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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: 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