Three major reports have been published recently about HIV prevention and how it is failing those most vulnerable.

The first reports comes from UNAIDS and the World Bank and concerns five sub-Saharan countries: Kenya, Lesotho, Swaziland, Uganda and Mozambique. The survey was conducted to find out how and where most HIV infections were occurring in each country, and whether existing prevention efforts and expenditure matched these findings.

An IRIN report noted that “In Lesotho, where nearly one in four are living with HIV, an analysis of national prevalence and behavioural data found that most new infections were occurring because people had more than one partner at a time, both before and during marriage. But Lesotho has no prevention strategies to address the problem of concurrent partnerships, or target couples who are married or in long-term relationships.

An evaluation of Mozambique’s prevention response found that an estimated 19 percent of new HIV infections resulted from sex work, 3 percent from injecting drug use, and 5 percent from men who have sex with men (MSM), yet there are very few programmes targeting sex workers, and none aimed at drug users and MSM.

The research also found that spending on HIV prevention was often simply too low: Lesotho spent just 13 percent of its national AIDS budget on prevention, whereas Uganda spent 34 percent, despite having an HIV infection rate of only 5.4 percent.”

The second is the latest edition of HIV & AIDS Treatment in Practice (HATIP) with two articles, one addressing prevention and care services for men who have sex with men and transgender people in resource-limited setting and the second reporting on the JEMS study a collaborative effort between the Wits University in Johannesburg, the Human Sciences Research Council (HSRC) and the Medical Research Council investigating HIV prevalence among South African MSM which is twice as high as general population.

HATIP’s editor oberved that “addressing the growing epidemics among MSM must start with two things: an acknowledgment that MSM exist and face enormous stigmatisation in almost all resource-limited settings, and that moral and criminal sanctions are counter-productive in addressing the serious epidemics now emerging.”

And finally Frits van Griensven and colleagues surveyed the global epidemic of HIV infection among men who have sex with men in a review article for Current Opinion in HIV and AIDS (article available on request). After surveying epidemics amongst MSM worldwide, van Griensven concluded,

“Our review shows that the trend of increasing HIV diagnoses among MSM in the Western world is continuing. In addition, steep increases in diagnoses of new HIV infections among MSM were seen in the developed economies of East Asia. In countries where traditional surveillance systems are available, MSM contributed the largest number of new HIV cases, and in some countries, they contributed the majority. A large number of epidemiologic studies have recently established the presence of populations of MSM throughout Sub-Saharan Africa, as well as high HIV prevalence among them. Similarly, populations of MSM with high and increasing HIV prevalence have been identified in Russia, China and in other parts of Asia. High MSM HIV prevalence rates were also seen throughout Latin America and the Caribbean. Globally, only a handful of HIV incidence studies among MSM could be identified, but where available, showed the spread of HIV among MSM to be continuing. Current HIV prevention efforts have been unable to contain or reduce the spread of HIV infection among MSM. Additional behavioral and biomedical interventions are urgently needed.”

Slowly but surely the world of HIV and hopefully the world at large, is awakening to the facts that not everybody is at the same risk of being infected by HIV and that adequate and relevant programmes are needed if we are to eradicate this epidemic one day. And all may start far away from conventional behavioural prevention, but by ensuring human rights for the most vulnerable.

“In countries without laws to protect sex workers, drug users and men who have sex with men, only a fraction of the population has access to prevention. Conversely, in countries with legal protection and the protection of human rights for these people, many more have access to services. As a result, there are fewer infections, less demand for antiretroviral treatment and fewer deaths. Not only is it unethical not to protect these groups; it makes no sense from a health perspective. It hurts all of us.”

Ban Ki-moon, Secretary-General of the United Nations, World AIDS Conference, Mexico City, 2008.

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