Plenary: Dynamics of the Epidemic in Contex

Paul Semugoma, a physician from Uganda, spoke passionately about the need for providers and communities to acknowledge that men who have sex with men are everywhere, and that they have special needs in terms of prevention that need to be addressed – especially stigma and decriminalization of homosexuality. He encouraged all of us to “end invisibility” of MSM in epidemiology, care provision, and policy-making.

Cheryl Overs, founder of an Australian advocacy group for sex workers, discussed special needs of this population in terms of HIV prevention. She detailed how biomedical prevention tools are incapable of addressing the power imbalance between sex workers and their clients, or to tackle multiple structural and societal issues that act against these women and men.

Debbie McMillan, a transgendered woman and former sex worker and drug addict, reflected on her own experiences on the street, in prison, and in recovery from drugs. She spoke poignantly about the impact of stigma on highly marginalized populations and her work as an advocate and peer counselor for these men and women. She echoed Cheryl Overs in a call to include representatives of at-risk communities in the design and implementation of prevention and advocacy programs – but in a meaningful way, not just as a token.

Gottfried Hirnschall, with the WHO, described his optimism about global ARV scale-up, and his confidence that 15 million people can be placed on ARVs by 2015. He reviewed data on ARV scale-up, and suggested that planning for programs beyond the 15 million mark ought to begin now – especially in light of the movement toward earlier and earlier treatment.