New Asia Pacific Statistics Reveal an Alarming Incidence of
HIV in MSM
Saturday, December 01, 2007
APCOM Ready to Play a Key Role as Governments and Civil Society in the Region Ponder Urgent Strategies to Tackle the Crisis
New Delhi/Beijing/Bangkok - Today, on World AIDS Day 2007, hundreds, perhaps thousands, of men who have sex with men (MSM) will become infected with HIV in cities across the Asia Pacific, becoming the latest statistics in an almost unrecognized but ever-growing crisis that many governments in the region are only just beginning to grapple with. As these efforts take shape, the Asia Pacific Coalition on Male Sexual Health (APCOM) is offering its partnership to develop and support new strategies aimed at tackling this regional challenge.
Paradoxically, it may be more challenging for APCOM to draw attention to the MSM HIV issue. The recent adjustment downwards of global HIV and AIDS figures has been construed in some quarters as an indication that the AIDS crisis has been "exaggerated" all along. However, APCOM and the stakeholders it represents are urging the Asia Pacific region, and indeed the world, not to confuse the true picture.
Most MSM who contract HIV today in city after city in the Asia Pacific region will never know they harbour the virus until they become ill with advanced symptoms. Without that knowledge, they probably will not change the very behaviours that put them, as well as their partners and loved ones, at risk. A recent survey in a major Asian capital suggested as many as 32% of MSM there are HIV positive. In other cities across the region, HIV infection rates for MSM range from estimates anywhere from 5% to 15% or 20% and higher.
"Despite MSM having higher infection rates than the general adult population, the financial investment for HIV prevention, care and support services for this marginalized group across the Asia Pacific is abysmally low in national HIV and AIDS programme planning, usually between zero and four percent," says Shivananda Khan, APCOM Chairperson and CEO of Naz Foundation International. "Less than one in ten MSM in the region have access to any sort of HIV services, woefully short of the eight in ten that UNAIDS describes as optimal coverage necessary for high-risk groups. Is it any surprise then that we really don’t have a clear picture of the true extent of the HIV crisis affecting men who have sex with men?"
Edmund Settle, HIV/AIDS Programme Manager for UNDP China, concurs. "You’ve got these really alarming statistics of ten, 20, 30 percent HIV infection rates among MSM in some major cities, but when you ask whether this picture holds true across other urban centres, or even in suburban or rural areas, the answer’s not at all simple. It ranges from `Yes, it’s somewhat likely’ to `Well, we’re not really certain.’ Still, we do know more today than just a couple of years ago."
That growing clarity comes from a recent review of available data, soon to be released by UNAIDS, that describes the epidemiology of HIV and sexually transmitted infections (STI), and behaviours of MSM in the Asia Pacific region that put them at considerable risk of HIV and STI. As the paper states: "Severe and established HIV epidemics are found among MSM in some countries while imminent or beginning HIV epidemics were observed in others." The review also recommends ways to change policy and programming that would confront this challenge and help improve the situation.
"This collection of data in the upcoming review allows us to highlight more accurately than before the extent of the HIV scenario vis-à-vis MSM in our region," according to Geoff Manthey, Regional Advisor on MSM for Asia Pacific UNAIDS Regional Support Team (RST-AP). "It also comes at a most opportune time, with the recent creation of the Asia Pacific Coalition on Male Sexual Health. We hope that the work of APCOM, and its strength in bringing together representatives from governments, the UN system, donors and NGOs side by side with affected communities will finally make the difference in creating a truly regional strategy to address the MSM HIV crisis -- and yes, even though it’s an overused word or sounds like a cliché, this is a crisis, make no mistake about that."
In 2006, a year before APCOM’s creation, JVR Prasada Rao, director of UNAIDS RST-AP, had warned that "data in Asia show that without interventions, male to male sex will become one of the main sources of new HIV infections in the region," He added, "We are facing a public health crisis, but you would never know it from the region’s almost invisible response so far" -- a fact supported by a UNAIDS report published this past August, Men who have sex with men -- the missing piece in national responses to AIDS in Asia and the Pacific.
The China Center for Disease Control and Prevention (CCDC) recently stated that HIV prevention for MSM was the latest hurdle for the government’s drive to curb a fast-rising AIDS epidemic. In fact, China -- the world’s most populous nation -- was the first country in the region to issue a specific national framework on MSM and HIV, which calls for urgent efforts to engage civil society in a concerted effort to reach out to men who have sex with men. China recently reported that male to male sexual transmission now accounts for 12.5 percent of new HIV cases in 2007, up from 2.5 percent in 2005.
Reflecting the growing regional awareness for enhanced surveillance that incorporates epidemiology as well as sociocultural awareness, the Center for HIV/AIDS/STI (CHAS) in Laos PDR has conducted the first survey of HIV among MSM in Laos and will soon be releasing the results. As governments and health partners across the Asia Pacific wake up to the realization that national HIV prevention strategies must include a significant MSM component, APCOM and its partners stand ready to support and strengthen such approaches.
"All of these surveys, these papers, these data and statistics represent hope that our region is making a breakthrough," says Dede Oetomo, who sits on APCOM’s interim governing board and is a noted long-time gay activist in Indonesia, a country with limited but successful and well-documented results in HIV and STI prevention among MSM. "However, the good work that’s emerged in recent times also serves as a warning that the hard work now really begins. With the multisectoral strength that APCOM provides, we are poised to finally reach out to MSM groups in a way that hasn’t been possible before. It’s an important, exciting time -- full of challenges, yet full of promise. Let’s go forward now and get the work done."
Shivananda Khan / New Delhi: +91 98392 21091 (mobile)
Paul Causey / Bangkok: +66 81 984 6515 (mobile)
Edmund Settle / Beijing: +86 1391 136 3025 (mobile)
Geoff Manthey / Bangkok: +66 81 870 2175 (mobile)
A concept that grew out of the mounting HIV crisis in MSM populations across the Asia Pacific, APCOM was formally launched in July 2007. APCOM is a direct outcome of the Male Sexual Health and HIV in Asia and the Pacific International Consultation held in New Delhi in late 2006. This three-day consultation brought together community members, government officials, policy makers and researchers to provide an opportunity to inform and develop strategic advocacy initiatives on key policy issues concerning MSM and the transgender community.
Opened to regional and sub-regional networks, as well as national networks and individual organizations, APCOM is governed by a 19-member Governing Board comprised of community representatives from 7 Asia Pacific sub-regions: the Pacific (including New Zealand), South Asia (including Mongolia but excluding India), Greater Mekong (GMS), South East Asia (excluding GMS), Developed Asia (Japan, South Korea, Singapore, Taiwan, Hong Kong and Australia), China and India. In addition, the board will consist of representatives from the transgender community, government sector, donors and a communication advisor. UNAIDS, UNDP and UNESCO will support APCOM as technical advisors.
A coalition of governments, UN partners, donors, NGOs and populations that are directly affected by the AIDS epidemic, APCOM’s goals are ambitious but have been meticulously planned. Through increased participation and MSM representation in regional and global bodies and conferences, APCOM will seek to scale up and increase attention to the needs of MSM in general and HIV issues in particular. Forums that APCOM has been, or will be, represented at include ASEAN ministerial meetings, ICAAP-9 and the 2008 International AIDS Conference in Mexico.
By the leveraging of technical assistance, support and mentoring to MSM HIV projects, state and national governments and to existing technical assistance facilities, as well as by identifying and assisting the development of MSM and HIV networks, APCOM will strengthen community work and help partnerships so that work can be shared and improved upon.
With the current vacuum of data on MSM and HIV in Asia (although recent surveys and reports are gradually filling some gaps), a critical role for APCOM is to assess and track -- country by country -- both the degree and quality of inclusion of MSM and HIV issues, and to report on national AIDS plans. All the while, APCOM will seek to promote the principles of good practice and lessons learnt to policy makers, service providers and MSM based on qualitative research and cost effective studies.
An APCOM website is being developed to serve as a focal point for information and examples of good practice, a repository of research papers with practical applications as well as publications for anyone interested in the issues of HIV and MSM, including academics, policy makers and members of the MSM community itself. The website will also be an online governance tool for APCOM’s trustees and for its members. APCOM will work with UNESCO in the creation of a companion website envisioned to be a clearing house for state-of-the-art information, BCC/IEC materials and research data on MSM and HIV (particularly in the Asia Pacific). The APCOM website, scheduled to be online in early 2008, will be located at www.msmasia.org.
APCOM’s temporary office is based in New Delhi. Contact information:
Aditya Bondyopadhyay, Secretariat Coordinator
Flat 25 DDA SFS, Sector-6, Pocket-1, Dwarka, New Delhi-110075, India
Telephone (mobile): +91-981-117-0181 or +91-931-117-0181