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Bangkok, 6 June 2016
Mr M. Sidibé
Executive Director
UNAIDS
20, Avenue Appia
CH-1211 Geneva 27
Switzerland
Ref. Urgent attention and investments needed to end HIV and AIDS among MSM and
transgender populations in Asia and the Pacific
Dear Mr Sidibé, dear Michel,
With this letter we would like to express our immediate and strong concerns regarding the
attention and investments in the HIV response among MSM and transgender populations in
Asia and the Pacific. Although there is some international attention for the issues of MSM and
trans populations in our region, in general investments and (international) political
involvement are sharply declining, while the HIV epidemic grows at a worrying rate among
MSM and transgender people. The recently published UNAIDS Fast-track update on
Investments needed in the AIDS Response 2016 Reference document has raised the red flag
for us in regard to investments in Asia and the Pacific.
We are disappointed with the not-nuanced claim made on page 12 of the reference document
where it states that “International assistance should continue to focus on low-income
countries, which have lower domestic ability to pay, and priority lower- middle-income
countries with high HIV prevalence and large numbers of people living with HIV….From 2014 to
2020, the share of HIV investment from domestic public sources is proposed to increase from
10% to 12% in 31 low-income countries, from 22% to 45% in 43 lower-middle-income
countries and from 84% to 95% in 42 upper-middle-income countries. This proposed
proportion of future domestic and international investment is consistent with the Addis Ababa
Action Agenda agreed in July 2015 at the United Nations Third International Conference on
Financing for Development."
The assumption that countries in Asia moving to middle-income status means that they will
increase domestic financing to 45% or 95% in 2020 is over-simplistic and far from reality. The
reality is that in our region there is a strong lack of enthusiasm in many countries to look at
the case of men-who-have-sex with men, transgender people and sex workers. The
criminalisation and increasing hostility towards our communities in certain countries will make
it impossible to address the issues and gather support to release domestic financing.
APCOM Secretariat | 66/1 Sukhumvit 2 Road, Klongtoey
Bangkok 10110 | Thailand | +66 2255 4410| [email protected]
Religious extremism and fundamentalism in certain countries will lead to governments shying
away from taking bold steps and actions and preferably silence the situation of key
populations in general. The most recent demands for closure of the UNDP “Being LGBT in
Asia”-programme in Indonesia, the renewed proposing of anti-LGBT laws in Kyrgyzstan, the
introduction of sharia law on a national level in Brunei, attacks on LGBTI activists in Bangladesh
underpin our argument that the assumption is wrong. The international end-HIV targets that
we desperately would like to achieve in our region therefore remain a dream and an out-ofreach vision if key international policy makers base their decisions on assumptions like these.
Instead, we need more attention to the situation of key populations and the development of
the epidemic in Asia.
UNAIDS is unfortunately no exception among many international agencies and donors, which
have limited or ended their financial support for community organisations in our region. This
has serious implications for the sustainability of the community response, as well as the
political engagement on MSM, transgender and HIV issues. National governments will simply
not be interested and held accountable if communities are not able to pressure them and
advocate for the issues concerning MSM, transgender people and HIV. It will concretely mean
that the situation in our region, especially for MSM, will worsen and that the vision as set out
by UNAIDS of ending AIDS in 2030 will not be met in Asia and the Pacific.
To support our call for increased attention and investments, we would like to recall for you the
latest alarming figures of the course of the HIV-epidemic among MSM, especially among young
people. National HIV prevalence is estimated to be more than 5% for men who have sex with
men in at least six countries (China, Indonesia, Malaysia, Myanmar, Thailand and Viet Nam),
and continues to rise in several cities and regions within these countries and also in India,
Mongolia and the Philippines.
Prevalence is particularly high — 15% to nearly 25% — in large urban areas including Bangkok,
Hanoi and Jakarta, among others. In the Philippines, the number of reported HIV cases jumped
from one per day in 2007 to thirteen by August 2013, with men who have sex with men
accounting for ten of those thirteen cases. Many men who have sex with men are becoming
infected at a young age. Already in 2008 the Commission on AIDS in Asia and the Pacific stated
that nearly 50% of all new HIV infections in 2020 will occur among MSM.
Male sex workers are more likely to be infected than their female counterparts in the same
cities, with an HIV prevalence as high as 18%. MSM are extremely vulnerable to get HIV,
especially because of the human rights situation in the region. Nineteen of the forty eight
countries in the region criminalise male to male sex and/or prostitution. MSM are often
subjected to police abuses, extortion, harassment, assault, detention and other human rights
violations. The 2012 report from the Global Commission on HIV and the Law “Risks, Rights &
Health” demonstrates clear evidence how human rights based laws can end an epidemic of
bad laws and transform the global AIDS response, especially for key populations like MSM and
transgender people.
Most worrying was the news that was released by the Asia-Pacific Inter-Agency Task Team on
Young Key Populations, which includes UNAIDS, for World AIDS Day 2015. The Asia-Pacific
region is facing a ‘hidden epidemic’ of HIV among adolescents. There were an estimated
50,000 new HIV infections among adolescents aged 15-19 in 2014, accounting for 15 per cent
of new infections. There are now around 220,000 adolescents living with HIV in the region,
with large cities like Bangkok, Hanoi and Jakarta being the hubs of new infections. It has to be
completely clear: It will not be possible to end the HIV epidemic as a public health threat by
2030 without tackling the epidemic among adolescents.
Another worrying trend can be seen in the funding towards the HIV response in the region.
The report on the AIDS funding landscape in the Asia-Pacific region “Investing for results: how
Asia-Pacific countries can invest for ending AIDS” was launched at the Asia-Pacific
Intergovernmental Meeting on HIV/AIDS in January 2015. The UNAIDS/World Bank
commissioned report states clearly that with many countries in the region graduating to
middle-income status, external funding is shrinking for HIV/AIDS programmes. The
recommendations of the report included introducing funding transition plans to greater
domestic investment, focusing resources where most new HIV infections occur, mainly in key
populations, and protecting funding for civil society. The recommendation is there, funding is
dwindling, but funding transition plans are completely absent.
As outlined above, the issues are crystal clear, as well as the way forward as recommended by
key international and national stakeholders and organisations. The time is now for urgent and
increased investments in innovative regional and national approaches and programmes for
and led by MSM and transgender communities to stop the growing epidemic among MSM and
transgender people in our region.
We call upon UNAIDS to increase its investments in regional and national MSM and
transgender community-led programmes and organisations in order to come to a sustainable
and successful MSM, transgender and HIV response including for organisations doing service
delivery and advocacy. Concretely APCOM proposes the following immediate measures:
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Scale up programmes targeting MSM, transgender and other key populations to have
lasting impact on the course of the epidemic.
The development and implementation of an (inter-)national funding plan for
community organisations in transitioning countries to make sure the community can
access sustainable sources of funding to keep doing its work.
A regional monitoring mechanism being put in place to force countries in the region to
gather and use the evidence and data on the HIV epidemic on key populations and
involve the community on all levels of national HIV planning and programme
implementation.
We are very aware that tough funding choices need to be made at times at UNAIDS’
secretariat, but we do like to stress that in our opinion UNAIDS’ recent decisions on decreasing
or ending support for community organisations and initiatives in Asia and the Pacific is a
missed opportunity to change the course of the epidemic among MSM and transgender
people in this region and will set a negative trend and tone which is easy to follow by other
international agencies.
Already we have noticed that UNAIDS’ example is followed by other agencies, like UNICEF and
UNESCO. UNAIDS has the obligation to be a bold leader in the universal HIV response, both
financially and politically and on all stakeholder levels. It is especially on the community level
that we see its sustainability now being threatened because of UNAIDS’ decisions, which for us
is unacceptable and inappropriate given the crucial and important role of the community in
the regional HIV response.
We would welcome further engagement with your senior staff to explore ways to work
together to stop this decreased investment and engagement and make sure sufficient and
dedicated resources are made available to come to a sustained MSM and transgender
community response and finally end the epidemic among MSM and transgender people in our
region by 2030.
We are looking forward to receiving your response at earliest convenience.
Yours sincerely,
Mr Dédé Oetomo
Chair Regional Advisory Group
APCOM
Mr Midnight Poonkasetwattana
Executive Director
APCOM
Co-signed:
Association of Transgender People in the Philippines (ATP), Philippines
Transgender Resource Center, Hong Kong
AFAO, Australia
AIDS Concern, Hong Kong
Woodwater Center for Healing, Philippines
Tonga Leitis' Association, Tonga
PSDN, Fiji
LoveYourself Inc, Philippines
Trung Tâm Hoạt Động vì LGBT tại Nghệ - Tĩnh (NT.LGBT), Vietnam
Rainbow Pride Foundation (Fiji)
The Help CBO, Myanmar
Dangal Pilipinas, Philippines
SCDI, Vietnam
Diversity and Actions (CODIVA), Timor-Leste
BC, Cambodia
VNMSM-TG, Vietnam
Myanmar MSM Network, Myanmar
Myanmar Youth Stars, Myanmar