A new joint report by the UN Development Programme and the Asia Pacific Coalition on Male Sexual Health finds that 90% of homosexual and bisexual men are denied HIV/AIDS related care due to hostility and discrimination in Asian countries towards these groups. The report was released to coincide with May 17th as the International Day Against Homophobia, and coverage of the report has largely highlighted the role of stigmatization in law and society as a major player in the skewed (higher) HIV prevalence within MSM communities-- particularly in countries where homosexual sex is illegal. In countries without actual criminalization however, stigma and targeted police hostility still create barriers to access. Of course, this won't be new information for many. But what I did find interesting was this quote from Mandeep Dhaliwal of the UNDP: "The effectiveness of the HIV response will depend not just on the sustained scale up of HIV prevention, treatment and care, but on whether the legal and social environment support or hinder programs for those who are most vulnerable."
At the same time, PEPFAR has made gender-based violence a priority for HIV prevention, and has allocated additional funding (USD 30 million) for scale up of responses to gender-based violence with particular focus on the Democratic Republic of Congo, Mozambique, and Tanzania.
Together, these amount to a recognition of the need for a holistic approach to HIV prevention that includes the risk environments in which vulnerable communities live, work, and access (or don't) health services. But at the same time, there seems ample room left to pursue a more integrated means of addressing these risk environments in programming and policy.
My colleagues and I have been discussing structural risk reduction in HIV prevention programs-- particularly in large-scale programs, where understanding of the diverse locally-specific contexts can be so important to efficacy and yet so elusive precisely because of a program’s large-scale. To address this challenge, we have been contemplating practical tools that can help programs considering scale to plan and implement activities that integrate locally-appropriate responses to diverse risk environments even as they take on the myriad other components necessary to keep a large-scale program running. --Does anyone have practical tools they have used to help map out how to integrate structural risk reduction activities into their HIV prevention programs? --Or how to figure out what "appropriate" risk reduction activities would look like for a diverse pool of local community contexts?
Links to relevant news coverage: