’Business as usual’ is no longer a viable response to the HIV-

Introduction
’Business as usual’ is no longer a viable response to the HIV-related risks of men who have sex
with men and transgender people1. Where data exist on HIV in these populations, they show that
our collective responses are failing far more often than they are reaching scale or succeeding. Just
as disconcerting, in many parts of the world, is the fact that few reliable data exist at all.
The Secretary-General’s call of alarm thus comes at a critical moment. It is increasingly clear that
commitment and resources allocated to HIV programming for men who have sex with men and
transgender people fall far short of what is required to achieve universal access to appropriate
HIV prevention, treatment, care and support services across the world. In the June 2008 United
Nations General Assembly High-Level Meeting on AIDS, fewer countries reported on services for
these groups than for any other, and those reports that were made available reflected, on average,
lower coverage levels for men who have sex with men than for the general population or for
other most-at-risk populations2.
The failure to respond adequately to the human rights and public health needs of men who have
sex with men and transgender people is reflected in epidemiological data. Almost universally,
even in generalized HIV epidemics, men who have sex with men are more affected by HIV
than the general population3. Biologically, unprotected receptive anal sex poses a much higher
risk than unprotected receptive vaginal sex, whether that anal sex is heterosexual or homosexual.
In addition, people with marginalized sexual or gender identities or behaviours sometimes lack
the ability or desire to protect themselves from infection, due to structural factors including selfstigmatization,
discrimination and lack of access to information and services. In certain studies,
HIV prevalence among men who have sex with men has been found to be as high as 25% in
Ghana, 30% in Jamaica, 43% in coastal Kenya and 25% in Thailand4. Among transgender people,
HIV prevalence is thought to be even higher. Data presented at the 2008 International AIDS
Conference in Mexico showed HIV prevalences of over 25% among transgender people in three
Latin American countries and prevalences ranging from 10% to 42% in five Asian countries5.
Overall, the HIV epidemic among men who have sex with men contributes significantly to
wider HIV epidemics. In most countries of the world, the majority of men who have sex with
men also have sex with women. In low-income countries, on average, 20% of men who have sex
with men report having sex with women at some time; 16% of men who have sex with men
also report having sex with a women in the last year; and 16% of men who have sex with men
also report being married6. A study in and around Mombasa, Kenya, of men who had sex with