the world show that the prevalence of HIV and other sexually

Introduction
Surveillance and special surveys in many parts of the world show that the prevalence of HIV and other sexually
transmitted infections (STIs) is high among men who have sex with men (MSM) and transgender people compared
with men in the general population. These infections can be transmitted to their sexual partners, who are men and,
in some parts of the world, frequently women as well. In some countries where the epidemic had previously been
contained, and in countries with good practices, a resurgence of HIV and other STIs has been noted, in particular,
among populations of MSM. The reasons for this resurgence are not well understood. A high HIV prevalence
among MSM and transgender people is being reported from countries that had previously ignored or denied the
existence of MSM in their populations.
Despite epidemiological evidence of a widespread and, in some cases, an increasing problem, available health
sector data show that, in many countries, coverage rates of essential prevention, care and treatment services are
extremely low for MSM and transgender people. Moreover, a large number of countries are not reporting on
indicators specific to MSM and transgender people; therefore, tracking coverage and trends over time is
compromised. Universal access to HIV prevention, care and treatment cannot be achieved without dedicated
action targeting these populations. There is a revival of interest in, and resources dedicated to, prevention, but in
most parts of the world, resources to address HIV/STIs among MSM, transgender people and their sexual partners
frequently do not match the burden of disease and high prevalence rates among them.
Nonetheless, in many countries, there is an increasing awareness at the highest political levels of the specific
needs of, and problems faced by, MSM and transgender people. Social and structural factors inherent in many
societies can and do lead to an increase in risk and vulnerability among MSM and transgender people. Stigma,
discrimination, homophobia and laws that criminalize sexual behaviours make it difficult for such individuals in
many countries to exercise their full human rights, including their right to seek health care, and access commodities
such as condoms and lubricants to protect themselves. Addressing issues of social justice, tackling underlying
inequalities and challenging human rights abuses faced by MSM and transgender populations are key components
of improving health and well-being for all.
The Secretary General of the United Nations (UN) recently called on “all countries to live up to their commitments
to enact or enforce legislation outlawing discrimination against people living with HIV and members of vulnerable
groups” and further called on countries to “pass laws against homophobia.”1 His call to action was echoed by the
Director General of the World Health Organization (WHO), Dr Margaret Chan, who told delegates to the 2008
International AIDS Conference held in Mexico City that “We must work much harder to fight stigma and discrimination,
including institutionalized discrimination.”2
The health sector can and should play an important role in addressing prevention, treatment and care of HIV and
other STIs among MSM, transgender people and their sexual partners. To this end, a three-day consultation was
held in Geneva from 15 to 17 September 2008. The purpose of the Consultation was to identify what more the
health sector should do (see Appendix 1 for the programme of the Consultation).
The specific objectives of the Consultation were:
• To define and describe the populations of MSM and transgender people who engage in same-sex behaviours
in different cultures and geographical regions;
• To examine the current epidemiology of HIV and other STIs among MSM and transgender people in different
geographical regions;
• To review past, current and planned behavioural and interventional studies among MSM;
• To define interventions, including models of service delivery, for the prevention and treatment of HIV and other
STIs among MSM; and
• To identify the best role for the health sector at the global, regional and country levels.
Forty-four participants from 26 countries attended the Consultation. They included members of civil society
organizations, representatives of ministries of health, activists, academics, clinicians and staff of international
nongovernmental organizations (INGOs) and bilateral agencies. Representatives from the Joint United Nations
Programme on HIV/AIDS (UNAIDS), United Nations Development Programme (UNDP), United Nations Children’s
Fund (UNICEF) and staff from WHO Headquarters and Regions also participated in the meeting (see Appendix 2
for the list of participants).