We are Africa’s key populations: gay and bisexual men and other men who have sex with men; trans and nonbinary people; sex workers of all sexual orientations, gender identities, and expressions; and people who use and inject drugs. And, we stand in solidarity with Africa’s lesbian, bisexual and queer women and intersex people excluded from targeted HIV prevention and treatment interventions. We convened on the sidelines of the 22nd ICASA, in-person in Durban, and virtually, and we reflected and agreed thus:
Our national governments; PEPFAR; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the UN family; and private and public foundations are failing us: criminalized, marginalized and excluded populations. And not only us—but our sex partners, our children, our communities too. The off-track AIDS response reveals this. And we are demanding nothing less than a revolution in the response to the epidemic in our communities.
62% of new infections are among key populations and their sex partners. Gay men and other men who have sex with men, sex workers and people who use drugs face a 25–35 times greater risk of acquiring HIV, while trans women face a 49 times higher risk. Data from Zimbabwe suggest a 38% prevalence in trans men sex workers. HIV in trans men remains understudied, leading to the assumption that they bear little virus burden.
Current data on the impact of HIV in Africa’s key populations is scarce, and data on Africa’s lesbian, bisexual and queer (LBQ) women and intersex and trans people is non-existent, resulting in unequal HIV responses. Worse, donor funding earmarked to address HIV in LGBTI communities does not include targeted initiatives across all of these subpopulations. Similarly, sex workers’ funding often excludes men and trans sex workers. Overall, we need donors to be accountable, inclusive, responsive, and flexible to adapt to the dynamic and evolving needs of key populations.
Only 2% of all HIV funding and 9% of resources for prevention are spent on key populations. These miniscule funding levels are a disgrace. New funding initiatives like the U.S. government Key Populations Investment Fund (KPIF) were created to transform this crisis but ended without any follow-up strategy or vision by PEPFAR. We cannot stand for this any longer. There will be no “end to AIDS by 2030” without major funding increases for our communities, without prioritization of direct investment in community organizations led by us, and without eliminating all forms of discrimination that we experience.
Data show that HIV responses are undermined by harmful laws. For example the criminalization of same-sex sexual conduct, sex work and drug use is associated with 18%–24% worse knowledge of HIV status and viral load suppression. Countries with laws advancing non-discrimination, and addressing gender-based violence, have better health outcomes, and are associated with significantly higher knowledge of HIV status and viral suppression among people living with HIV. Non-discrimination protections were associated with 9.7% higher knowledge of HIV status and 10.7% higher viral suppression among PLHIV. Gender-based violence laws were associated with 15.9% higher knowledge of HIV status and 16.2% higher viral suppression.
The COVID-19 crisis has poured fuel on this fire. African states have used lockdown to intensify state violence against us. And we have suffered from national lockdowns and restrictions that have made us even more vulnerable to hate, discrimination, and stigma. The COVID-19 crisis has strained funding for AIDS, and it is important that states engage in mitigating the harms of the COVID-19 crisis while securing the paradigm shifts in global treatment and vaccine access needed to respond to COVID-19 while powering and protecting funding and political focus on the response to global AIDS.
For far too long key population programs have been designed and implemented without accountability to key populations, disregarding our lived experiences, and expertise. In fact, many PEPFAR implementing partners exploit our dedication and labor, paying us virtually nothing for doing the real work of linking key populations to prevention and treatment. No more. And virtually no global funding is being spent on advocacy to dismantle the structural drivers of these inequitable outcomes.
We, Africa’s Key Populations, demand:
More money to fund the fight against HIV in key populations
Investment in raising the institutional capacities of KP-led CSOs
Decriminalization, and funding for human rights advocacy
Better funding criteria, strategies, and expectations
Dignity, quality, and accountable healthcare
Better evidence for programming
Endorsers include (in alphabetical order, in formation):