Routine HIV and STI surveillance and case reporting

Routine HIV and STI surveillance and case reporting should include appropriate information on MSM and
transgender people, and the data should be age-disaggregated.
In order to accomplish this, every country should conduct formative and operations research if these have not
already been undertaken. Such research should include a focus on elucidating and understanding the risk
environment, as well as operations research focused on evaluating models of service delivery. Research should
be tailored to meet the needs of specific groups of MSM and transgender people, for example, young men and
adolescents, men in specific settings such as prisons or the uniformed services. This should include a stated
element of capacity building for local institutions to conduct the research with community support. Interventions
should be monitored and periodic evaluations planned for and undertaken.
Surveillance, surveys, monitoring and evaluation of and research on MSM and transgender people should adhere
to the highest standards of internationally accepted research ethics, and include these groups in research design,
implementation and dissemination of results.
2. Provide basic services for HIV and other STIs
Participants at the meeting recognized that it is critical to complement HIV prevention for those who are uninfected
with services for PLHIV. For PLHIV, preventing inadvertent HIV transmission is only one of their needs. Others
include preventing illness, receiving care for opportunistic infections (OIs) and accessing ART. Further details on
recommended services for PLHIV are given in Essential prevention and care interventions for adults and adolescents
living with HIV in resource-limited settings.17
Basic services that should be made available for all include the following:
• Provision of condoms and lubricants for MSM and transgender populations;
• Outreach and information, education and communication (IEC)/counselling services on sexual health, risk
reduction and substance use;
• HIV testing and counselling;
• Detection and management of STIs including appropriate services for the diagnosis and treatment of oral and
rectal infections;
• Provision of ART for MSM and transgender people who are HIV-positive and meet the recommended criteria
for ART, as well as appropriate therapy to prevent or treat OIs;
• Where resources permit and the epidemiological picture justifies it, it is recommended that hepatitis B
vaccination be made available for all MSM and transgender people.
3. Adopt a sexual health approach for MSM and transgender people
Participants emphasized the need to take a holistic approach to providing prevention and care services for MSM
and transgender people. While prevention and care of HIV and other STIs was the prime focus of the Consultation,
there was widespread recognition that provision of these services alone will not adequately meet the health needs
of MSM and transgender people. Adopting a sexual health framework means acknowledging the rights of MSM
and transgender people to also receive the following kinds of services:
• Support for sexual health problems that give rise to sexual dysfunction, anxiety, psychological problems, etc.;
• Care for substance use issues;
• Care for victims of violence, and referral to violence prevention programmes;
• Specific care for other clinical problems in the genital area (e.g. anal fissure);
• Provision of comprehensive care for gender reassignment, including appropriate use of hormonal therapy;
• Delivering priority interventions within a framework of sexual health care which includes, inter alia, discussions
of relationships, self-esteem, body image, sexual behaviours and practices, spirituality, sexual satisfaction
and pleasure, sexual functioning and dysfunction, stigma, discrimination, alcohol and drug abuse.
Some participants emphasized the desirability of providing a service that is able to meet the needs of individuals
throughout the life-cycle. Such an approach would recognize that risk is not static, but changes with age. For
example, younger MSM and transgender people may be involved in more high-risk activities compared with older
ones.