Complex barriers to tackling HIV transmission among MSM

Craig Knowles and Ani Lamont
Asia and the Pacific faces enormous challenges if it is to arrest rapidly rising  rates of HIV infection among men who have sex with men (MSM), APCOM's 'Foreplay – the final push towards the Three Zeros' event heard at 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP). The numbers of new infections among MSM continue to rise, despite treatments having been available for almost two decades.

"This is an incredible challenge, we have to ask ourselves how can this be happening in this era?" said Professor Chris Beyrer, President-elect of the International AIDS Society. "As an epidemiologist, I know an epidemic when I see one, and we have one here in this region right now."

National HIV prevalence among MSM is estimated to be more than 5% in at least six countries in Asia and the Pacfic: China, Indonesia, Malaysia, Myanmar, Thailand and Viet Nam. Prevalence is particularly high – 15% to nearly 31% – in large urban areas including Bangkok, Hanoi and Jakarta.

“This is an extraordinary rate of acquisition (of HIV) and the highest rates are in young men aged between 18 and 21 years of age,” said Prof. Beyrer, who is from Johns Hopkins Bloomberg School of Public Health in the United States.

Speakers at the packed pre-conference event called for “urgent scaling up of funding” for at-risk communities, including men who have sex with men, many of whom face stigma and discrimination and are still criminalized in some countries.

A recent APCOM study presented at the meeting shows a complete lack of epidemiological research in countries with significant MSM epidemics, such as Cambodia and the Philippines. It also highlighted an almost complete lack of studies involving the region’s transgender community.

APCOM is the Asia Pacific Coalition on Male Sexual Health. Founded in 2007, it is a coalition of members – governments, UN partners, non-profits and community based organizations from Asia and the Pacific.
Swastika Lama, Nepal

Swastika Lama, Peer Leader, Sexual and Gender Minorities Student Forum, a part of The Blue Diamond Society, Nepal said: "The Blue Diamond Society is the only organisation working in Nepal on MSM and transgender human rights. The Sexual and Gender Minorities Student Forum within that works with students if they have some sort of problem – teasing, or if they have issues they want to raise about their education or barriers they are facing. In short, we help them to get their education. There is just one thing that I would like to stress at this ICAAP: whatever the programme, whatever the objectives or strategy you design for youth – please be inclusive. Include young MSM and transgender people, because these are their issues. If you include them then you can design programmes that use their solutions."

Jeffry Acaba, Project Officer, Action for Health Initiatives Inc. (ACHIEVE, Inc.), Philippines said: "We conduct capacity training workshops for young affected populations, including young MSM and young transgender people. We focus on leadership and advocacy skills and communication skills, so they will be able to formulate their own advocacy messages and participate in legislative processes. At this time of the epidemic, we need to document good practices from other countries to see if it can be replicated successfully. Community-based organizations provide a bridge between governments and communities themselves. CBOs have the eye to see what the real concerns or issues are."

Jonathan Wala, Area Coordinator working with MSM and transgender in Port Moresby, Poro Sapot Project, Papua New Guinea said: "We do peer-to-peer outreach, working with around 25 volunteers in MSM and transgender communities. Stigma and discrimination is always the main issue that we face. In Port Moresby alone, there are places that we’d like to go, where we cannot go because of stigma; we might be harassed, physically or verbally in those places. We need law reform, because MSM, transgender and sex work are not legalized. If we are found in the act of male-to-male sex we will be arrested on the spot. It makes it difficult for us to do anything like a big advocacy campaign, because it is illegal, so we mainly focus on peer-to-peer education."

Craig Knowles and Ani Lamont
November 2013

Note: This article was first published in 11th ICAAP INSIGHT, the official daily conference newspaper of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) in Bangkok, Thailand. This newspaper was managed by Inis Communication and CNS.