Fairness in HIV Prevention Funding
Major Organizations Call for Fairness in HIV Prevention Funding
Policy Brief documents inequitable funding for HIV prevention for gay/bisexual men
DAYTON,OH—This afternoon AIDS Resource Center Ohio (ARC Ohio), which serves more than 2/3 of Ohio’s 88 counties, called upon state and local governments to “ensure that HIV prevention efforts for gay and bisexual men receive an equitable share of public resources—a share that corresponds to the continuing impact of HIV on gay and bisexual men.”
The request for equitable funding allocations is one of a series of recommendations made in a policy brief entitled “Two Steps Forward, One Step Back: Gay/Bisexual Men (MSM) and HIV/Sexual Health Education in Ohio.” The brief, which is also endorsed by major local and statewide HIV/AIDS and Lesbian, Gay, Bisexual and Transgender (LGBT) rights organizations, was released to coincide with LGBT Pride Month, held in June every year in cities across the U.S.
The brief is being distributed to policymakers and media outlets across Ohio, and will be shared through social media websites. [See Brief, attached.]
“Gay and bisexual men still represent approximately 2/3 of all new HIV cases in Ohio,” noted Bill Hardy, CEO of AIDS Resource Center Ohio, “but less than a third of state HIV prevention dollars are allocated to HIV prevention programs specifically designed to reduce HIV among gay and bisexual men. The data confirm what are clearly skewed priorities—misplaced priorities that could have tragic consequences for gay and bisexual men in our state.”
The policy brief quotes a recent federal study noting that gay and bisexual men—sometimes referred to in public health circles under the broad heading of Men who have Sex with Men (MSM)—are 44 times more likely to be living with HIV infection than heterosexual men/non-MSM.
In addition to changes in funding priorities, Two Steps Forward, One Step Back concludes with calls for adequate funding of HIV prevention efforts overall; expanded utilization of evidence-based interventions in HIV prevention for MSM; and assurances that agencies receiving public HIV prevention funds are “sensitive to, and inclusive of, the needs and experiences of gay and bisexual men / MSM.”
“Gay and bisexual men are still bearing the enormously disproportionate burden of this epidemic,” concluded Hardy, “and their organizations and communities are working very hard to address that need. But we need the tools and resources, proportionate to the challenge, to continue those efforts. Now, when communities across Ohio are celebrating LGBT Pride Month, we call upon public funders to fairly distribute resources based on need and impact, so that everyone has an equal chance to enjoy health and well-being.”
Effective July 1, ARC Ohio and Columbus AIDS Task Force merge to become Ohio’s largest AIDS services organization. Offices in Columbus, Dayton, Lima, Mansfield, Toledo, Athens, Chillicothe, and Newark will provide linkage to care, financial assistance and supportive services to more than 2,500 HIV-positive Ohioans. Thousands more will be reached with evidence-based prevention and HIV testing.
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Gay/Bisexual Men (MSM) and HIV/Sexual Health Education in Ohio
Gay and bisexual men (MSM) have been, from the very beginning, disproportionately affected by HIV/AIDS in the United States, and here in Ohio. But Lesbian, Gay, Bisexual and Transgender (LGBT) communities didn’t just stand idly by: they took action by creating education campaigns, supporting research, and volunteering to care for sick friends.
Much has been accomplished, but much remains to be done. Gay and bisexual men are still 44 times more likely to live with HIV infection than other men. There is growing concern, in Ohio and across the U.S., that HIV prevention efforts focused on gay and bisexual men are not receiving the public resources they need. We must adopt the right perspective in HIV prevention programs for gay and bisexual men, use the right tools and programs, commit the right resources, and ensure that resource allocations equitably match the true impact of HIV on MSM in Ohio.
From the outset, gay and bisexual men have been disproportionately affected by the HIV/AIDS epidemic in the U.S. At first there was little in the way of treatment, so those who were diagnosed with AIDS often got sick, and died, quickly. Many gay and bisexual men who did not acquire HIV infection nevertheless watched many of their friends suffer illness, discrimination, and death. The medical and emotional toll on U.S. LGBT communities was devastating.
Because MSM were so deeply affected by AIDS, they pioneered prevention programs, and advocated for risk reduction among peers. Those efforts were effective in reducing HIV rates in many major U.S. cities. And by the mid-1990s, it was clear that new treatments for HIV held out the promise of enhanced length and quality of life for many. Across the board, LGBT community advocates and public health authorities believed that progress was being made.
Still, in 2011, gay and bisexual men remain disproportionately affected. A 2010 study by the Centers for Disease Control and Prevention (CDC) estimated that 19% of sexually active gay men in the United States are HIV-positive, and nearly half are unaware of their infection. In addition, recent trends have shown an increase in new infections among younger gay and bisexual men, in part because success in medical treatment of the disease has reduced the perceived urgency for HIV risk reduction among all young persons. Of equal concern is the reality that HIV does not affect all MSM equally: while all MSM are at dramatically increased risk, African American and Latino MSM are currently more likely to have acquired the virus than their white counterparts.
In 2009 (the last year for which data are available), the Ohio Department of Health (ODH) concluded that male-male sexual contact remains the leading transmission category for HIV infection in the state. For that year, ODH estimated that 84% of new Ohio HIV/AIDS cases among all male cases were among MSM, and 67% (2/3) of all new 2009 cases were men who have sex with men. In Ohio, then, as in the rest of the U.S., men who have sex with men remain disproportionately affected by HIV/AIDS.
What it Will Take
What will it take to achieve greater reductions in HIV infection among MSM? Here are a few critical recommendations:
The Right Perspective. The evidence is clear: if HIV prevention programs are to be effective for gay and bisexual men, they must be based on an affirming view of LGBT sexuality and identity, and must recognize the importance of equal rights for LGBT persons. Judgmental, biased perspectives simply do not work. Entities carrying out HIV prevention programs for MSM must be grounded on a confirmation of the rights of gay/bisexual men to equal treatment, the responsibilities that MSM have to themselves and each other, and a positive attitude about human sexuality.
The Right Programs. Decades of experience developing and implementing HIV prevention programs for MSM have yielded an array of successful program models, generally referred to as “Effective Behavioral Interventions” (EBIs) by the CDC. They include community-based programs such as Mpowerment, small group programs such as Many Men, Many Voices, and one-on-one interventions. HIV testing and outreach is an essential part of all EBIs. These programs have been tested and validated, and a number of them are now being implemented in Ohio. It is clear that behavioral science has developed a range of effective strategies, and that only those strategies that have proven validity—programs that are “evidence-based”—should be carried out.
The Right Tools. It is also clear that if MSM are to reduce their HIV risk, they need ready access to the right tools. HIV prevention will mean adopting one of three strategies: 1) 100% abstinence from all sexual risk behaviors; 2) mutual, faithful sexual monogamy with an HIV-negative partner; or 3) consistent, correct condom use. Condom availability is essential for HIV prevention programs, including programs for MSM.
The Right Resources. We also need the resources to support these critical programs. In recent years HIV prevention funding has not kept pace with the growth of HIV/AIDS. A number of cities in Ohio are “making do” with substantially fewer HIV prevention resources than in the past, even as HIV grows by nearly 56,000 new cases every year in the U.S. Clearly HIV prevention resource investments now will pay off both in the short-term, and the long run.
The Right Allocation of Resources. Many public health analysts have noted the stark disparity between the percentage of HIV infections accounted for by gay/bisexual men, and the percentage of funding distributed to prevention efforts focused on gay/bisexual men. In Ohio, for example, less than 30% of Ohio Department of Health (ODH) HIV prevention funding goes to programs reaching MSM, even though, as noted earlier, 67% of new cases of HIV infection in 2009 were among MSM. While ODH has worked to reduce this disparity, there is still a long way to go before prevention equity has been achieved.
Recommendations / Taking Action
We urge advocates, public health officials, service/prevention agencies, and funders to take the following steps:
ü Work with public entities and private funders to ensure that HIV prevention efforts overall are adequately funded.
ü Work with local health departments and funders to ensure that HIV prevention efforts for gay and bisexual men receive an equitable share of public resources—one that corresponds to the continuing impact of HIV on gay and bisexual men.
ü Encourage “Evidence-Based Interventions” in HIV prevention for MSM, to ensure the most effective use of scarce resources.
ü Ensure that HIV prevention agencies and programs overall are sensitive to, and inclusive of, the needs and experiences of gay and bisexual men / MSM.
The policy education activities of Healthy Gay Men Ohio, a program of www.arcohio.org, are funded in part by The George Gund Foundation and Elton John AIDS Foundation. Two Steps Forward, One Step Back was written by AIDS Resource Center Ohio/Columbus AIDS Task Force, and is endorsed by the AIDS Taskforce of Greater Cleveland, Caracole (Greater Cincinnati), the Ohio AIDS Coalition (statewide) and Equality Ohio (statewide).
AIDS Resource Center Ohio and the Columbus AIDS Task Force formally merged the two agencies in June of 2011. The merged agency, which retains the name AIDS Resource Center Ohio, now serves 2/3 of Ohio’s 88 counties.
Public health authorities often use the term “Men who have Sex with Men” (MSM) to account for the fact that some men may have sex with other men but not identify as gay or bisexual. The use of “MSM” instead of “gay/bisexual” in a public health context keeps the focus on risk behaviors. In this Policy Brief we recognize there are valid reasons for using both terms, and generally use them interchangeably.
In a survey conducted by the National Association of State and Territorial AIDS Directors (NASTAD), 74% of states in 2009 reported cuts in overall HIV prevention programs, with total cuts equaling approximately $170 million—even as new cases increase. See http://www.nastad.org/Docs/Public/Resource/2010520_FY2011%20CDC%20HIV%20Prevention%20Funding.pdf.