Defining the extent of the HIV

MSM, injecting drug users and sex workers are among the key populations at higher risk for HIV transmission in
many settings, and are often defined as being among the most-at-risk populations. Defining the extent of the HIV
epidemic among MSM and transgender people in many countries is problematic for a number of reasons:
behaviours are stigmatized or even illegal; individuals and populations remain hidden or hard to reach; and the
size of the denominator (population at risk) is undefined.Despite these difficulties, countries are required to report on key indicators for MSM as a component of their
UNGASS reporting, which includes the following:
• Percentage of most-at-risk populations who received an HIV test in the past 12 months and know their results;
• Percentage of most-at-risk populations reached with HIV prevention programmes;
• Percentage of most-at-risk populations who both correctly identify ways of preventing the sexual transmission
of HIV and reject major misconceptions about HIV transmission;
• Percentage of men reporting the use of a condom the last time they had anal sex with a male partner;
• Percentage of most-at-risk populations who are HIV-infected.
In 2007, 83 countries reported on MSM indicators to UNGASS. However, UNGASS indicators are a broad-brush
measure of risk, vulnerability and behaviours among MSM. Correctly defining, identifying and measuring the extent
of risk and vulnerability among these men can be a complex process।
Moving to scale at such a rapid pace required considerable infrastructure and resource inputs, the support of the
community being targeted, as well as of the wider Avahan project. The lessons learned from this scale up can be
summarized as follows:
• A “franchised” approach to HIV prevention services allows for standardization of approaches with room for
local innovation.
• It is possible to work with NGOs with limited experience in working with MSM communities by involving MSM
from the inception stages to help understand their issues.
• Working on social/violence issues is important for demonstrating commitment to the community.
• Local advocacy is stronger when supplemented by advocacy at higher levels.