developing HIV epidemic to the existence

Programmatic responses and models of service delivery
In many countries, care is delivered through the model of an integrated service, where clients can receive all
needed services at one stop. Even countries such as Thailand, which owe their early success in stopping a rapidly
developing HIV epidemic to the existence of a large network of STI clinics and the surveillance data they generated,
have adopted the integrated model and now provide, or attempt to provide, a variety of services under one roof.
However, although integrated services are appealing, attempting to deliver this model in many settings is beset
with barriers, not least a shortage of the required resources, especially human resources to run the clinics. Providing
targeted services for particular population groups (such as MSM and transgender people) may be particularly
challenging in these circumstances.
The Consultation heard examples from a number of countries detailing how the health sector addresses the
specific issues faced by MSM and transgender people.
5.1 Country-level responses
The following country data were presented at the meeting.
5.1.1 Brazil
The HIV prevalence in the adult population in Brazil is estimated at 0.8% in men and 0.42% in women, while for
MSM it is 4.5–10.8%, with evidence that an increasing number of cases is being seen in younger compared with
older men. The Government of Brazil has outlined opportunities for addressing MSM and transgender people in its
national health plan, and aims to reduce vulnerabilities and implement appropriate responses for HIV prevention,
health promotion and access to integral care. The opportunities to conduct programmes for MSM and transgender
people are enhanced by the existence of active social movements in the country, and a protective legislative
environment.
5.1.2 China
At the end of 2007, there were an estimated 700 000 people living with HIV (PLHIV) in China, with an annual
incidence of 50 000 newly infected people that same year. Among the newly infected, it is estimated that 12% were
MSM. Surveys in one city (Chengdu) showed an increase in HIV prevalence among MSM, from 0.6% in 2003 to
10.6% in 2007.
The Government of China has outlined specific responses and interventions for addressing the prevention and
care of HIV among MSM populations:
• Providing dedicated financial support for community-based organizations
• Developing national working protocols and guidelines
• Organizing an annual meeting on preventing HIV in MSM
• Organizing a systematic training programme for the staff of the Chinese Centers for Disease Control and
Prevention and MSM peer educators
• Providing free condoms and lubricants for MSM.
During the period 2007–09, the Government is funding a national pilot programme aiming to provide comprehensive
HIV control for MSM. It is being implemented in 61 cities across the country and, in addition to enhanced clinical
care services including STI services, the surveillance system has also been strengthened. Furthermore, interventions
such as the use of popular opinion leaders for improved behaviour change communication are being implemented
across the country. These strategies are being supported by involving managers or owners of entertainment
venues (gay bars, saunas, bath houses), i.e. sites where high-risk behaviours may be taking place. Despite this
level of activity, some challenges remain, such as a low uptake of HIV testing among MSM, continued reports of
low condom use at last anal intercourse (between 40% and 50% in most surveys), and widespread stigma.
5.1.3 Mexico
Mexico registered its first case of AIDS in 1983, and now has an estimated 200 000 PLHIV, of whom 125 000 are
MSM. The epidemic is highly concentrated among men, with a male:female case ratio of 5:1. It is estimated that
MSM in the country have a 109 times higher risk of being HIV-positive (prevalence in MSM 15%) compared with the
general population (adult prevalence 0.3%).