Meg Davis, a noted human rights lawyer and advocate, who founded Asia Catalyst a decade back, shared statistical findings to support key arguments for counting size estimates of key populations accurately. She said, "In countries where same-sex behaviour was not criminalized there was a reasonable size estimate of MSM population but in countries where same sex behaviour was criminalized and which imposed penalties like imprisonment or fine we had a smaller size estimate for MSM population. In countries where there were death penalties for same-sex behaviour we had even tinier MSM size estimates. This is what key populations have been saying for years but now we have statistical evidence to back this up.
"Second finding we had was that countries that did criminalize MSM were doing 'better' in terms of HIV testing for MSM - they had reported 'higher' coverage of HIV testing among MSM. This seems odd and we looked at countries that criminalized and had reported 90% to 99% HIV-testing coverage among MSM (some countries reported even 100%). We found that most of these countries had no MSM size estimates, and tiny samples were used as basis to calculate the service coverage, Algeria for example, had tested 59 men and 57 of these men picked up their test results so Algerian authorities arrived at 96.6% HIV testing coverage among MSM. Hungary tested 388 men and reported a 100% HIV testing coverage. Criminalization can lead to low size estimates, and low denominators result in inflated coverage," added Meg Davis.
Is money locked up in banks or used for saving lives?
Cash absorption is how much of the cash that comes from international aid agencies is actually getting spent on HIV, TB and malaria programmes. "2015 data from the Global Fund to fight AIDS, Tuberculosis and Malaria (The Global Fund) shows that top 20 countries that had very high HIV burden also had very high cash balances -- which means money was coming in the countries but sitting in banks - sometimes for 3 months, 6 months, 9 months, a year or year and a half! Even for as long as 61 months money was just sitting there unspent! Commodities were not being procured, healthcare workers were not being hired, programmes were not being started to serve their communities! There were many reasons for this delay in utilizing aid that goes in these countries: procurement supply-chain issues, laws and policies, or reluctance to start programmes for key populations for one reason or another. The Global Fund is trying very hard to address this issue and have made tremendous progress on reducing this cash balance. But with next round of Global Fund replenishment these high HIV-burden countries are likely to get a massive allocation -- in some cases higher than before. It is very important for communities to be aware of absorptive capacities that how much cash is there at the country level and how much is getting spent. We need to get that expenditure information transparent!" added Meg.
Governments of all countries in Asia Pacific, and globally, have committed to achieve Sustainable Development Goals (SDGs) by 2030, one of which is to end AIDS by 2030. If we do not want to fail in achieving SDGs by 2030 or earlier, we need to ensure that size estimates of all key populations are accurate, components of all programmes are well resourced, money is not being locked up or delayed rather getting fully utilized optimally, and HIV rates decline fast enough to keep us on track to meet the promises made for 2030.
Bobby Ramakant, CNS
(Bobby Ramakant is the Health Editor at CNS and WHO Director-General' WNTD Awardee 2008. Follow him on Twitter: @bobbyramakant)
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