could play in addressing the HIV and STI prevention

The Consultation focused on the role that the health sector (see Appendix 4 for the WHO definition of health sector)
could play in addressing the HIV and STI prevention, care and treatment needs of MSM and transgender people.
The health sector is not limited to those services that provide clinical treatment and care services, but includes
activities aimed at promoting and maintaining health. These services can be delivered by a broad range of
institutions. The Consultation identified key components of both prevention and care interventions for preventing
and treating HIV and other STIs in MSM and transgender people. It also identified a number of underlying principles
which should guide the provision of these interventions and services in all settings. Predominant among these were
the implementation of a rights-based approach, and the need for partnerships to increase coverage of services.
• A rights-based approach
Adopting a rights-based approach guarantees the human rights of MSM and transgender people, and ensures
that they and their male and female sexual partners have the right to information and commodities that enable
them to protect themselves against HIV and other STIs, protection from discrimination and criminalization, as
well as information on where to seek appropriate care for these infections. Importantly, it also ensures their
right to access appropriate and effective prevention and care services of the highest possible quality, delivered
free from discrimination.
• Knowing the epidemic
Knowing the epidemic and the response to it means knowing where infections are occurring, who is at risk or
vulnerable and who is infected. It also means understanding the local, social and structural determinants of risk.
• Partnerships
Addressing the HIV and STI epidemics among MSM and transgender people cannot be achieved by the
health sector alone, though it plays a crucial role. It requires partnerships and engagement both across sectors
(particularly with the legal and education sectors) and, crucially, with the MSM and transgender communities.
Recommendations
1. Collect strategic information
Knowing the epidemic and the response to it means knowing where infections are occurring, who is at risk or
vulnerable, who is infected, and how programmes are performing in order to reduce risk and vulnerability and
provide interventions. It also means understanding the local determinants of risk, including its social and structural
determinants. Understanding the barriers that MSM and transgender people face in fulfilling their sexual, social
and economic lives will be key to identifying what works for the control of HIV and STI epidemics in different
settings.
Countries should conduct surveys with MSM and transgender people, at a minimum in urban settings (capital and
main cities). These surveys should address:
• Population size estimation (denominator). This could be addressed through the inclusion of appropriate
questions on sexual behaviour in population-based surveys such as demographic and health surveys.
• Biological and behavioural indicators which focus on:
Sexual identity;
Sexual practices (use of barrier methods, sexual preferences, unprotected anal sex, sex with different
partners including women);
Understanding sexual and social networks;
Experiences of stigma and discrimination in a variety of settings including health services;
Use of drugs and alcohol;
Availability and coverage of services;
Inclusion of the core UNGASS indicators (as noted earlier).