Regional Overview of HIV/AIDS Prevention, Care and Support Programmes for MSM

On the first day, participants were given an overview of the epidemiological situation of male-to-male transmission. Then came presentations by the national AIDS programmes and NGOs from four subregions of Latin America and the Caribbean. A reporting group synthesized the information; its conclusions highlight the following challenges:

· Dehomosexualization of AIDS in Latin America and the Caribbean: Most national and regional AIDS programmes are unaware that male-to-male transmission of HIV is predominant in the region;

· Decentralization: Throughout the region, health-care programmes are being decentralized, presenting new challenges to raise awareness and train local AIDS programme managers;

· Policies of health-care systems: In most countries in the region, new policies are being implemented with a strong focus on the cost-benefit/efficiency of HIV/AIDS programmes, often with negative implications;

· Lack of indicators: There is a lack of appropriate and dependable indicators to evaluate projects targeting men who have sex with men;

· Community development versus professionalism: There is a constant clash between experience in the field and the position of NGO professionals.

· Low political commitment: On almost all levels throughout the region, political commitment to implementing adequate HIV/AIDS prevention, care and support programmes is lacking.

· Good NGO/governmental relations, but scant action: Although there are many good relationships between NGOs and governments, these are seldom converted into project financing and implementation;

· Low political influence on HIV/AIDS policies: In general, NGOs and CBOs have little power or influence over governments’ HIV/AIDS policies and are in a poor position to make demands on their governments for concrete action.

· Corruption and nepotism: These phenomena exist throughout the region, and so funds are frequently allocated as a result of “connections” or as “political favours”;

· Human rights: Men who have sex with men face social, cultural and sometimes legal and economic discrimination because of their sexual behaviour. HIV/AIDS prevention, care and support programmes must be accompanied by activities which promote equality and non-discrimination;

· Poor understanding of epidemiology: Epidemiological information in the region is often poor because of under-reporting. Where there is reliable information, it is frequently not used to direct HIV/AIDS programmes.