amfAR Announces New Round of GMT Grants

In an effort to address the unrelenting disproportionate impact of HIV/AIDS on gay men, other men who have sex with men (MSM) and transgender individuals -- collectively known as "GMT" -- amfAR, The Foundation for AIDS Research, has awarded substantial new research grants to study the impact of innovative HIV service delivery models for GMT in low- and middle-income countries.

"Part of the problem is we don't have a whole lot of solid evidence of what's effective in preventing the spread of HIV in low- and middle-income countries," said Kent Klindera, director of amfAR's GMT Initiative. "We are investing in serious research implementation science to evaluate if they're working at reducing the spread and impact of HIV."

Through amfAR's GMT Initiative, the awards, totaling more than $2.6 million over three years, will support three major studies aimed at determining the most effective ways of identifying those who are HIV positive, putting them on treatment, and ensuring that they remain on treatment so that their virus is fully suppressed. Identifying gaps in the continuum of HIV care -- the so-called treatment cascade -- and improving access to effective HIV prevention, testing, treatment and care services is essential for controlling and ultimately diminishing the epidemic among GMT.

Despite encouraging declines in the number of new HIV infections among the general population in many countries, rates of infection among GMT are unchanged or continue to climb in many settings. According to UNAIDS, gay men and other MSM are estimated to be 19 times more likely to be infected with HIV than the general population and transgender women are 49 times more likely to be living with the virus.

Underserved and at higher risk of HIV, these key affected populations are often denied access to the entire spectrum of HIV testing and treatment services due to barriers such as stigma, discrimination, and poverty.

"Research has shown that targeted interventions such as early diagnosis of HIV and suppression of viral load are critical to changing the course of the epidemic among GMT," said Kevin Robert Frost, amfAR's Chief Executive Officer. "Through implementation science research, we want to determine conclusively which interventions work best for different populations so that these strategies can be put into practice, scaled up, replicated, and start to make a real impact."

In one study, Dr. Chris Beyrer of Johns Hopkins University will lead a team of researchers and community-based service providers (in collaboration with the International HIV/AIDS Alliance Myanmar) in evaluating the effectiveness of promising interventions for GMT in Myanmar, where increased HIV testing and treatment opportunities are becoming available. The researchers will assess the effectiveness of HIV self-testing done in the privacy of one's home, point-of-care CD4 testing, and the use of "peer navigators" familiar with the local health system to help those newly diagnosed gain access to HIV treatment and care.

In Lima, Peru, Dr. Javier Lama of Asociaci�n Civil Impacta Salud y Educaci�n and his team aim to improve the continuum of care among transgender women by using an innovative model that integrates HIV prevention and treatment services with transgender-affirming medical care. Working in collaboration with the Boston-based Fenway Institute and two community GMT organizations, IMPACTA and EPICENTRO, Dr. Lama and his team will integrate routine cross-sex hormone therapy into HIV and sexually transmitted infection prevention, testing and treatment services, and will implement health services and peer case management for 200 transgender women.

"I think for me, this project in Peru is most exciting," said Klindera. "Most transwomen you talk to talk about the need for transitional health care, gender-affirming health care, hormones and transition support. This study offers them that as a means to ensure they will be retained in care, remain adherent to their ARVs and become virally suppressed. If we can show we offer this great gender-affirming healthcare and it works, that would be great!"

And in Bangkok, Thailand, Dr. Nittaya Phanuphak and her team at the Thai Red Cross AIDS Research Centre aim to show how innovative technologies such as GMT-targeted websites using online counseling and support can be utilized to increase rates of HIV testing and referrals to prevention and treatment programs. Working in collaboration with Adam's Love, a web-based health platform for GMT individuals, and two community-based organizations (Service Workers in Group/SWING and The Rainbow Sky Association of Thailand), the team will compare the effectiveness of online services and support interventions with traditional clinic-based HIV services, and a hybrid model that combines elements of both strategies.

Since 2007, amfAR's GMT Initiative has provided financial and technical support to local GMT organizations in low- and middle-income countries to strengthen the community response to HIV. Recently, larger and more sustainable donors such as PEPFAR and the Global Fund have increased their support to community organizations working to reduce the spread and impact of HIV among GMT.

In the U.S., the Centers for Disease Control and Prevention tracks which programs are successful HIV service delivery models for gay men. But as rates of HIV among young gay men of color continue to rise, Klindera notes that healthcare is just one of many issues factoring into their daily lives.

"I think we need to listen to young men of color, especially with all the drama around police brutality. There are huge issues that impact young men of color, and HIV is just one of them," said Klindera. "We need better data on what's going to reach them, because the messages we are putting out there about testing and care aren't working. I think it's bigger than that; the message given out should be that black lives matter."

As part of an intensive review of programmatic options to achieve maximum impact and optimize the use of available resources, amfAR consulted with leading experts on HIV among GMT. On the basis of this review, the Foundation made a strategic decision to focus future support on research that can have a direct impact on alleviating the epidemic among these key affected populations. The three new projects were selected after a highly competitive process and rigorous peer review.

"Our ultimate goal is to improve HIV-related health outcomes for gay men, other men who have sex with men and transgender individuals worldwide," said Klindera. "There is an urgent need to address their specific needs, and focusing on these populations is critical to ending the AIDS epidemic. What we need to do now is accelerate the delivery of innovative community-led HIV service models that we know work so we can ultimately lower HIV incidence and deaths among GMT."

Learn more about the GMT Initiative's first round of HIV implementation science grants here.