“MSM and HIV in Asia and the Pacific: Cross-cutting Issues”

(Bali)  The risk behaviours among MSM and TG in Asia Pacific combined with the unique social, cultural and economic pressures that influence them create cross-cutting issues that must be taken into account by those seeking to support, educate and advocate for these often neglected communities.

This was the topic of today’s satellite forum [10 August 2009] by APCOM with FHI-APRO and WHO-WPRO as part of the 9th International Congress on AIDS and Asia Pacific (9th ICAAP). An overflow crowd of well over 200 Congress delegates filled every corer of the room to hear experts on specific Asia Pacific geographies discuss the unique challenges they face, and the creative solutions they are applying to reach MSM at risk in cultural environments that make such outreach especially complex.

“The vast majority of MSM is Southeast Asia are married or will be married, whether they want to be or not,” said Shale Ahmed of the Bandhu Social Welfare Society, Dhaka, Bangladesh. “”In China, more than 70 percent of the MSM are in partnership with a woman. Throughout the region, MSM face pressures of fatherhood, lineage, and religion, and many of them unknowingly infect their sex partners in other groups, such as female sex workers and their own wives.”

In addition, a large number of MSM in the region who are sex workers face a double stigma, exacerbated by low access to condoms, drug and alcohol abuse, low levels of education, a high level of mobility and dealing with harassment and violence.

Difficult issues such as these, that demand a high level of cultural wisdom and sensitivity, made the APCOM satellite forum one of the highlights at the opening day of ICAAP. Philippe Girault (FHI/ARPO, Bangkok) gave a passionate account of the role drug abuse plays in the lives of the region’s MSM and TG communities and how the use of drugs during sex is rising rapidly in Asia Pacific countries. While ecstasy remains the drug of choice, a wide variety of substances are being abused for a variety of purposes – increased energy and productivity, stress relief, weight loss, self-esteem, prolonged sexual intercourse, etc.

Solutions that are helping curb and contain the crisis, which greatly increases the likelihood of HIV infection, include a “buddy system” at events where MSM and TG are likely to use drugs, making condoms and lubricant more easily available, specialized risk reduction counseling and making creative use of existing networks to help educate those at highest risk and help them understand they are not alone.

Robert Sutherland (ACON, Sydney) explored one of the most difficult of all challenges, reaching young MSM who are HIV-positive and often overwhelmed by the multiple stigmas they face. These individuals can be sexually active for many years, posing a risk of further infection to their sex partners. “These people must be given support,” Sutherland said. “Young MSM must be reached before they become sexually active so they understand the risks involved. They must be given STI information presented in a broad framework that takes into account issues of family, drug use and culture.” An important tool for doing this, he said, was the use of peer-based education – using young MSM to educate others. He also said it was essential to reach young MSM with the tools they use to communicate with one another, especially the Internet.

“Today’s forum on cross-cutting issues was a great example of APCOM living up to its mission to bring together communities across the region to share information and innovative thinking that leads to positive change for Asia Pacific’s MSM and TG communities,” said APCOM Chairperson Shivananda Khan, OBE.

Now in its second year, APCOM is a regional coalition of MSM and HIV community-based organizations, the government sector, donors, technical experts and the UN system. Its main purpose is to advocate for political support and increased investment in and coverage of HIV services in Asia Pacific. APCOM promotes principles of good practice and lessons learnt by bringing together representatives from diverse groups in an effort to share experience, knowledge and expertise. Additional information is available at www.msmasia.org.

Presentations from the satellite:

• Manop_Uthaikorn_presentation.pdf
• Philippe_Girault_presentation.pdf
• Rob_Sutherland_presentation.pdf
• Shale_Ahmed_presentation.pdf