Asian countries urged to address HIV/AIDS in MSM
Authors: Margaret Harris Cheng
Journal: The Lancet (2009)

A sharp rise in HIV/AIDS infections could be looming among men who have sex with men in Asia unless they are given better access to health services, say experts. Margaret Harris Cheng reports. Widespread adherence to colonial laws against sodomy, along with political and social denial of homosexuality, mean that Asia has been caught unawares by a rapid rise in HIV/AIDS cases among men who have sex with men (MSM). “We're really in for big trouble. I think there is still time to do something but we've got to do it quickly”, Frits van Griensven, chief of behavioural research at the US Centers for Disease Control and Prevention's regional office in Bangkok, told a meeting jointly held by WHO, UN Development Programme, and UNAIDS in Hong Kong last week to find ways to deal with the problem. Their primary conclusion was that there is a “paucity of information and several knowledge gaps” due to lack of surveillance but the research that has been done indicates “widespread HIV transmission throughout the region where MSM and TG [trans gender] appear increasingly and disproportionately affected by the HIV epidemic”. One of those knowledge gaps is an accurate measure of the number of men who are having sex with other men in the region. 10 million has been suggested, but as Zunyou Wu, director of the National Center for AIDS/STD Control and Prevention at the Chinese Center for Disease Control and Prevention in Beijing notes, “Some say more than 5 million, some say more than 10 million, others say over 30 million. We have no idea which is the correct figure.” In China, it has been estimated that MSM have a 45 times higher risk of contracting HIV than men in the general popualtion. Although HIV/AIDS has now become the leading cause of death from infectious diseases in China, it is not feared like severe acute respiratory syndrome or avian influenza, said Wu. “One challenge we face, when we talk about HIV [is that] people are not afraid of it.” van Griensven reports similar attitudes in Bangkok where his group have measured the prevalence of HIV among MSM rising from 18% in 2003, to 28% in 2005, and 31% in 2007. “There's safe sex fatigue”. Recalling his early days working in San Francisco among emaciated, desperately ill people with HIV/AIDS, van Griensven said: “There's new generations of MSM who don't have that image. Young MSM in Bangkok, they have no idea about the HIV epidemic. It's such a western concept. They have no clue what they're getting into and not enough is being done to stop it. There are no religious, legal, cultural, or social restraints, and condom use is low, 40 to 50%.” Although the lack of restraints may be fuelling the epidemic in Bangkok, in many countries it is legal restraints, particularly a British legacy, the anti-sodomy article 377 carefully preserved by Asia's former British colonies (Singapore, Malaysia, India, Pakistan), that are being blamed for the rise in HIV/AIDS among MSM. In only four countries in continental Asia—China (including Hong Kong), Cambodia, Thailand, and Mongolia—is sex between men legal or has been decriminalised. Those who attended the Hong Kong meeting are hoping that China, often seen as the most conservative of Asian nations, can be used as a model to persuade countries like Malaysia, Singapore, India, and Pakistan to repeal their sodomy laws and to start working with MSM in their communities. Within less than a decade, China's central government has gone from refusing to acknowledge the existence of HIV/AIDS to major surveillance and research, along with efforts to engage with affected groups. “I don't think there are any obstacles preventing us communicating with our government”, said Zhen Li, of Tong Zhi—the major advocacy group for MSM in China. HIV/AIDS surveillance, management, and prevention programmes are all hindered, or rendered non-existent, by laws criminalising homosexuality. The laws encourage men who wish to have sex with other men to do it in the least safe manner, said Shivananda Khan, of the Asia Pacific Coalition on Male Sexual Health, who has spent the past 20 years working with MSM in Pakistan, India, Bangladesh, and Afghanistan. “The social environment is not conducive to safe sex. When your whole understanding is self-stigmatisation, self-hatred, you take more risks.” China's evolving response to HIV/AIDSOver the past decade, China's response to HIV/AIDS has transformed from denial and inertia to pragmatic prevention and treatment programmes. Still, massive challenges remain for the country. Full-Text PDF