.
The Zimbabwe training Sundararaj participated in is synergistic with MSMGF’s “Speaking Out” initiative, a turnkey program to help community leaders across dozens of countries document discrimination in hospitals and ask leaders of NGOs to develop action plans to prevent discrimination.
Even with the escalation of homophobia and the expansion of criminal sanctions against HIV transmission and homosexuality, MSMGF says they expect to expand the capacity for gay communities to be proactive in advocating for resources.
“But unfortunately, the efforts and money needed to reach MSM in these countries is still not in proportion to the level of the epidemic,” Sundararaj says.
“The Re-gaying of the global HIV Epidemic” is the theme of MSMGF’s pre-conference, part of AIDS 2016 in Durban, South Africa, in July. For more information, go to www.msmgf.org.
Larry Buhl writes A&U’s Hep Talk column.