In Asia, every 7.5 minutes, an MSM (men who have sex with men) gets infected with HIV. This translates to an estimated 200 new HIV cases among MSM everyday. Recognising the enormity of the issue and the urgent need to deal with it, the 9th International Congress on AIDS in Asia Pacific had a one-day prelude forum focussing on HIV among the regions’s MSM and transgender (TG) communities. The meeting that opened with presentations from eminent global researchers and policy makers, aimed at scaling-up evidence-based effective HIV interventions for the MSM and transgender community in the region.

The latest epidemiological data, released today at the forum, shows that the epidemics in the region is accelerating, with an estimated HIV prevalence rate of over 30 percent among the MSM community in Bangkok, and just below 30 percent in Yangon, Myanmar. One significant trend is the high rate of infection among the youngest age group (18-22 years) of the MSM and TG communities. A just completed cohort study in Thailand that followed 1,000 HIV-negative MSM for three years between 2003 and 2006 found that 20 percent became infected with HIV. Among those between 18 and 22 years, one in every three persons got infected.

Research Studies Explaining the epidemiological studies, Frits Van Griensven, Chief, Behavioral Research, US CDC, said, “HIV has established itself among the MSM and transgender community in all Southeast Asian cities, with Bangkok and Yangon being the most alarming. In Myanmar we are seeing the same pattern as in Bangkok, starting with the very young.

Among the TG community in Jakarta the prevalence rate is 34 percent, which is extremely high. We have learned that when the prevalence rate is low in the beginning you still have time, but if you don’t have the resources, prevalence will grow and it will be very difficult to bring it down.”

Griensven also pointed out that while there is paucity in HIV incidence studies among the MSM community in the region, the transgender community is not even listed as a separate category in the reporting systems. According to him, the cohort studies also point to five conditions - selling sex, drug use, suicidal tendencies, social isolation and alcohol use - that increase the prevalence of HIV among MSM and should be considered while addressing HIV among the MSM and TG community.

Funds Allocation
Dr. Sawarup Sarkar, Director, Asia Unit, Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) said at the forum that despite the statistical evidence, investments in HIV programmes for MSM remains abysmal. In Cambodia, for example, where the prevalence rate among MSM is about 10 percent, he said that virtually none of the government spending on HIV is allocated to the MSM community. “Almost everywhere in Asia and the Pacific, the MSM epidemic is going up, even if the overall HIV infection rate in some countries is declining,” Sarkar remarked. “Unless we address it immediately, it will produce a huge number of infections and will require huge amounts of resources.” He also pointed out that while over the last five years a cumulative $ 4 billion was spent by countries in the region, less than 2.5% of it was spent for MSM.

Atrocities against MSM and TG The failure of national governments to allocate resources to their MSM and TG communities constitutes nothing less than “a crime against humanity,” according to Shivananda Khan, Chairperson Asia Pacific Coalition on Male Sexual Health (APCOM). “MSM are beaten, criminalized, harassed, imprisoned, and denied services. No wonder HIV is increasing so rapidly. We need to put faces to the figures thrown at us. It is not only about condoms. We cannot get medicine. We are not accepted as human beings. It is this discrimination that leads to high rates of HIV.” “Nearly 200 MSM and TG are infected every day across the Asia Pacific region and this number is shocking and shameful. The only way we can win this battle is if we work together and stand shoulder to shoulder to address the crisis. We have the technology and knowledge to stop it” said Khan.

The HIV prevalence among the MSM and TG communities is 35 percent. “Their access to treatment, care and support is poor and this is unacceptable,” said Dede Oetoma, APCOM/Insular, Southeast Asia.

Challenges
While from a situation of denial, the issues concerning the MSM and TG communities are now brought to the discussion tables, there is still a long way to go. Among the many challenges are a need for a legal environment at the national level and the inclusion of MSM in the disbursement of global funds. According to Dr. Prasad Rao, Regional Director, UNAIDS, Asia Pacific, the everyday challenges facing the MSM and TG communities are glaring. For instance, he mentioned extreme stigma and capacity issues of delivering health services to them. He warned that if business as usual continues, MSM will the community that would be affected the most.

UNAID’s Action Framework
Speaking at the Forum, Jeff O‘Malley, Global Director, UNDP, HIV/AIDS Group, said: “Diversity gives the community strength. So does adversity – the fights against sodomy laws, against the lack of marriage rights, against day to day discrimination, and invisibility are all important by themselves but just as importantly, they forge new communities and new generation of leaders.”

According to Malley, the MSM and transgender communities in the Asia Pacific region are already significantly affected by HIV, but shocking is the silence about it. “The strategy and solutions that make sense in 2009 in Asia and the Pacific are of course different than those that made sense in different places in different times. Nevertheless you can learn from the successes and failures of others as you craft your own responses for here and now,” he said.

The UNAIDS’ official Action Framework on Universal Access for MSM and transgender people which is now complete is built around three guiding principles and three key results – to ground all work in an understanding of human rights and commitment to fight stigma; action to be taken from evidence; and action requiring a broad coalition of partners for the short term and the long term. The objectives of the Framework includes improving the human rights situation for MSM and transgenders; strengthening and promoting evidence based data; and strengthening capacity and partnerships to ensure higher quality and more comprehensive responses.

The way forward
The all-day forum offered an interactive platform for exchanging information and knowledge. The forum discussed various facets of the growing HIV crisis among MSM and TG communities throughout the Asia Pacific region. The forum was of the view that the Millennium Development Goals and universal coverage cannot be met if HIV among MSM and TG was not addressed. Among the agenda for action are continued advocacy, higher allocation of resources, enhancing access and standards of services, capacity building and strengthening of community systems. Also needed is to build a strategic knowledge base to make informed interventions and to explore newer ways of addressing stigma and discrimination. The situation can be addressed, but not until coordinated and sustained action is taken on various fronts. The governments in the region have to work together to scale up prevention interventions and end the stigmatization and criminalization of this group, which is often socially, economically, politically and culturally isolated. 


Chairs:

Shivananda Khan, O.B.E., Chairperson, APCOM

Dédé Oetomo, GAYa  NUSANTARA, Foundation


Opening Speakers:

Michel Sidibé, Executive Director, UNAIDS (video message)

J.V.R Prasada Rao, Regional Director, UNAIDS, Asia Pacific

Jeff O’Malley, Global Director, HIV/AIDS Practice, UNDP

Swarup Sarkar, Director, Asia Unit, Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)

Frits Van Griensven, Chief, Behavioural Research Section, Thailand MOPH-U.S. CDC Collaboration

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