A recent report produced by The Foundation for AIDS Research's (amfAR's) Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) initiative highlights the growing epidemic of HIV among men who have sex with men (MSM) in Asian-Pacific countries. The report, MSM and HIV/AIDS Risk in Asia: What is Fueling the Epidemic among MSM and How Can it Be Stopped,1 was released in early August in advance of the XVI Annual International AIDS Conference in Toronto. It is based on several related studies, epidemiological data, and nearly 50 interviews with HIV/AIDS researchers, counselors and government officials in more than 20 Asian-Pacific countries.2 The report, the first of its kind focused on the needs of MSM in Asia, presents sorely needed information about the culture, behavior, and marginalization of MSM in Asian-Pacific countries.3
The TREAT Asia report also brings attention to the growing epidemic of HIV/AIDS in Asian-Pacific countries and makes several recommendations for prevention efforts aimed at MSM communities. “Given the difficulty of surveillance in these populations, rates of HIV infection could actually be far worse,” said Kevin Frost, amfAR's Vice President of Global Initiatives and the director of the TREAT Asia program. “This report shines a light on the extent of high-risk MSM behavior and serves as a wake-up call for Asia. Governments in the region and international donors need to support appropriate prevention, care, and treatment efforts for MSM populations, or face a spiraling epidemic that could be far worse than any seen in gay communities in the West.”
Although overall rates of infection on the Asian continent are low compared with Africa, the large populations of many Asian countries means that even a low rate of HIV/AIDS can indicate that a significant number of people are infected.4 Estimates from 2005 show that 8.3 million people in Asia were living with HIV, and AIDS claimed some 520,000 lives.5 Traditionally, prevention programs in Asian-Pacific countries have focused on such at-risk groups as intravenous drug users (IDU) and sex workers.6 Notably, there has been little to no focus on preventing the spread of HIV among MSM, despite the fact that in many Asian-Pacific countries, MSM represent a large population. Figures of men who report ever having had sex with men range from 5% to 49%.7 Even in countries where the MSM population is relatively small, the rate of HIV prevalence among this group is much higher than in the general population. HIV rates among MSM in various Asian-Pacific countries range from an estimated low of 1-3% in China to a high of 15.3%-28.3% in Thailand.8
High rates of unsafe sex and low rates of condom use have contributed to the rise in HIV infection. This low condom usage and a lack of knowledge about the risks of male-to-male sex can be attributed to the larger problems of social stigma against MSM and a lack of government response targeted to MSM communities in Asian-Pacific countries. The TREAT Asia report indicates that, in many countries, prevention efforts have largely ignored the needs of MSM and have instead focused primarily on the dangers of IDU and heterosexual sexual behaviors, leading many MSM to believe that their own sexual behaviors are not risky.9 Additionally, many MSM are afraid to seek testing or services because of stigma and marginalization. Health care providers in many Asian-Pacific countries are also unequipped or unwilling to deal with issues faced by MSM. Reluctance to access services is also due to the illegality of male-to-male sex in several countries and a fear of prosecution for same-gender sexual behavior.10
According to the report, participatory programming and campaign development to address the needs of MSM communities in Asian-Pacific countries are desperately needed. Non-governmental organizations (NGOs), the primary deliverers of these prevention services, are in need of government support and international funding that supports appropriate efforts for MSM communities. In particular, the TREAT Asia report highlights evidence-based research that indicates the need for programming which emphasizes condom usage and does not stigmatize MSM. Unfortunately, the U.S. federal government's current AIDS-related assistance efforts, which fund many Asian-Pacific HIV prevention programs, inadequately address both condom usage and the high risk behavior of MSM. Instead, the Bush Administration purports to support an “ABC” plan to fight AIDS: abstinence until marriage, being faithful to one sexual partner; and if those conditions are not practiced, the use of condoms.11
Although the ABC plan contains condom use as one of its prevention approaches, advocates for comprehensive prevention efforts are frustrated that the Bush Administration promotes only the “A” and “B” portions of the plan and that the U.S. Congress has stipulated that a substantial proportion of international aid funds be spent on encouraging abstinence and promoting marriage. These programs are severely criticized in the fight against AIDS in Africa for promoting abstinence to the detraction of other effective HIV prevention strategies.12 The findings from the TREAT Asia report illustrate that these same abstinence-only-until-marriage strategies will likewise do little to stem the spread of AIDS in Asia since they blatantly ignore the needs of one of the most at-risk groups: men who have sex with men.
To view the complete report, please visit: www.amfar.org/cgi-bin/iowa/index.html
- “MSM and HIV/AIDS Risk in Asia: What is Fueling the Epidemic Among MSM and How Can it Be Stopped,” (New York: TREAT Asia, August 2006), accessed 15 August 2006, <http://www.amfar.org/cgibin/iowa/index.html>.
- “HIV Prevalence High Among MSM in Asia-Pacific Countries, Lack of Government Resource, Stigma, Ignorance Primary Causes, Report Finds,” Kaiser Daily HIV/AIDS Report, Kaiser Network.org, 14, August 2006, accessed 15 August 2006, < http://www.kaisernetwork.org/daily_reports >.
- The report presents information about Bangladesh, Bhutan, Brunei, Cambodia, China, East Timor, India, Indonesia, Japan, Laos, Malaysia, Myanmar, Nepal, North Korea, Pakistan, Papua New Guinea, Philippines, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, and Vietnam.
- Asia, UNAIDS, accessed August 15, 2006, <http://www.unaids.org/en/Regions_Countries/Regions/Asia.asp>
- “ FHI Targets MSM, TG Groups in Asia,” Family Health International, accessed 16 August 2006, <http://www.fhi.org/en/HIVAIDS/country/Asia/index.htm>.
- “MSM and HIV/AIDS Risk in Asia: What is Fueling the Epidemic Among MSM and How Can it Be Stopped.”
- “India: Repeal Colonial Era Sodomy Law: Entrapments, Arrest Harm AIDS prevention Efforts,” (New York: Human Rights Watch, 11 January 2006), accessed 15 August 2006, <http://hrw.org/english/docs/2006/01/11/india12398.htm>.
- Dan Brown, “Africa Gives ABC Mixed Grades,” Washington Post , 15 Aug 2006, accessed 18 August 2006, http://www.washingtonpost.com/wp-dyn/content/article/2006/08/14/AR2006081401458.html .
- “US Criticized for HIV Aid Effort,” BBC News , 16 August 2006, accessed 16 August 2006, <http://news.bbc.co.uk/2/hi/health/4797537.stm>.