• Vulnerable groups

Vulnerability

This report profiles efforts by small, grassroots community-based organisations worldwide that are leading work to provide HIV prevention, education, care, support, and advocacy services to men who have sex with men (MSM) and transgender people. The authors observe six major themes that characterise the work of these organisations and that service providers say are key to programme success. These are:

• addressing basic needs is often a necessary step in order to provide HIV services that people can utilise. Helping them acquire simple life and job skills such as computer training or cooking, for example, can allow MSM to build more stable lives, which in turn makes it easier for them to protect themselves against HIV.
• creating a safe space for MSM and transgender people is central to an organisation's capacity to deliver HIV services.
• establishing and maintaining trust with community members is an essential element of effective programmes. MSM and transgender people need to be meaningfully engaged and consulted about their needs and preferences, and given a voice in programme design, implementation, and evaluation.
• providing a range of integrated services creates synergies that can optimise programme success - for example,combining HIV prevention education for MSM and transgender communities with sensitisation initiatives designed to reach law enforcement agenciesand health care providers. This is especially true in settings where MSM and transgender people are stigmatised and discriminated against, and are the targets of violence.
• tailoring and revising services on an ongoing basis is crucial to ensuring effective responses and service utilisation.Organisations should be prepared to adapt their programmes to the diverseand changing needs of community members.
• routinely collecting process and outcome indicators provides organisations with opportunities to track progress, build on strengths, and respond to changes in their local environment bymaking programme modifications as needed.

In addition, the authors highlight a few common challenges faced by community-based organisations - most notably, poverty, stigma and discrimination, and the diversity of community members'  identities and needs. The authors argue that another common thread is the lack of resources to address the HIV epidemic among MSM - especially in light of epidemiological data that point to dramatically higher infection rates among this population.

In conclusion, the authors outline recommendations highlighting major issues - among them, stigma and discrimination, resource needs, and the inclusion of MSM and transgender groups in planning and decision making - that must be addressed to ensure an effective and sustained community-based response to HIV among MSM and transgender people.

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