HIV rates rapidly rising among men having sex with men

The number of men who have sex with men (MSM) infected with HIV in Asia is rising rapidly, a new study has found. TREAT Asia's report on MSM, an initiative of the Foundation for AIDS Research (amFAR), found rising HIV prevalence rates across the region and a dangerous neglect of the gay community by public health professionals and policymakers. HIV prevalence rates had jumped to 28 percent in the Thai capital, Bangkok, 14 percent in the Cambodian capital, Phnom Penh, and 16 percent in the southern Indian state of Andhra Pradesh. “Although many Asian countries have thrown themselves into the fight against AIDS on many fronts, their failure to grapple with the epidemic among men who have sex with men has now left them with the possibility of a public health disaster,” the report said. The political will and creative ideas were needed to reach out to the largely invisible gay community or the consequences would be dire, it warned. "Men who have sex with men will face a crisis more devastating than that experienced by gay men in the West in the epidemic’s earliest years,” the report said. In Asia a diverse spectrum of men – from transgender or feminine acting men in Thailand and Cambodia to rural Indian truck drivers and Bangladeshi rickshaw pullers - were having sex with other men. This diversity had been an obstacle to devising effective outreach programmes, the report said. “The absence of a vocal, self-identifying MSM population prevents the application of Western models of HIV prevention and behaviour change, which are based on establishing behavior norms in a self-reinforcing community,” the report said. Many Asian men, especially in south Asia, had 'situational sex' with each other as a culturally tolerated outlet in circumstances when women were not available, the report said. TREAT cited other studies that found 15 percent of Indian truck drivers and 22 percent of Bangladeshi rickshaw pullers had acknowledged having sex with other men. A study of men in rural Laos found that 18 percent had admitted having sex at least once with another man. However, few of these men would identify themselves as ‘gay’. The study said there was a lot of social pressure to marry in most Asian countries, with up to 50 percent of MSM also sleeping with women. This provided a “bridge population” for the virus to general society. “Male-male sex is widespread, diverse and hidden,” the study said. Moreover, most men in the region were still unaware of the risks. Asia’s HIV/AIDS prevention campaigns – often focusing on the dangers of unprotected commercial sex and injecting drugs - had left some men with the false impression that sex with another man was a safer option than sex with a woman. “MSM often show much higher condom use when having sex with women than when having sex with men,” the study said. A study in Vietnam found that 40 percent of MSM reported using a condom in their last sexual encounter with a man, while the rate of consistent condom use among MSM in Cambodia was 14 to 17 percent - far lower than the usage in commercial sex with women. TREAT also said that the difficulty Asian men faced in having socially-sanctioned, long-term relationships with other men meant they had a higher number of sexual partners. In Ho Chi Minh City, Vietnam, a study found that MSM reported sleeping with 15 different partners in a year. Stigma and discrimination meant that prevention campaigns aimed at MSM were often prohibited or denied funding, the report said. Homosexual sex is still illegal in many Asian countries, especially those weighed down by legal codes from colonial times. The report called for more political leadership to recognise the dangers and for governments to provide material support for services targeting MSM. TREAT said MSM needed to be included in HIV surveillance and greater recognition given to the group in education, prevention and clinical efforts to stem the epidemic. More accurate information about the risks of anal sex, promotion of condoms and lubricant and a greater provision of services to MSM were a must. The report concluded that Asian governments had to be brought into the equation so that “those in power realise the extent of the MSM epidemic and contribute to the response”. “Real partnerships between government and civil society are the only way that both large-scale and community-based responses can be effectively marshalled,” it said.