Most Gay Men In Asia Have No Access To Hiv Prevention, Care

[george]

Most gay men in Asia have no access to HIV prevention, care

More than 90 per cent of men having sex with men (MSM) in Asia and the Pacific do not have access to HIV prevention and care services. And if the situation is not urgently addressed the spread of HIV will rise sharply in this vulnerable population in the near future, a conference in Bangkok heard yesterday.

Laws across the region need a dramatic and urgent overhaul to allow public health workers to reach out to gay men, or the consequences could be dire and stretch well beyond MSM to affect the general population.

This warning came at a symposium - "Overcoming Legal Barriers to Comprehensive Prevention Among Men who have Sex with Men and Transgender People in Asia and the Pacific" - held at the 9th International Congress on Aids in Asia and the Pacific (ICAAP). The event was hosted by the UN Development Programme (UNDP) and the Asia Pacific Coalition on Male Sexual Health (Apcom).

Speakers said effective and comprehensive HIV prevention among MSM and transgender people could only occur when a conducive and enabling legal environment was created to allow unimpeded dissemination of prevention messages and services. They also discussed appropriate provision of treatment, care and support services, plus confidence-building measures among the most marginalised and vulnerable to seek essential information and access services.

"In order to achieve universal access to HIV prevention, treatment, care and support and realise the Millennium Development Goals, we must facilitate an enabling legal environment and human-rights-based HIV policies and programmes for MSM and transgender people," Jeffrey O'Malley, global director of UNDP's HIV Group said.

"This will mean stepping up our investment in legal and social programmes which effectively address stigma and discrimination directed at MSM and transgender people."

Due to the increased availability in recent years of epidemiological data on HIV among MSM, there is a better understanding of the magnitude and nature of the HIV epidemic amongst MSM and transgender people in Asia and the Pacific. But speakers said there was still a dangerous lack of interventions to prevent HIV, and treat and support such people with HIV.

A survey in 2006 of HIV "interventions" in 15 Asia Pacific countries estimated that targeted prevention programmes reached less than 10 per cent of MSM and transgender people. That was far short of the 80 per cent needed to turn the HIV epidemic around.

"One of the key challenges for overcoming barriers to prevent HIV is to promote the formulation of humane laws and policies which enable people to participate in addressing the disease in a cooperative manner, rather than driving those living with HIV underground," said Vitit Muntarbhorn, a law professor at Chulalongkorn University.

Driving people with HIV "underground" was bad, he said, because it made the disease more difficult to control.

"For this reason, it is essential to advocate the adoption of laws which do not lead to discrimination and marginalisation, and to provide space to respect sexual activities between consulting adults in the private sphere in their diversity," he said.

Some 20 countries in the Asia Pacific criminalise male-to-male sex, and these laws often took the force of vigilantism, leading to abuse and human rights violations. Other laws violated the rights of MSM and transgender people via arbitrary and inappropriate enforcement, which obstructed HIV interventions, advocacy, outreach, and services.

These structural barriers made gay men much more vulnerable to HIV and had a huge adverse effect on their health and human rights. Developing strategic partnerships and alliances between affected communities, the legal profession, human rights bodies, parliamentarians and policy makers was critical, speakers said. Given the global economic crisis and the ever-rising cost of life-saving anti-retroviral drugs, the impetus for effective HIV prevention was vital, they said. Only comprehensive rights-based prevention, supported by an "enabling" legal set-up, offered hope of cutting the number of people with HIV.

Thus, it was cost-effective and imperative that governments introduce and implement legal and social programmes that counter discrimination and stigmatisation that have long targeted gay men and transgender people.

-- The Nation 2009-08-13

[Ijustwannateach]

Furthermore, many MSM in this region do not self-identify as gay, which makes programmes and services targetted to a self-consciously 'gay' community seem irrelevant or threatening to them. That is one sense in which western attempts to address HIV prevention among men who have sex with each other have failed; in that they required them to have the same political/psychological models as western 'gay' men. Fortunately, as the use of MSM in the article demonstrates, aid agencies are becoming more sophisticated and recognise that many men who have sex with men do not view themselves as 'gay' by western or even by their own connotations of the word.