Transgender people

In India, the HIV epidemic is seriously affecting men who have sex with men (MSM) and transgendered people.
Credit: UNAIDS

Rupali always felt she was different. Born as a boy in India, she liked wearing girls’ clothes and finally at the age of 20, decided to disclose to her family her gender orientation. She declared she wanted to live as a woman.

“When I first decided to tell people about my sexual orientation and gender identity, I was scared,” said the 22-year-old. “But eventually I told everyone—my family, relatives, neighbours and friends.”

Rupali did several jobs, but found it too difficult to live openly as a man who has sex with men and work in a mainstream office. So, for the past two years she has been a sex worker in New Delhi. With the money she earns from her clients she supports her mother and younger brother. Her mother has had a heart problem for several years and Rupali needs to pay for her costly medicines every month.

But her job threatens her health as Rupali has a high risk of HIV infection.

In India, the HIV epidemic is seriously affecting men who have sex with men (MSM) and transgendered people. Among this population, 427 000 (in 2010) are considered at higher risk because they have multiple sex partners and many receive money in exchange for sex.

“When a customer is drunk, it is often difficult to convince him to use condoms,” said Rupali.

While sex work pays her bills, Rupali has been attacked several times. Like many transgendered people, Rupali finds it challenging to be fully accepted by her family and community. “The local thugs keep us in a constant state of terror. We fear them striking our faces with blades or brutally beating us up. But we fear the police even more,” said Rupali.

In India, the prevalence of HIV among MSM reached 7.3%, which is 20 times higher than among the general population. Recent data shows that HIV prevalence among transgender people in major cities like Mumbai and Delhi has soared even higher to nearly 25%. HIV programmes for MSM and transgendered people are gradually being scaled up.

The Pahal Foundation in Faridabad gets funding from the Haryana state government to provide HIV testing, treatment for sexually transmitted diseases, counselling and condoms to 750 MSM and transgender people, but hundreds more use their facilities every month.

“Everyone needs a support system. Without the support of their families and society, men who have sex with men and transgendered people often take their own lives or run away from home,” said Maksoom Ali, Project Manager at Pahal.

The Foundation has found that only a handful of the people they support are open about their HIV status with their families.

“Employment is a real problem for MSMs and transgender people,” said Manoj Kumar Verma, Outreach Worker at Pahal. “Many of us MSM try our best to appear straight, but eventually we get ‘outed’. I know several people who lost their jobs because they were severely discriminated against by their co-workers.”

There has been some progress in India for men who have sex with men and transgendered people. In the next phase of India’s National AIDS Control Programme (NACP4), there are plans to develop and implement programmes focused on the specific needs of transgender people. Three years ago, the Delhi High court decriminalized sex between adult men in a historic judgement.

Rupali is involved with an organization for MSM in West Delhi and she said she wants to contribute to her community. “Everyone has dreams but not all of them come true,” said Rupali. “That’s true for me too but I want to do something for my community and I want to be a better person.”

Transgender people in Argentina advocating for the passing of the gender identity law.

In Latin America, transgender people face stigma and discrimination based on their gender identity every day. Such situations limit their access to the education system, job opportunities and health services which, in turn, increase their vulnerability to HIV.

However, the commitment and mobilization power of the transgender community have achieved important political and social changes leading to a more pluralistic and democratic society based on the respect for diversity. Some of these achievements have been compiled in "Making Rights a Reality. The experiences of organizations of transgender people" launched on 17 May on the occasion of the International Day Against Homophobia and Transphobia.

Produced by the International HIV/AIDS Alliance, the Latin American and Caribbean Transgender Network (REDLACTRANS) and UNAIDS, the report is a compilation of six case studies. It focuses on the efforts made by transgender organizations in Latin America to achieve an inclusive society based on respect for human rights.

“This work reflects the needs of transgender people in the Latin American context, while highlighting their leadership and how it led to significant political and institutional changes,” said Cesar Nuñez, UNAIDS Regional Director for Latin America. “Only through participation and leadership of transgender people in identifying strategies to protect and guarantee their human rights we can reach a world with zero discrimination,” he added.

Progress has been made in Argentina and Uruguay regarding the legal recognition of human rights of transgender people, the report highlights. In the first case, the passing of a gender identity law confirmed transgender people as full citizens in the eyes of the law. In Uruguay, through a government decree, sex work has been formalized and legalized. Now sex workers are entitled to health insurance, retirement and other benefits.

In Argentina, the transgender organization ATTTA played a key advocacy role in the recent passing of the law on gender identity. “With this law we are claiming our right to identity. We will no more be forgotten by democracy. With this law we are here to make history,” said Marcela Romero, President of ATTTA and Coordinator of REDLACTRANS.

In Honduras and Bolivia, the publication stresses the achievement of transgender people’s participation in decision-making spaces within key structures of the AIDS response such as the Country Coordination Mechanism for Global Fund grants. In addition, El Salvador and Ecuador led initiatives in the field of comprehensive health which, resulted in the development of national programmes that now meet the specific needs of transgender people.

All of these achievements have one thing in common: the leadership of transgender people to demand and defend their rights.

"This compilation is in itself a valuable tool for advocacy and will increase the knowledge about transgender issues in the region and in the world, allowing decision-makers to improve existing programmes and approaches,” said Javier Hourcade Bellocq, the Latin American and the Caribbean Regional Representative of the International HIV/AIDS Alliance.

Mr Bellocq stressed that the leadership and participation of transgender people are essential to achieving social justice and strengthening the rule of law. “We cannot scale up universal access to HIV services if we do not have a strong regulation in place that recognizes gender identity. We need governments to ensure 'zero tolerance' to violence, abuse and crime," said Mr Bellocq.

Message from UNAIDS Executive Director Michel Sidibé

GENEVA, 14 May 2012—In the last year, we have seen greater acceptance of diversity. A new dialogue of openness and tolerance has emerged.

Yet in 79 countries, territories and areas, we still have laws that criminalize same-sex relations between consenting adults. These laws are serious barriers to an effective AIDS response and are driving lesbians, gays, bisexuals and transgender people underground where they cannot access life-saving services.

A society’s value should not be based on money or power. It must be measured by the way it values people, regardless of their sexual orientation or social status. A prosperous society is one that ensures inclusiveness and respects all people.

To our gay, lesbian, bisexual and transgender friends, UNAIDS stands with you.

Your engagement is essential to achieving our vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths.

The HIV epidemic in Latin America is mainly concentrated among men who have sex with men (MSM) and transgender persons.
Credit: UNAIDS

The Inter-American Commission on Human Rights (IACHR) has created a specialized technical unit to strengthen its capacity to protect the rights of lesbian, gay, bisexual, trans, and intersex (LGBTI) people in the Americas.

The IACHR is an autonomous body of the Organization of American States (OAS), with a mandate to promote respect for human rights in the region and act as a consultative body to the OAS in this matter.

The specialized unit, created in January 2012, is part of IACHR’s comprehensive approach to promoting the interdependence and indivisibility of all human rights. It takes into account the specific needs of individuals and groups which have been historically the focus of discrimination. Among its functions, the unit analyzes and investigates individual petitions in which violations of human rights of LGBTI are alleged to have been committed by Member States of the OAS.

The HIV epidemic in Latin America is mainly concentrated among men who have sex with men (MSM) and transgender persons. The latter group has reported HIV prevalence rates of 27.6% in Argentina and of 29.6% in Peru in contrast to an estimated HIV prevalence among the general population of 0.5% and 0.4% in both countries respectively.

In addition, the region has experienced an alarming increase in violence and intimidation towards transgender people and MSM. The Inter-American Commission has received information about murders, rapes, and threats against LGBTI people. The Commission agrees that LGBTI persons face serious discrimination both at social and legal level.

UNAIDS has been working closely with the IACHR in recent years. “UNAIDS and the Inter-American Commission established a strategic alliance, based on a set of actions aimed at achieving zero discrimination and violence, with a human rights approach,” commented Víctor Madrigal-Borloz, Principal Specialist at the Inter-American Commission on Human Rights.

The UNAIDS Regional Director for Latin America Dr César Núñez commended the creation of such a specialized unit. He called upon all countries in the region to fully respect the human rights of men who have sex with men, lesbians and transgender people through “enforcing laws to protect them from violence, promoting campaigns that address homophobia and transphobia and ensuring that crucial health needs are met.”

Expert meeting on violence and impunity against LGBTI people

At the end of February 2012 and under the auspices of UNAIDS, the Commission brought together more than 20 independent experts from academia, human rights institutions, civil society, representatives of security forces, the UN and the IACHR to discuss issues around “violence and impunity against lesbians, gays, trans, bisexual and intersex people”.

The expert meeting was the second of six meetings that will contribute to the first ever Hemispheric Report on Sexual Orientation and Gender Identity. Marcela Romero from REDLACTRANS participated in the meeting and highlighted that “trans people, trans women and men in the Americas face social exclusion that keeps them away from health care, employment and justice, increasing their vulnerability to HIV and human rights violations.”

In 2013, the Commission will evaluate the unit's work and will decide whether to create an Office of the Rapporteur on the Rights of LGBTI Persons.

Representatives from the community of people living with HIV and key populations most at risk urge governments in Asia and the Pacific to work with them to reach global AIDS targets and commitments.
Credit: UN ESCAP

Dressed in a striking blue and red shalwar kameez (traditional dress from South and Central Asia), Akkai, a transgender woman from Bangladesh, steps onto the stage. Turning to her audience of government officials from Ministries of health, justice, public security, drug control, social protection; United Nations officials; and fellow members of key populations most affected by HIV, she started to sing:

“I born as me/ My feelings changed… / I started behaving like a girl / I started walking like a girl / I started dressing as a girl / When my parents forced me to stop myself /  I was beaten up / I was locked up / I was tortured…./ …There was nobody to ask these things / … / This kind of torture, violence, harassment /  Is not faced only by me / Where to live?/ Where to share?/ Where to survive our life?”

Joining the scene, the coordinator of the Women’s arm of the Asia-Pacific Network of people living with HIV explained: “I have been living with HIV for 17 years. Fortunately I have had access to treatment. But now free-trade agreements are compromising access to essential medicines,” she said. “Eighty percent of generic medicines are made in this region. Without access to affordable medicines we cannot get to zero,” she added.

These personal experiences were two of many shared by people living with HIV and key affected populations at the United Nations Economic and Social Commission for Asia and the Pacific (UN ESCAP) high-level intergovernmental meeting held in Bangkok, Thailand from 6-8 February 2012. The meeting was an opportunity to review the region’s progress towards international targets on AIDS.

“For the first time in history we have the possibility to end AIDS and Asia-Pacific nations have shown we can lead the world in making an impact. But we cannot ignore the challenges our region faces and how these can jeopardize our ability to progress,” H.E. Ratu Epeli Nailatikau, President of Fiji, who underlined his long-term commitment and leadership on HIV as Chair of the high-level talks.

Representatives from the most-affected communities urged government delegations from Asia-Pacific nations to recognize the existing challenges in accessing HIV services posed by punitive laws and practices, threats to continued availability of HIV treatment and widespread stigma and discrimination. They also called upon governments to work increasingly with communities to ramp-up action to reach HIV goals.

The call to action was heard. By the end of the three-day talks, co-convened by UNAIDS and other UN partners, the nations present endorsed a framework to fast-track regional action on AIDS towards the achievement of global targets and commitments by 2015. Countries agreed to create ‘spaces’ for key affected communities—including people who use drugs, men who have sex with men, people who buy and sell sex, and transgender people—to be involved in the development of practical solutions to legal impediments and HIV service scale-up at the policy and programmatic level.

“It was recognized here that we have to find new ways to reach the maximum amount of people in the short time we have before 2015,” said UNAIDS Director of the Asia-Pacific Regional Support Team, Steven Kraus. “And there is no question; this must be done hand-in-hand with the community.”

Akkai, a transgender woman from Bangladesh, sings about the stigma and discrimination she faces.
Credit: UN ESCAP

In recent years, Asia and the Pacific has experienced significant progress in reduction of new HIV infections, increase on numbers of people receiving antiretroviral treatment and expansion of programmes to reach key populations most at risk.

Examples given by a number of countries at the Bangkok talks illustrated that scaled up HIV services coupled with intensive engagement of key affected populations, have led to declining epidemics. In Thailand for example, the transgender people-led initiative “Sisters”, which provides social services and support to transgender people in the Pattaya area reports that HIV incidence fell from 12 to 8% among people using its services in the last 5 years.

With such examples of progress, the importance of developing the next generation of community leaders is a central regional priority. The new Asia-Pacific framework for accelerated action underlines that young people from key affected populations must be heard, heeded, and have space at the policy and programme tables.

Emphasizing the readiness of young people most affected by HIV to take on a leadership role in the region’s future HIV response, Coordinator of Youth LEAD, the regional network for young HIV key affected populations, Thaw Zin Aye said: “Young people are taking ownership of the AIDS response and we are committed to carrying on the legacy. We urge governments to continue taking action with us.”

The endorsed regional framework emphasizes the need to share good practices and lessons learned in implementing the measures and commitments related to HIV. Asia-Pacific countries also requested UN ESCAP, UNAIDS and other cosponsors to support implementation of the road map.

Efforts to increase access to HIV prevention and treatment services must be scaled up alongside societal efforts to eliminate homophobia

NEW DELHI, 5 July 2011—UNAIDS lauds efforts by India’s National AIDS programme to provide HIV services for men who have sex with men and transgender people. Currently around 67% of men who have sex with men in India are accessing prevention services. According to estimates of the National AIDS Control Organization, there are more than 400 000 men who have sex with men inIndia; HIV prevalence in this population is about 7.3% compared to a national adult HIV prevalence of 0.31%.

“India’s rich tradition of inclusivity and social justice must include men who have sex with men and transgender people,” said Michel Sidibé, UNAIDS Executive Director, on the side lines of the National Convention of Parliamentarians and elected representatives. “India’s successful AIDS response has been possible due to the strong participation of communities of men who have sex men, sex workers, people who inject drugs and transgender people backed by a strong and progressive National AIDS policy.”

UNAIDS welcomes the call by the Prime Minister of India, Dr Manmohan Singh, to have an “HIV sensitive” policy and programmes so that the marginalized populations affected by HIV are not denied the benefits of health and development programmes. “We should work to assure for them a life of dignity and wellbeing. We have to ensure that there is no stigma and discrimination towards HIV infected and affected persons,” said Dr Singh. During the inauguration of the National Convention, Dr Singh reiterated his government’s strategy to provide HIV services to groups at higher risk of HIV infection.

“There is no place for stigma and discrimination on the basis of sexual orientation,” said Mr Sidibé. “I welcome the bipartisan call by Mrs Sonia Gandhi and Mrs Sushma Swaraj to end all forms of stigma and discrimination against people at increased risk of HIV infection.”

In 2009 the Delhi High Court overturned a law that criminalized consensual adult sexual behaviour. This stand was also supported by the Government of India in its affidavit filed with the Supreme Court.

“Consistent with WHO’s disease classification, UNAIDS does not regard homosexuality as a disease,” said Mr Sidibé. According to the recently released UNAIDS and WHO guidelines on prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people, legislators and other government authorities should establish anti-discrimination and protective laws in order to eliminate discrimination and violence faced by men who have sex with men and transgender people.

UNAIDS is committed to providing support to India’s successful AIDS response, which has seen new HIV infections drop by more than 50% in the last decade. India currently produces more than 85% of high-quality generic antiretroviral drugs for the majority of low- and middle income countries.India’s courts have progressively protected the human rights of people living with HIV and men who have sex with men by striking down discriminatory laws. 

UNAIDS will work with the Government of India, civil society and community groups in realizing the vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths in India.

Credit: Patricia Leiva/OAS

A new resolution adopted by the General Assembly of the Organization of American States (OAS), condemns discrimination against persons based on sexual orientation and gender identity. The same resolution urge states to adopt the necessary measures to prevent, punish and eradicate such discrimination.

Under the theme of “citizen security in the Americas,” the 41st General Assembly brought together Ministers of Foreign Affairs and delegates representing 34 countries to El Salvador from 5-7 June 2011.

“This is a success for us and our work,” said German Rincon-Prefetti, lawyer and human rights activist from Colombia and member of the Coalition of Lesbians, Gays, Transgender, Bisexuals and Intersex populations. The Coalition had been advocating over the past five years to strengthen the resolution to protect their human rights.

The General Assembly provided the opportunity, for the first time ever, to a transgender person to address the members present. Speaking on behalf of the Coalition of Lesbians, Gays, Transgender, Bisexuals and Intersex populations, Monica Hernandez shared the Coalition’s concerns about to the wave of violence and hate crime experienced by sexual minorities in the region. “Acts of violence, human rights violations and discrimination practiced against us because of our sexual orientation and gender identity is the reality of our every day life,” she said.

The HIV epidemic in Latin America remains concentrated among men who have sex with men and transgendered persons. The latter group has reported HIV prevalence rates of 27.6% in Argentina and of 29.6% in Peru. At the same time the region has experienced an alarming increase in violence and intimidation towards transgender and other sexual minorities. “All forms of discrimination and violence—including transphobia—block access to HIV prevention programmes and impact the quality of care for people living with HIV. Working for the respect of human rights is at the core of the HIV response in Latin America,” said Edgar Carrasco, UNAIDS Country Coordinator in Venezuela who represented the joint programme at the General Assembly.

UNAIDS has been working with the Inter American Commission on Human Rights (IACHR) since 2010 to support the development of a Hemispheric Report on Sexual Orientation and Gender Identity. The IACHR is a principal organ of the Organization of American States (OAS), mandated by the OAS Charter to promote the observance and protection of human rights in the region.

German Rincon- Prefetti is optimistic of the impact this resolution will make. “Now we have an instrument to document the human rights violations we are facing and to make changes for the better,” he said. “The new resolution requests IACHR to prepare the Hemispheric Report in time for the next General Assembly to take place in Bolivia in 2012, with the member states full participation and in collaboration with civil society.”

In follow-up to the new resolution, UNAIDS regional office in Latin America, in collaboration with the Pan American Health Organization (PAHO), supported the first of five expert meetings to establish the foundations for the Hemispheric Report on 17-18 June. 

The expert meeting developed a network of resource people linked to HIV and health issues for lesbians, gays, transgender, bisexual and intersex populations that will elaborate a roadmap for the Hemispheric report including the draft State and non-State questionnaire. This will provide the comprehensive and standardized information for the report to be implemented in the 35 countries.       

Organization of American States

The Organization of American States is a regional international organization whose members are the 35 independent states of the American Continent. It is headquartered in Washington, D.C., United States.

Credit: UN Photo/Jean-Marc Ferré

During its 17^th session, the United Nations Human Rights Council passed a historic resolution on human rights violations based on sexual orientation and gender identity on 14 June. Presented to the Human Rights Council by South Africa and Brazil, the draft resolution was cosponsored by 39 countries from all regions of the world. This is the first UN resolution on this subject and it was passed by 23 votes in favour, 19 votes against and 3 abstentions.  

Homophobia and transphobia, which block effective responses to HIV, is institutionalized in many parts of the world. In 2010, more than 75 countries criminalized same-sex behaviour—and in some countries, it is punishable by death. Transgender people often face discrimination and violence with recent killings reported in Guatemala and Honduras among other countries.

Entitled Human rights, sexual orientation and gender identity (L.9/Rev.1), the resolution calls for four key actions, including a request to the High Commissioner for Human Rights to commission a worldwide study to document discriminatory laws, practices and acts of violence against individuals based on their sexual orientation and gender identity. The study will also outline how international human rights law can be used to end violence and related human rights violations based on sexual orientation and gender identity.

The council also decided to convene a panel discussion to take place during the 19th session of the Human Rights Council, informed by the findings of the study commissioned by High Commissioner. This panel will aim to hold constructive, informed and transparent dialogue on the issue of discriminatory laws and practices and acts of violence against individuals based on their sexual orientation and gender identity.

“This resolution is an important step for the international community. We must remove all barriers that prevent people from accessing HIV-related services because of stigma and discrimination based on sexual orientation and gender identity,” emphasized UNAIDS Executive Director Michel Sidibé.

The recently adopted General Assembly Political Declaration on HIV/AIDS: Intensifying our efforts to Elimination HIV/AIDS, mentions for the first time men who have sex with men as a specific group at higher risk of HIV and states that “many national HIV prevention strategies inadequately focus on populations that epidemiological evidence shows are at higher risk.”

In 2009, 63 out of 67 countries reported a higher HIV prevalence among men who sex with men compared to the general population. Homophobia and transphobia block effective responses to HIV, driving already vulnerable populations underground and out of reach for HIV prevention and treatment services. 

UNAIDS’ strategy 2011-2015: Getting to Zero calls for a revolution in HIV prevention to reduce by half new sexually transmitted HIV infections by 2015, including among young people, men who have sex with men and transmission in the context of sex work—a global goal echoed by the 2011 Political declaration on HIV/AIDS mentioned above.

GENEVA, 21 June 2011—New public health recommendations from the World Health Organization (WHO) and partners aim to help policymakers and doctors scale up access to treatment and prevention services for HIV and sexually transmitted infections among men who have sex with men and transgender people. These are the first global public health guidelines to focus on these specific population groups.

There has been a recent resurgence of HIV infection among men who have sex with men, particularly in industrialized countries. Data are also emerging of new or newly identified HIV epidemics among men who have sex with men in Africa, Asia, the Caribbean andLatin America. Generally, men who have sex with men are nearly 20 times more likely to be infected with HIV than general populations. HIV infection rates among transgender people range between 8 to 68% depending on the country or region.

One reason for this is the stigma experienced by many men who have sex with men and transgender people. In many countries, criminalization of same sex relationships drives such relationships underground, making people afraid to seek HIV prevention and treatment services. WHO and its partners advise more inclusive approaches and suggest some practical ways to improve their access to HIV prevention, diagnosis, treatment and care services.

"We cannot imagine fully reversing the global spread of HIV without addressing the specific HIV needs of these key populations," said Dr Gottfried Hirnschall, WHO's Director of HIV/AIDS Department. "We are issuing these guidelines to help countries and communities scale up the services needed to reduce new infections and save lives."

"Men who have sex with men and transgender people everywhere face huge difficulties in accessing HIV services," said George Ayala, Executive Director of the Global Forum MSM & HIV (MSMGF), a key partner in producing the recommendations. "The guidelines both present evidence for effective prevention interventions for these populations and provide recommendations to help ensure that pervasive barriers like stigma and criminalization no longer stand in the way of life-saving services.” 

The new guidelines "Prevention and treatment of HIV and other sexually transmitted infections (STIs) among men who have sex with men and transgender people: Recommendations for a public health approach" provide 21 recommendations for actions to be taken by multiple stakeholders, in close cooperation with men who have sex with men and transgender people, including:

• For national policy-makers: To develop anti-discrimination laws and measures to protect human rights, and to establish more inclusive services for men who have sex with men and transgender people based on their right to health
• For health service providers: To offer HIV testing and counselling followed by treatment for patients with CD4 count 350 or below as recommended in the WHO 2010 HIV treatment guidelines
• For communities: To scale up behavioural interventions for the prevention of HIV and STIs among men who have sex with men and transgender people
• For affected individuals: Practice consistent condom use over choosing partners based on HIV infection status (sero-sorting)

"Urgent action is needed to ensure that the basic human rights of people most at risk of HIV infection are respected and that they have the information and tools to protect themselves against HIV and gain access to antiretroviral therapy if needed,” said Mariângela Simào, Chief, Prevention, Vulnerability and Rights, UNAIDS.

The WHO guidelines have been developed over the past year through global consultations involving public health officials, scientists, and representatives from donor organizations, civil society and health service providers. The new guidelines can be found at: http://www.who.int/hiv/pub/guidelines/msm_guidelines2011/en/ .

Credit: UNAIDS/P.Virot

Men who have sex with men (MSM) and transgendered people are amongst the most stigmatized populations in the Middle East and North Africa (MENA). In spite of social tension and sensitivities, most countries in the region have recognized the importance of programming for, and working with, MSM to strengthen effective national AIDS responses. Nevertheless, existing prevention programmes have remained limited in scope and scale, highlighting limitations in coverage and quality.

In this context, UNAIDS brought together representatives from civil society, governments, national AIDS programmes and regional and international partners to a workshop in Lebanon to discuss ways to scale up interventions that focus on the needs of MSM in the region.

The workshop was organized in collaboration with Helem-Lebanese Protection for LGBT association, the International AIDS Alliance (AA) and the Regional Arab Network Against AIDS (RANAA). It focused on the outcomes of a policy research project entitled “Enabling Access to HIV Services for Men Who Have Sex with Men - Situational analysis and Partnership Development”. The main purpose of the research, conducted in Algeria, Lebanon, Morocco and Tunisia, was to identify ways to enable and facilitate this access to HIV services.

Existing repressive laws and policies deter MSM from seeking HIV prevention, treatment, care and support services.  Currently 18 of the 21 countries that form the MENA region criminalize male to male sex behaviour—and 4 enforce capital punishment.

Participants at the meeting highlighted the importance of creating enabling environments that allow unrestricted dissemination of prevention messages and services, appropriate provision of HIV treatment, care and support services, and the empowerment of MSM and transgender population in planning, implementing and evaluating programme strategies.

Participants also reviewed a handbook developed by UNAIDS, based on field experiences and lessons learnt, to inform effective, expanded and culturally sensitive programmatic interventions among MSM and transgender people.

“Most programmes in MENA are still at a pilot stage. We need to scale up current programs using the extensive experience over the last years. This handbook, adapted to the region’s context, will hopefully inform interventions among MSM and transgender people,” said Ms Nicole Massoud, Regional Monitoring and Evaluation Advisor for the UNAIDS regional support team.

There are no reliable estimates of the number of men who have sex with men in the region. However, there is documented evidence of increased HIV spread and risk among MSM and transgender people, which may result in concentrated HIV epidemics over the next decade.