The Global Fund plans to monitor and publicise cases where funding proposals have been, or might be, rejected due to policy environments where human rights violations are impeding the implementation or impact of interventions against AIDS, TB and malaria. This is one of the highlights of the Global Fund's policy and implementation plan on Sexual Orientation and Gender Identity (SOGI), collectively referred to as the "SOGI Strategy," adopted by the Fund during the course of 2009. The Global Fund says that its SOGI Strategy applies "to all people whose sexual orientation, gender identity and/or sexual behaviors do not conform to majority norms and values, focusing on adults engaging in consensual sexual behaviours that increase their health-related vulnerabilities." In practice, this primarily means men who have sex with men (MSM), transgenders, and female, male, and transgender sex workers. Earlier, the Global Fund adopted a policy and an implementation plan on Gender Equality (see GFO 100 and 113.) The Global Fund says that while its SOGI Strategy and its Gender Equality Strategy have been developed as two separate documents through separate consultations, they are considered to be components of a single Global Fund Gender Strategy. HIV/AIDS disproportionately impacts MSM, transgenders and sex workers. HIV prevalence among sex workers is higher than in the general population. Among MSM, both the incidence and prevalence of HIV/AIDS is high in all regions of the world, with recorded HIV prevalence rates as high as 25% in Africa, 11% in the Caribbean, 28% in Southeast Asia, and 51% in some parts of Latin America. Among transgendered persons, HIV prevalence is believed to be even higher than among MSM. Criminalisation of people due to their sexual orientation or gender identity impacts their ability to negotiate health and health services. In some countries on every continent, rights related to SOGI populations and access to health are still explicitly or implicitly denied through laws, religion, social institutions and cultural traditions. This includes vocal hostility and incitation to violence by political leaders and religious leaders. Sex between consenting adults of the same gender is criminalized by approximately 85 countries, including 34 African countries, with 10 countries having death penalties for homosexual relations between consenting adults. The SOGI Strategy acknowledges that in terms of being able to access or benefit from Global Fund grants, MSM, transgenders and sex workers face serious challenges. They face limited access to decision-making or control in CCMs, PRs and SRs, and there are many social and structural barriers to the realisation of health and rights for these populations. Around the world, even in countries where SOGI populations are nominal beneficiaries of Global Fund funding, there are consistent and extensive reports of funds not being allocated to appropriate interventions, a severe lack of services related to health and rights, and continued disregard for human rights. The strategy acknowledges that work in this area is "difficult and sometimes controversial in many part of the world," and that "there is no one approach for every situation." The SOGI Strategy contains 19 activity areas, including the following:

• strengthening CCMs;
• strengthening the proposal and application process;
• strengthening the expertise and capacity of the Technical Review Panel; and
• ensuring that monitoring, evaluation and reporting is positively oriented toward work addressing sexual orientation and gender identities.

The strategy also contains a "logical framework," which identifies, for each activity area, activities, planned outcomes and indicators. For example, for strengthening CCMs, the following activities are listed:

• Analyse CCM capacity related to SOGI.
• Review and strengthen CCM guidelines and tools.
• Include SOGI training and briefings during regional CCM meetings, and other relevant national and regional meetings.

"The Global Fund Strategy in Relation to Sexual Orientation and Gender Identities (SOGI)" is at www.theglobalfund.org/en/publications/other. Some of the information for this article was taken from "Sexual Orientation and Gender Identities Strategy: Plan of Action 2009-2012," 11 December 2009, and "Analysis of Sexual Orientation and Gender Identity Related Activities in Round 8 and 9 Global Fund Proposals," undated. Neither document is currently available on the Global Fund website, but both are mentioned in "The Global Fund, HIV and Sexual Orientation / Gender Identities Strategy Update," a report prepared for the Global Fund's Third Replenishment meetings in 2010, available at www.theglobalfund.org/en/replenishment/hague/documents.