Last month marked the 8th annual observance of National Asian & Pacific Islander (API) HIV/AIDS Awareness Day. With HIV/AIDS diagnoses steadily increasing among API's in the United States, as well as other ethnic and sexual minority groups across the country, we are reminded of the power of marginalization to drive the HIV epidemic. Sadly, marginalization in the U.S. AIDS response is not an isolated phenomenon, but a defining characteristic of the global epidemic. There is perhaps no greater example of this than the Pacific Islands themselves, where I have worked in LGBT and HIV advocacy for the past 15 years. UNAIDS estimates that there are more than 50,000 people living with HIV in the Pacific. On the island of Papua New Guinea alone, there were up to 4,800 new infections estimated in 2009. Among gay men, other men who have sex with men (MSM), and transgender people, the epidemic is worse. UNAIDS reports that MSM account for 43% and 65% of all people living with HIV in Micronesia and Guam, respectively. The epidemic among MSM and transgender people in the Pacific Islands is propelled by stigma, discrimination, and criminalization. Hostility toward MSM and transgender people in the healthcare system push these populations away from health services, reducing access to vital HIV prevention and treatment resources. And in countries and territories where homosexuality is criminalized, such as the Cook Islands, Samoa and Papua New Guinea, MSM cannot disclose their sexual behavior to a service provider without risking criminal sanctions. These factors are at work in every region around the world, preventing MSM and transgender people from accessing the services they need. Unique to the Pacific, however, is the fact that the entire region itself is marginalized in the global response. The Pacific is characterized by a number of obstacles to HIV programming, including high linguistic diversity, expensive transportation, and a poor communications infrastructure. These issues are compounded by preexisting legal barriers, stigma and discrimination and gender inequality in the region. The Pacific Sexual Diversity Network (PSDN), a regional network of Pacific MSM and Transgender organizations, is fighting to address these distinct challenges. Despite the clear need for tailored intervention in the Pacific, our unique needs end up subsumed, de-prioritized or forgotten altogether, and the result is a lack of data, lack of programs, and lack of resources. Donors such as the Global Fund and UNAIDS are gradually directing funding to include MSM and transgender communities, but more needs to be done. The upcoming International AIDS Conference, returning to the U.S. for the first time in 22 years, is no exception. With little to no funding from governments or donors in our region, The PSDN needs support to attend this year's Conference. The International AIDS conference is a crucial opportunity for advocates and service providers to network, build capacity, and participate in the high-level dialogues that shape global AIDS policy and resource flows. This opportunity is especially important for the Pacific, a region of small island nations with few domestic resources. We rely on international support to address our epidemics among MSM and transgender people, where many local governments have neither the resources nor the interest in providing support. The International AIDS Conference is a key gateway for integrating the Pacific into the global response. We call for acknowledgement of Pacific Islander communities and their unique place in the global AIDS epidemic. Marginalization begets marginalization, and the cycle must be broken. Without the opportunity to participate in the global dialogue, we will remain sidelined without the resources we need to stop this growing epidemic. ** Ken Moala is one of the founding members of the Pacific Sexual Diversity Network. For more information contact Mr. Ken Moala at [email protected].
