From personal survival to public health: community leadership by men who have sex with men in the response to HIV.

Community leadership and participation by gay men and men who have sex with men (MSM) have been central to the response to HIV since the beginning of the epidemic. Through a wide array of actions, engagement of MSM has been important in the protection of communities. The connection between personal and community health as drivers of health advocacy continue to be a powerful element. The passion and urgency brought by MSM communities have led to the targeting and expansion of HIV and AIDS research and programming, and have improved the synergy of health and human rights, sustainability, accountability, and health outcomes for all people affected by HIV. MSM are, however, frequently excluded from the evidence-based services that they helped to develop, despite them generally being the most effective actors in challenging environments. Without MSM community involvement, government-run health programmes might have little chance of effectively reaching communities or scaling up interventions to lessen, and ultimately end, the HIV pandemic.

Partnership, sex, and marginalization: Moving the Global Fund sexual orientation and gender identities agenda.

After almost three decades of work to address HIV and AIDS, resources are still failing to adequately address the needs of the most affected and marginalized groups in many societies. In recognition of this ongoing failure, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has approved a sexual orientation and gender identities (SOGI) Strategy. The Strategy is designed to help its investments more effectively reach men who have sex with men; transgender populations; male, female, and transgender sex workers; and women who have sex with women. The Global Fund financing model is unique and based on ideas of broad partnership. It emphasizes the importance of country-ownership while ensuring that work is appropriately targeted, evidence-based, and rooted in principles of human rights. The classic international development tension of pursuing a rights-based agenda, while also supporting strong country ownership, has moved the Global Fund into a more substantive technical, advocacy, and policy arena, resulting in the creation of the SOGI Strategy, which emphasizes the needs of marginalized groups. A strong commitment to participation and consultation was crucial during the development stages of the Strategy. Now, as the Strategy goes live, it is clear that progress will only be achieved through continued and strengthened partnership. The diverse partners - in particular the governments and other stakeholders in recipient countries that helped develop the Strategy - must now commit to stronger collaboration on this agenda and must demonstrate bold leadership in overcoming the considerable technical and political challenges of implementation that lie ahead.

Barcelona 2002: law, ethics, and human rights. Advancing research and access to HIV vaccines: a framework for action.

In light of the continuing spread of HIV infection and the devastating impact of the disease on lives, communities, and economies, particularly in the developing world, the investment in new treatments, vaccines, and microbicides has clearly been inadequate. Efforts must be intensified to develop effective HIV vaccines and to ensure that they are accessible to people in all parts of the world. This article is a summary of a paper by Sam Avrett presented at "Putting Third First: Vaccines, Access to Treatments and the Law," a satellite meeting held at Barcelona on 5 July 2002 and organized by the Canadian HIV/AIDS Legal Network, the AIDS Law Project, South Africa, and the Lawyers Collective HIV/AIDS Unit, India. In the article, Avrett calls for immediate action to increase commitment and funding for HIV vaccines, enhance public support and involvement, accelerate vaccine development, and plan for the eventual delivery of the vaccines. The article briefly outlines steps that governments need to take to implement each of these objectives. The article also provides a menu of potential actions for vaccine advocates to consider as they lobby governments.

HIV vaccines: current challenges and future directions.

Volume seven of the Review will mark the tenth anniversary of the Canadian HIV/AIDS Legal Network with a series of articles that describe past developments and future directions in several areas of policy and law related to HIV/AIDS. The following article is the first of these, discussing current challenges and future directions in the development of and access to HIV vaccines. It argues that governments are under public health, ethical, and legal obligations to develop and provide access to HIV vaccines. It further explains what is required for governments to fulfill their obligations: additional commitment and resources for HIV vaccine development in the context of increased global research and development regarding diseases of the poor; increased support and advocacy for partnerships to develop HIV vaccines; enhanced regulatory capacity in every country to review, approve, and monitor HIV vaccines; and assurance of global supply of, procurement of, delivery of, and access to vaccines in the context of efforts to increase global access to public health measures and technologies.