Marwaan Macan-Markar
BANGKOK, Aug 11 2006 (IPS) – When the Thai government accepted men who have sex with men (MSM) as a vulnerable community in the country s fight against AIDS, earlier this year, it gave them hope of being covered under HIV prevention programmes.
It was an unprecedented gesture, bringing to an end over two decades of silence, since governments in Bangkok had chosen to ignore the spread of the killer disease among the country s homosexuals and bisexuals. That was the first time that MSM were identified as the most at risk population and needed preventive programmes, Paul Causey, an independent HIV programme consultant in Bangkok, told IPS. The government is now going to community groups working with MSM to ask what they need, which was never the case earlier.
What precipitated this spirit of openness were stark revelations about the high percentage of HIV prevalence within the MSM community in Thailand. It shattered the belief that had taken hold in this South-east Asian country that its success at slowing down the spread of the deadly virus through awareness programmes and condom-use campaigns aimed at heterosexuals was enough.
But the disturbing rise in the prevalence of HIV among Thai MSM is part of a more worrying trend across Asia, reveals a report released Friday ahead of a major international conference on AIDS that begins on Aug. 13 in the Canadian city of Toronto. HIV rates among MSM is as high as 28 percent in some of the 23 Asian countries surveyed in the report by TREAT Asia, a network of clinics, hospitals, and research institutions promoting safe and effective delivery of HIV/AIDS treatments throughout Asia and the Pacific.
In recent years, MSM in Asia have experienced an extraordinary rise in HIV prevalence. Various studies report infection rates as high as 14 percent in Phnom Penh, Cambodia; 16 percent in Andhra Pradesh, India; 28 percent in Bangkok, Thailand, states the report, MSM and HIV/AIDS Risk in Asia.
A lack of political will and resources will condemn MSM in Asia to face a crisis more devastating than that experienced by gay men in the West during the epidemics earliest years, warns the 85-page report. The nature of MSM activity across the continent is so diverse that it forces us to rethink the basic strategies of fighting AIDS: awareness, outreach, education and testing.
The prevalence of consistent condom use among men is as low as 12 percent, and up to half of all MSM is some regions have never used a condom. Yet a majority of these men believe that they are at low risk, it states. Up to half or more of these men also have sex with women (due to) situational sex (or) the social pressure to marry and can then serve as a bridge population for HIV/AIDS infection.
Given the difficulty of surveillance in these populations, rates of HIV infection could actually be far worse, says Kevin Frost, director at the Bangkok-based TREAT Asia. This report shines a light on the extent of high-risk MSM behaviour and serves a wake-up call for Asia.
The debate that the report is expected to generate at the 16th International AIDS Conference will be a continuation of a dialogue that began at the 15th International AIDS Conference, held in Bangkok in 2004, where the once marginalised issue MSM moved from the margins to mainstream discussions.
Lack of MSM-targeted education, resulting in unsafe behaviour, has, according to the report, triggered HIV prevalence rates of up to 2.5 percent among MSM in Jakarta, Indonesia, 4 percent in Kathmandu, Nepal, 6.5 percent in Chennai, India and 4.4 percent in Tokyo. In addition, there are eight percent MSM with HIV in Ho Chi Minh City, Vietnam, eight percent in Taiwanese bathhouses, 16.8 percent in Maharasthra, India and 15.3 percent in Chiang Mai, Thailand.
Many countries in which overall HIV prevalence is low (less than one percent) nevertheless have high (MSM) HIV prevalence, the report adds. Of reported HIV cases in the Philippines and Hong Kong, 23 percent and 24 percent respectively are attributed to MSM.
In Cambodia, for instance, the HIV prevalence rate among all adults is 2.6 percent, but in the capital Phnom Penh, there are 14.4 percent of MSM with HIV. China offers a similar case, where the HIV prevalence rate among all adults is 0.1 percent, but the MSM HIV prevalence rate in Beijing is 3.1 percent.
Thailand s picture is the most troubling, according to the report. Tthe prevalence of HIV among all adults is estimated to be 1.5 percent, while the HIV rate among MSM in Bangkok is 28.3 percent. And while HIV prevalence among all of Vietnam s adults is 0..4 percent, the HIV prevalence rate among MSM in that country is six percent.
Other reasons that have fuelled the spread of HIV among Asian MSM include misconceptions about risk factors; high levels of unprotected anal intercourse; high level of transactional sex; high numbers of sex partners, it adds. MSM congregate where sex is solicited or sold. This greatly increases the chances of greater promiscuity in Bangladesh, for example, 26 percent of MSM respondents averaged over 10 different sexual partners a month.
The report warns Asian countries about a potential spike in their HIV/AIDS numbers as a result of spread among MSM. It comes in the wake of U.N. agencies raising the alarm about the general spread of AIDS across the continent. There are close to 8.3 million people living with HIV in Asia, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said in its 2006 report released this year. Approximately 930,000 people were newly infected with HIV in 2005, while AIDS claimed an estimated 600,000 lives.
MSM in Asia need not suffer the same fate as many gay men in the West, says Frost. We ve paid for that lesson with too many lives.