There is mounting evidence that within southern Africa’s generalized HIV epidemic there are under-estimated concentrated epidemics among key affected populations (KAPs) such as sex workers and men who have sex with men (MSM). Recent studies have found HIV prevalence among MSM to be as high as 46.7% in Botswana[1] and 71.1% in Durban, South Africa.[2] Among sex workers, Malawi, Namibia and Swaziland report prevalence rates of 70%.[3] Despite these alarming statistics, national AIDS spending in these countries consistently neglects MSM and sex workers. With little to no money coming from governments, KAPs rely on support from funding partners such as the US government and the Global Fund to ensure access to life-saving treatment and prevention services. Global Fund support for targeted programming has also been less than adequate. In southern Africa, roughly 2% of total Global Fund investments in HIV prevention were allocated to sex workers.^[4] Only 0.07% went towards MSM and transgender (TG) communities.^[5] Part of the problem is that challenging legal contexts and a lack of political will means countries do not always request funding for these at-risk groups. Of all southern African proposals to the Global Fund (Round 1-10) only three included targeted interventions for MSM, and only 12 had programming designed specifically to reach sex workers.^[6] To help address these issues, the Global Fund Board approved a Sexual Orientation and Gender Identities Strategy in May 2009. More recently, under the Global Fund’s new funding model (NFM), the Key Populations Action Plan (2014-2017) proposes significant change in the way MSM and sex workers should be prioritized. With January 30 marking the fifth window of concept note submission for the NFM, are African countries drawing budget lines for MSM and sex worker programming, or is it business as usual? An analysis of the concept note budgets from Botswana, Malawi and Swaziland suggests a promising change.

Table 1: Proposed KP Programming in Country Concept Notes to the Global Fund

Botswana’s request of $3,079,174 for key populations programming represents 7% of total funding requested by the country. With half of this for MSM and transgender communities, this far exceeds the regional average in previous rounds.[7] This is also the first time Swaziland has ever included programming specifically for sex workers and MSM in a Global Fund proposal.[8] Malawi’s $3,078,000 request is also significant, though the majority of it sits in the above-allocation amount. This means that it is part of incentive funding, which will only be granted if all or part of the allocated funding request is deemed sound by the Technical Review Panel (TRP), and only then after a competitive process and when additional resources become available. This may imply that KAP programming is still not seen as a top priority in Malawi. It remains to be seen how the amounts requested by these three countries will change or be re-allocated during TRP review and grant-making, but the potential for improved Global Fund commitment to key populations programming in the region is there. There is still a long way to go, particularly towards ensuring that governments dedicate public resources to KAPs to make the HIV response more sustainable. But we’re moving in the right direction.