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23 Jul 2010

Asia Internet MSM Sex Survey 2010 preliminary report

The Asia Internet MSM Sex Survey 2010 preliminary report which focuses on cross-country comparison was released at the Vienna AIDS conference on 22 July. The study is one of the largest of its kind in the world with 13,882 respondents. A more detailed analysis on risk factors will follow in a few months.

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Introduction

To download the report (in PDF), click here.

The advent of the Internet in the 1990s has fueled the emergence and rapid growth of gay communities across Asia. Broadband Internet access in many countries in the region has allowed MSM to meet and communicate with one another, overcoming barriers such as social stigma and government regulation. 

In the last few years, there have been reports of new or newly identified epidemics of HIV among men who have sex with men (MSM) in Asia[i], against a backdrop of a global epidemic of HIV infection where MSM continue to be disproportionately affected. Some studies suggest a strong correlation between Internet use and multiple risk behaviours of MSM[ii], which may be contributing to the epidemic. The Internet may have made it easier to have more sex partners, of seroconcordant or serodiscordant HIV status, and has become one of the most popular venues for MSM to find sex partners. The Internet has also been associated with unprotected sex and sexually transmitted disease outbreaks [iii-ix].

Objectives

To conduct an annual large scale, multi-language Internet-based survey of MSM who use the Internet on their sexual history, risk behaviour, HIV and STI testing history and self-reported HIV prevalence which will allow the direct comparison of similar populations from different countries

Methods

The Asia Internet MSM Sex Survey was conducted over 2 months of each year. Participants were invited to complete a confidential, anonymous self-administered questionnaire online and asked to provide information on socio-demographic characteristics including age, ethnicity, educational attainment, and employment. They were also asked about their sexual orientation and HIV test history. Men were asked about where they met their sexual partners and how old they were when they first had anal sex with another man and whether a condom was used during their first anal sex experience. There was no incentive offered to complete the questionnaire.

The survey was launched in English in 2009 (www.msmsexsurvey.com), and expanded to include 9 additional Asian languages and dialects in 2010 under the new AIMSS branding (www.2010aimss.com): Chinese (Mandarin Simplified, Taiwanese Traditional and Cantonese), Japanese, Thai, Tagalog, Bahasa Malaysia, Bahasa Indonesia and Vietnamese. Participants could seamlessly switch between languages at any point in the survey. Translations were provided by native speakers who were also either MSM from a community-based organisation or researcher working in HIV so as to ensure the language used would be appropriate to local MSM contexts.

The 2010 survey contained new questions on male clients of men who sold sex, alcohol use before or during sex, age of sexual debut and several other new sections.

Participants were recruited exclusively through online methods, primarily through web banners and electronic direct mailers (EDMs) sent through a network of community coalition partners. Over 40 community coalition partners from 12 countries participated in 2010. These partners include gay websites, bars and clubs, saunas and community organisations.

Results

A total of 5,806 completed the online questionnaire in 2009 and 13,882 in 2010. 

The median age of the men at the time of the survey was 25 years in 2009 vs 29 years in 2010 (range 11 to 77 years). The majority of the men were of Asian ethnicity and most were either in full time employment or education. Over half said they had a University or post-graduate degree. Nearly all the men self-identified as gay or bisexual (97% in 2010 vs 98% in 2009) and about a third said they have been in a relationship with another man for more than 6 months at the time of the survey. 41% in 2010 vs 30% in 2009 of the men have had an HIV test; of those who have had a test, self-reported HIV prevalence was

5% in 2010 vs 6% in 2009. 

Around 60% of the online sample reported little or no risk for HIV transmission. These men either had no sexual contact, only oral sex (no anal intercourse), or always used a condom for anal intercourse. Over 70% of the participants had used the Internet to seek male sexual partners. 

Differences were found in between participants from each country in several areas, highlighting the diversity of the populations.

The following are selected charts from the report. To view references and the report (in PDF) in its entirety, click here to download

Limitations

1. The participants may not be representative of the Internet using MSM population

2. Marketing efforts in each country was not consistent and hence reach into each country's population was not equal. This means the demographic make up of respondents from each country is also not on par.

Discussion

Emerging trends

• Internet as primary means for men to meet other men for significant number of MSM who use the Internet
• Sex parties are becoming commonplace in most countries
• Recreational drugs, including methamphetamines are being used for sex
• Sex with regular partners have much lower rate of condomuse than with casual partners 

Philippines is of particular concern and appears to have the preconditions for a future epidemic:

• Low condom use
• Low testing rates
• High prevalence amongst those who have been tested
• Multiple sex partners
• Sex parties

Acknowledgements

This survey would not have been possible without the assistance and inputs from A Prof Nai-Ying Ko (Kaohsiung, Taiwan), Jane Koerner (Nagoya, Japan), FHI Vietnam, FHI Indonesia, Kosol (Rainbow Sky Association of Thailand), Philippe Girault, Jan van Wijngaarden, Brad Otto, Mandy Govender, Roy Ngerng, A Prof Roy Chan, and all our community coalition partners. 

Dr Stuart Koe is founder and CEO of Fridae. He holds a Doctor of Pharmacy from the University of Minnesota, specialising in HIV therapy and is currently a Board member of Hong Kong’s Aids Concern (since 2006), a founding Trustee of Singapore’s Action for AIDS Endowment Fund (since 2003), and a long time AIDS activist, having also served on AfA’s Executive Committee for several terms (since 1998). He is also the Vice Chair of APCOM's first governing board, elected in June 2010.

Reader's Comments

1. 2010-07-23 19:17  
Wow! Great work! I participated in the study... Congrats!
2. 2010-07-24 08:27  
even though many sexual partners can satisfactorily appease infinite seduction yet impossible, at least to me, smartly date few in the meanwhile. you all good la for being so clever to hush one another sexual partners. my faithful one sure discover my unfaithfulness if i date few.
3. 2010-07-24 11:29  
Many bigots in the world would like to kill gay people.

That is terrible.

Let us not kill ourselves by unprotected sex.

Regarding many many sexual partners, we are humans not animals, right?
4. 2010-07-24 12:28  
My view is that we should not be moralistic - or adopt the higher moral ground - by admonishing or condemning those who have multiple sexual partners.

The more important message to get across is the need for safer sex awareness and practices. Although the inherent risks of infection increase with having multiple partners, that is not a source of transmission per se. Rather, the risks should be ameliorated via protected sex and safer sex practices.
5. 2010-07-24 17:02  
klwl... couldn't agree more. But Asian societies love to be judgemental... especially in cases like this, where the promiscuous are getting more sex that the moralists

I was horrified, but not surprised, by the Malaysian data on the high level of unprotected sex and the low level of HIV testing

There is an appalling level of ignorance in Malaysia on matters relating to sex....on everything really.
This is partly due to Islam's reluctance to entertain any form of sex education. Being 30 yrs behind the rest of the world they are only now experimenting with a trial program that will run for five years... Talk about reinventing the wheel??... or is it called procrastination???

There is also a frightening level of ultra-ultra-conservatism and a total lack of curiosity and questing for knowledge amongst Malaysians of all races.
6. 2010-07-24 17:36  
I know from your campaign work that you acknowledge the existence and value of negotiated safety -- so why would you report UAI-C and UAI-R together in the same graph (#15)?
7. 2010-07-24 18:56  
Because there is data that demonstrates that one of the main sources of infection comes from unprotected sex with regular partners - it is a false sense of security - unprotected sex still exposes one to risk regardless of whether it is negotiated.

1 out of three people who have unprotected sex with a regular partner ALSO have unprotected sex with casual partners. Even if one person is sure he does not have sex outside a relationship, there is no guarantee his partner is doing the same.
8. 2010-07-25 21:16  
I second dense on this one in the sense that the statistics, while horrifying from the Malaysian point of view, is in line with the current government policies.

There's a lot more to be done here.
9. 2010-07-25 21:23  
I guess it doesn't surprise me about Malaysia and Philippines. I know people from both. Indonesia was a bit of a surprise, but not much, given the tourism.
10. 2010-07-29 23:29  
it's great to know that more Malaysians hav gone for testing to know their status, however it is unnerving to find out more people chose to practice unsafe sex even at this age where awareness and STD knowledge is exposed.
11. 2010-07-30 10:53  
As for Malaysian, in the gay community, there are those who are educated and they are aware of the knowledge on HIV, its transmission and safer sex lifestyle, but shockingly its not the case in their bahaviour.. I think its similar like in Singapore when I left the country 5 years plus ago.. since we are talking about those who are educated and internet savvy, and who have access to the HIV knowledge and information, still do not practise safer sex lifestyle, what about those who do not have access to the information on the internet or any where else..

this is referring to those who are living in the urban areas in Malaysia, what about those who are from sub urban and rural areas, I think they are the least to have access to this info. Thus, you can imagine in another 5 years or 10 years down to road, what will be the scene and situation in Malaysia will be.. among the MSM and gay community.. are going to be like Thailand in their 80s? I wonder..

Malaysia being a muslim country and with other religions believe system, which is still very much conservative and the obstacle to open sexual and sexuality discussions in this nation, is not helping much in the prevention of this HIV epidemic..

What is the politician and government leaders thinking? Why can they not see this clear picture in the future for Malaysia? There will be no future for Malaysia, as we are talking about One Malaysia, if they do not wake up from their slumber and truly understand the current situation here in Malaysia.

As for those who claimed to be activists in the scene are also not seeing the real picture and getting themselves involve with NGOs who are currently already doing the ground work and to lend a helping hand to walk their talk and not just like sounding gongs without much bigger impact in changing the scene..

Thanks to fridae for this great project as it does help to bring out the facts of what is really going on in Malaysia from the participation of the Malaysian members in this project. Bravo and kudos for the job well done and great actions will be needed for the Malaysia counterpart to truly want to change the scene for better in years to come.
12. 2010-08-01 03:42  
It doesn't matter what you do in the bedroom as long as you don't do it in the street and frighten the horses
13. 2010-08-01 03:53  
I practice safe sex - I use an airbag

In golf as in life it is the follow through that makes the difference.

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