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El Salvador: Transvestites get help to fight AIDS

A revolutionary model for international aid helps El Salvador's transvestites battle AIDS.

El Salvador, gay pride parade
A participant of the Gay Pride Parade in San Salvador poses on June 27, 2009. (Jose Cabezas/AFP/Getty Images)

SAN SALVADOR, El Salvador — Carla, in her late 40s, is a big-boned woman who feels trapped in her male body. In the deeply homophobic culture of El Salvador, the confusion over her sexual identity nearly got her killed.

It takes courage to be gay in Latin America, and especially in El Salvador, where a sizeable portion of the country is controlled by gun-toting street gangs with a concept of masculinity that does not allow for much nuance.

Being a professional sex worker at night didn’t help. An enraged potential male client shot Carla nine times. Released from the hospital, she was shot again.

In 2001, she was thrown in jail and tested positive for HIV/AIDS.

“I didn’t want to believe it,” Carla recalled. “I didn’t know what to do.”

Prison saved her life. After doctors detected the disease, she was able to start taking anti-retroviral treatment. Today she's a dynamic activist in the city’s transvestite community.

The anti-retroviral treatment would not have been available, and Carla would probably be dead by now, if it had not been for the Global Fund, an innovative, relatively new actor on the international development scene.

The fund provides a revolutionary model by investing in carefully structured projects proposed by governments or nongovernmental organizations (NGOs). To avoid corruption, the aid money is not simply handed over. Enough money is granted to get a project started, but before additional funds are released, the project must achieve clearly identified benchmarks that are independently audited.

If the project is not working, the funding is suspended.

“We offer an 85 percent to 90 percent success rate on investment, said Jon Liden, the Global Fund’s head of communications in Geneva. “That is unique.”

The fund — whose full title is the Global Fund to Fight AIDS, Malaria and Tuberculosis — is loosely tied to the United Nations. G8 countries provide roughly 80 percent of the funding, with the United States responsible for about 30 percent. Norway, which kicks in $4 million, has the highest per capita contribution.

El Salvador now has one of the lowest HIV/AIDS rates in Central America, less than 1 percent of the population. But that could change quickly, especially since an estimated 50 percent of cases go unreported. The rate of HIV/AIDS among men having sex with men is nearly 18 percent, the highest in the region. HIV/AIDS among sex workers ranges from 3 percent to 16 percent depending on the area of the country.

The solution, analysts say, is a combination of education, free testing and affordable treatment with retrovirals. Social change and a respect for sexual identity are also key elements.

“I didn’t even know that I was gay,” said Kassie, a friend of Carla’s. “I didn’t know that I was a homosexual. Little by little, I learned about sexual orientations.”

The actual relationship between the Global Fund and cases like Carla's is indirect but effective. The government of El Salvador handles 85 percent of the cost of HIV/AIDS, but it would not have been able to afford the retrovirals needed to save Carla without the financial boost from the fund.