both men and women found an HIV

both men and women found an HIV prevalence of 12.3%—more than double Kenya’s estimated
adult HIV prevalence of 6.1% at the time of the study (2005)7. In certain contexts, there can also
be significant reinforcement of epidemic dynamics, as some men who have sex with men and
transgender people are also involved in sex work and/or inject drugs. For example, in Hanoi, Viet
Nam, 9% of men who have sex with men reported that they have injected drugs at least once in
their lives8. Addressing the HIV epidemic among marginalized groups is not just important in and
of itself; it is often one of the most effective strategies to reduce heterosexual spousal transmission
and avert larger heterosexual epidemics.
In 2007, the Global HIV Prevention Working Group, convened by the Bill & Melinda Gates
Foundation and the Henry J. Kaiser Family Foundation, estimated that HIV prevention services
reach only 9% of men who have sex with men9. The latest global data available (UNGASS 2008
country reports) on the percentage of men who have sex with men receiving HIV prevention
services show that, while 71% of countries did not report on this indicator, where information
was reported, access to HIV services for men who have sex with men varied from 12% in Africa
to 43% in Latin America10. Little is known about access to appropriate HIV treatment, care and
support for men who have sex with men and transgender people, but it is reasonable to assume
that stigma, discrimination and fear of public exposure mean that, in many countries, these two
groups are less likely to access appropriate services than other groups. There is evidence that
several factors impede access to appropriate HIV interventions: an unwillingness of governments
to invest in the health of men who have sex with men and transgender people and the impact
of social marginalization on the desire to access health-related services and on the equal access
to these services as well as to social benefits. While very little HIV transmission results from
sex between women, structural factors, including sexual violence, may make lesbians and other
women who have sex with women more at risk of acquiring HIV than would otherwise be
thought11. Stigma, discrimination and lack of knowledge regarding lesbians and other women who
have sex with women is also thought to make such women less able to access appropriate HIV
treatment and care services if they are infected. However, given the relatively low prevalence of
HIV among women who have sex with women, this framework document will focus primarily
on HIV among men who have sex with men and transgender people, because of their HIV risk
and burden of HIV-related disease, combined with often systematic discrimination.