Vientiane - In the car park of a local beer shack in Vientiane, capital of Laos, Nakhornphet Pasomsouk is watching his team of peer educators interact with young men arriving to have a drink with their friends on a Friday night.
"Many Lao men will try sex with another man at least once in their lifetime," said Pasomsouk, assistant project officer at the Men Having Sex with Men peer-education programme of the Burnet Institute, an Australian medical research facility. "Many of them might just be trying it to see what it's like and never do it again; others might do it again. There is not just one category of men having sex with men."
The peer educators approach customers heading for the beer shack, have a quiet chat, and give them a brochure and occasionally a condom before the young men move on for their evening's entertainment.
It is part of an outreach project that runs three times per month and is designed to get safe-sex messages to "hidden" men who have sex with men (MSM). "Unlike transsexuals or openly gay men, hidden MSM can be homosexual, bisexual or straight," said Anan Bouapha, former MSM project coordinator with the Burnet Institute. "They might not want to be identified as MSM but we need to get the safe-sex message to them, no matter how difficult this is."
Hidden MSM are probably the largest group of men having sex with men in Laos but are difficult to identify in HIV prevention and surveillance and are not reached by other MSM programmes in the country.
Making contact with Laos’ MSM, and particularly hidden MSM, is key to this small Southeast Asian country’s fight against HIV/AIDS. HIV prevalence in the general population is a low 0.1 percent, but among MSM it is 5.6 percent, according to a 2007 study by the Burnet Institute, done in conjunction with the Ministry of Health.
This figure represents a worrying trend in a country whose neighbours - Cambodia, Thailand and Vietnam - already have documented HIV epidemics in their MSM communities.
The study also surveyed risk behaviours among MSM and found that while the vast majority of respondents knew unprotected anal sex was high-risk, less than a quarter used condoms with non-regular partners, and more than half also reported having sex with women.
A lack of knowledge about HIV/AIDS among hidden MSM, particularly those who have female partners, could potentially lead to an epidemic in the broader community, something which the country has so far been able to avoid.
Targeting people who don't want to be targeted
Rather than targeting known gay and transvestite haunts or using drop-in centres, teams from the Burnet Institute visit places where most young adults like to hang out – beer shacks, video shops, saunas.
"We always seek the owner's permission and they're really supportive. Many even suggest we come into their shops to talk to customers, but that's not the approach we like to take. How would you feel if someone sat down next to you and started talking about STIs [sexually transmitted infections] while you were having a drink?" said Pasomsouk, explaining why the peer educators chat to men in parking areas.
According to Bouapha, the peer educators are trained in the prevention of HIV and other STIs, as well as how to approach MSM so they feel comfortable and able to ask questions.
The approach appears to work. Sonepasith, one of the peer educators at the car park, has just been in deep discussion with a man in his early twenties. "He said he's not gay but has had sex with two men," Sonepasith told IRIN/PlusNews after the man had left.
"Now he's worried he's got an STI. I explained he needs to have safe sex from now on, told him what that means, gave him the clinic hotline number, six condoms and the brochure, which has safe sex information and all the clinic details."
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Interventions like those of the Burnet Institute may not be enough to stem an HIV/AIDS epidemic in Laos, where prevention, care and treatment programmes for MSM have yet to be rolled out across the country.
Laos is one of Southeast Asia's poorest nations, but considerably more investment is needed if it is to avoid the infection levels of its neighbours.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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