Director of the National Aids Programme Secretariat (NAPS) Dr Shanti Singh has described a recent study which found that existing programmes in Guyana for men who have sex with men (MSM) are small scale as not being “entirely true.”
Dr Singh said some of the nine organizations that do work with civil society do work with the vulnerable group and are very effective.
She revealed to the Sunday Stabroek that the organizations were chosen by an independent technical review panel which selected the programmes that received funding from Global Fund.
According to Dr Singh it was not a case of the Global Fund giving the money to work specifically with MSM but rather the money was given and then a call for applications was made and based on the proposals the organizations which received funding were selected by the technical review panel.
“In the most extreme case, funding for MSM programmes supported by the Global Fund in Guyana dropped by 96% between initial proposal and final budget,” said the report released last week by amfAR, The Foundation for AIDS Research and the Center for Public Health and Human Rights (CPHHR) at Johns Hopkins University.
According to the study, which was conducted by students in eight countries, despite HIV prevalence among MSM in Guyana being nearly 20 times that of the general population, “prevention efforts are hampered by criminalization that prevents many government bodies from directly addressing the HIV epidemic among MSM; programmes, where they exist, are limited to small-scale behavioral interventions.”
The report on the study, titled ‘Achieving an AIDS-Free Generation for Gay Men and Other MSM,’ found that funding to prevent and treat HIV consistently fails to reach programnes designed to control the disease among gay men and other men who have sex with men.
The report also found that resources dedicated to addressing the epidemic among MSM are “grossly insufficient, and that funding intended for this population is often diverted away from MSM-related services.”
At risk groups
targeted
In interview with the Sunday Stabroek, Dr Singh explained that the Ministry of Health initially accessed a fund from a World Bank programme, which has since ended, but which targeted the MSM population, the commercial sex worker population and some of the most at risk groups.
She said when they knew that the World Bank funding was coming to an end and they wrote to Global Fund and efforts were made to ensure sure that there was substantial funding for civil society, including MSM.
Dr Singh, who heads the country’s leading organization in the fight against HIV, said the funds received to do work in civil society were submitted to the Country Coordination Mechanism (CCM) office, which oversees the management of the Global Fund grant. The CCM then set up an independent technical review panel and a call was put out for proposals some of which when submitted were approved for funding.
“And so there was money for civil society organisations and depending on the proposals that came in those were what was funded. Right now we have nine civil society organizations that were approved by the technical review panel that was set up by the CCM,” Singh told the Sunday Stabroek.
Dr Singh stressed that it was the proposals that were sent into the technical review panel which were reviewed, pointing out that a call was made in the newspapers for proposals.
“We were very specific in the call; the MSM population was number one on our list in terms of priority groups… and again, we had to work with what we got,” she stressed.
According to Dr Singh every effort was made to ensure that emphasis was placed on the specific groups including MSM, but she admitted that at present there are no programmes specifically among the MSM group.
Her admission coincided with what the report stated as it had indicated that the Guyana Government provided extremely limited support for MSM-specific HIV programming.
The government also does not provide funds for MSM research directly—largely because most, if not all, HIV research is donor funded. The government provides support for research indirectly through the work of NAPS staff, but no direct funding is given.
Turning to the PEPFAR programme, Dr Singh said that there are civil society organisations that have MSM specific programmes and work plans.
“Funding is one, but when you look at the actual work that is being done, how do we monitor what is going on?” Dr Singh queried, while adding that the behavioural studies done by the ministry in 2004, 2008 and 2009 would indicate what impact they have been having on the group.
She said there is a steering committee at NAPS and this is co-hosted by Guyana HIV/AIDS Reduction and Prevention, which has defined how work is done in the MSM population. The NAPS head explained that it was based on evidence obtained from an intervention undertaken through the steering committee that the Centers for Disease Control (CDC) would have conducted a randomized trial and verified what needed to be done for the programme to work.
The trial would be done within an NGO which would identify a person as an MSM who would then be given a stipend to go out “and do peer education, interpersonal communication, make condoms accessible to the populations and assist people to come into the treatment site.“
Significantly, Dr Singh stated that the person identified to do the work with the MSM “does not engage any more but has the contacts in the field.”
The study on Guyana, which was done by research consultant Joel Simpson, found that MSM-specific programmes in Guyana are, by and large, limited to behavioural interventions; they include community outreach, peer education, peer counselling, VCT, and referrals to health services, almost exclusively provided by civil society.
Most of the persons interviewed by Simpson agreed that the law on same-sex sexual practices influences the government’s reluctance to provide targeted health and other support programmes to MSM, which are needed to reduce their vulnerability to the epidemic.
“With the partial exception of the Ministry of Health, criminalization restricts government entities from being involved in MSM-specific programming in many important ways. One respondent pointed to the reluctance of the Ministry of Home Affairs to provide HIV prevention services (such as condoms) in prisons and the army because of the legal regime criminalizing sex between men,” the report said.
Asked about this, Dr Singh said the current law which makes it illegal for a man to have sex with another man may constrain the ministry’s work with that group, although the evidence shows that it is a high risk group and this is reflected in the proposals and work plans.
“I wouldn’t say that it [the law] really confines us; we have been given all flexibility and all leeway to work because of the evidence that this is a high risk group that we need to work in,” she added.
Most respondents, however, agreed that the criminalisation of same-sex activities is the main reason that stigma and discrimination against same-sex sexual practices and MSM are rampant throughout Guyana society. There was general consensus too that such laws further entrench stigmatizing cultural and social attitudes, which in turn lead to significant self-stigma and limited self-esteem among members of the population.
The impact is also substantial regarding health and HIV programming and interventions, the report said.
It noted that MSM-related stigma and discrimination constrain research and surveillance, including the construction of sound sampling methods, which means that little data or viable estimates exist even as to the size of the population.
Importantly, the report said that in Guyana stigma and discrimination regarding MSM are also rampant in health facilities, though some interviewees said the discrimination among health workers had decreased over the years as a result of training and sensitization. However, it was noted that although some HIV services in Guyana are open to all in need, and many MSM access them, few prevention or social services targeting MSM currently exist.
