HIV/AIDS interventions throughout Asia have maintained a deathly silence on the subject of sex between men. This has left many males who have sex with males (MSM) unaware of the need to protect themselves from HIV and ignorant of the prac-tices that will lower their risk of being infected.

For many years, there was virtually no data collected about MSM and HIV in most Asian countries. Recent efforts to fill this gap have confirmed some people’s fears — certain MSM popu-lations have alarmingly high HIV prevalence rates. Studies are also beginning to yield insights into the factors driving MSM HIV/AIDS epidemics.

The purpose of this booklet is twofold: 1. to summarize key findings about the epidemiology of HIV/AIDS among Asian MSM; and, 2. to discuss the programmatic impli-cations of those findings.

The central epidemiological issues were presented in detail in AIDS in Asia: Face the Facts, a report issued by the Monitoring the AIDS Pandemic (MAP) Network in 2004. This publica-tion follows up by highlighting main issues that relate specifically to male-male sexual behaviour. It also describes how those points should inform HIV prevention strategies.

This is one of a series of three programming-themed booklets based on AIDS in Asia: Face the Facts. The other two are MAP Report 2005: Drug Injection and HIV/AIDS in Asia and MAP Report 2005: Sex Work and HIV/AIDS in Asia. Taken together, they provide insight into how to respond to the behaviours driving the spread of HIV in Asia’s most at-risk popula-tions.

Download Male-Male Sex and HIV/AIDS in Asia

PDF format, 1.9MB, 24Pages.

Contents
Male-Male sex and HIV/AIDS in Asia: a summary 3
1. Introduction 4
2. Why Asian HIV prevention efforts must target MSM 5
Ignoring male-male sex has skewed risk perceptions 6
Male and transgender sex workers 6
Sex and drugs 8
Men who have sex with men and women 8
3. Facing the facts: translating the evidence into strategies
for reducing HIV transmission among MSM 10
Starting with the prevention basics: condoms and lubricants 10
Services for males who have sex with males 10
The role of the community in MSM HIV prevention efforts 12
The need for supportive government policies and programmes 12
4. Conclusion 13
Appendix 1: Members of the Monitoring the AIDS Pandemic Network 15
Appendix 2: Sources used in this report 16

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MAP is a collegial network of internationally recognized technical experts seeking to assess the status and trends of the global HIV/AIDS pandemic. MAP was created in 1996, through the collaboration of the AIDS Control and Prevention (AIDSCAP) Project of Family Health International, the Francois-Xavier Bagnoud Centre for Health and Human Rights of the Harvard School of Public Health, and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Male-Male Sex and HIV/AIDS in Asia: a summary

Many of the first reported HIV cases in Asia were among males who have sex with males (MSM). As the heterosexual and injecting epidemics grew, male-male sex was largely ignored in HIV/AIDS interventions. This is in part because male-male sex is so difficult to characterize in many Asian countries. It encompasses a large spectrum of behaviours between people with various social and sexual identities. In recent years, renewed efforts to understand the risk of exposure to HIV in anal sex between men have yielded some alarming findings.

❏ In Bangkok, Thailand, a 2003 study found that 17 percent of men who have sex with other men were infected with HIV.

❏ By 2000, 15 percent of men who engage in male-male sex in Phnom Penh, Cambodia, tested positive for HIV.

❏ Among transgender sex workers in the Indonesian capital, Jakarta, HIV prevalence increased from 6 percent in 1997 to 22 percent in 2002, according to a survey.

As a result of the recruiting methods used, it is possible that these findings represent the segment of the MSM population that is most at risk, rather than the MSM population overall. However, they still give cause for alarm in the Asian countries that continue to neglect male-male sex in their prevention, care/support and treatment programmes.

Programme managers addressing male-male sex need to consider the following issues.

❏ Condom use. Most HIV/AIDS interventions have focused strongly on reducing unprotected commercial sex between men and women, and have done little to tackle risky sex between males or between males and transgenders. The result is that in most countries, males are far more likely to report condom use in sex with a female sex worker than with a male partner, even though the risk of HIV transmission in anal sex is higher than in vaginal sex.

❏ Selling sex. Males and transgenders who sell sex to other males are at particularly high risk, because their turnover of partners tends to be very high. Risky behaviour remains common in this part of the population. Simple risk reduction strategies involving the provision of condoms and water-based lubricants are little known in some countries. HIV risk reduction initiatives at an adequate scale are urgently needed for males engaging in high-risk behaviour with other males.

❏ Sex and drugs. When male-male sexual behaviour overlaps with drug use, including drugs that are injected and other drugs like amphetamines, the risk of HIV infection may increase. Prevention programmes need to take into account the possibly high potential for drug use among males who have sex with males and either integrate drug use reduction approaches into programming or establish linkages with other agencies working in this field.

❏ Males who have sex with men and women. In many parts of Asia, studies have revealed that men generally assumed to belong to the heterosexual mainstream report high levels of bisexual behaviour. These may include men who identify as heterosexual, even while buying sex from transgender sex workers. Also, males selling sex to men have reported being sexually active with women. These complex sexual networks all can potentially serve as pathways for the spread of HIV. The integration of information about the risks of male-male sex in prevention programs is critical.

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