This guest column was written by Nigel Collett for Hong Kong's Civil Rights for Sexual Diversities (www.cr4sd.org), a NGO working for the rights of people who may be disadvantaged by the law, policies and social prejudices in Hong Kong because of their sexual orientation, gender identity and sexual expression. The fortnightly column will be written by founding member Roddy Shaw and various writers.
How much worse does the HIV epidemic have to get before we are so alarmed that we do something about it? There is no real answer to that question, of course, except the very obvious one that, horribly, we have not reached that point yet. And that is despite the fact that things are getting considerably worse here in Hong Kong, as they are across gay Asia.
Things get worse the closer you look at the figures. Broken down by quarter for 2006 they show a trend of greater increases in MSM infection rates than the annual figures suggest. The third quarter's unaccountable decline has reduced the overall trend, so making the annual 17.8 percent increase for MSM infection look much better than it might have done. Compared with the quarterly figures for 2005, the figures for 2006 MSM infections show:
1st Quarter - + 31.3%
2nd Quarter - + 41.2%
3rd Quarter - - 15.6%
4th Quarter - + 42.1%
This frightening state of affairs was reviewed at a conference held by the Advisory Council on AIDS in Hong Kong on 20 April, at which Tim Brown of the East-West Center, Honololu, presented a paper entitled HIV in Hong Kong: Living on the Edge. In it, he pointed out that Hong Kong was on the edge of a rapid increase in HIV prevalence and called for a 'red alert' to stop the situation sliding further. Figures he presented, coupled with those from Hong Kong's AIDS Concern, made it clear that MSM infections are those which concern experts the most. Their figures show rapidly increasing infection rates after 2005, which appears to have been the year when the virus began to break out of its box.
Brown estimates that about 3-5 percent of sexually active gay men in Hong Kong may already be infected with HIV. Ah yes, you will say, but this is just a guess. How could anyone know? Well, we can get on firmer ground than that. The Department of Health has just published a fact sheet on a PRiSM survey of the HIV prevalence and risk behaviour of MSM, conducted in Hong Kong in 2006. The researchers approached men in two venues, gay saunas, and bars and clubs, asking them to volunteer to complete a questionnaire and give a urine sample. The urine sample was tested for HIV but the donors were not identified or informed of the result, so the study was anonymous. 859 men agreed to take part, making it some 45 percent of the total men approached. 37 urine samples tested HIV positive, an infection rate of 4.05 percent. This actual figure is at the upper range of the earlier estimates. Alas, even this is likely to be a figure lower than reality, given the fact that 55 percent of the men approached refused to participate. Many of these are likely to be in fear that they may have a real reason not to participate.
So, already in Hong Kong we have the certainty that over 4 percent of sexually active gay men are HIV positive. Where this will take us is becoming startlingly evident in the rest of Asia. Similar PRiSM studies conducted in 2005 found far worse rates elsewhere; in Tokyo the figure was then already 4.4 percent, in Vietnam 6-8 percent, in Taiwan 8 percent and in Bangkok a staggering 28.3%. If the trajectory of this epidemic is not altered, the projections are clear that Hong Kong will reach these figures within a few years. In Bangkok, for instance, the graph showed a rise in the infection rate from 17.3 percent in 2003 to 28.3 percent in 2005, a rise of 10 percent in only two years. If the virus continues to spread unchecked, Hong Kong could be at this point within the next ten years.
The East is poised at the point the US reached in the 1970s, when the undetected and therefore unchecked spread of the virus led to the catastrophic outbreaks of AIDS which severely impacted gay communities across the country. There was no cocktail of drugs then to halt the epidemic. What slowed its spread eventually were two stark facts: the virus burned itself out by killing those it infected; and the surviving gay population became so traumatised by the devastation that it changed its sexual practices. Shock and fear made for safe sex and terror made for abstinence. The outbreak - frequently referred to as "gay cancer" at the time - was an education more graphic than any government health department could have conjured up and Larry Kramer's vastly unpopular calls for monogamous relationships, for an end to promiscuity and for safer practices were heeded willy-nilly.
Do we have to go through all this again in Hong Kong? Yes, there is a treatment, but no, there is no cure, no vaccine, no ridding one's body of the virus once you've got it. Without a cure, the virus will mutate and beat every treatment in the end. What do we have to do to make the next generation understand this? For it seems it is the young, heedless of what their predecessors endured, who are welcoming all this again.
Barry Lee of the Hong Kong AIDS Foundation, who has worked with this problem for over a decade, believes that the age of infection is dropping and that now even 15-year-olds are becoming infected. He attributes this in part to the growingly accepted drug culture, to the belief (widely propagated on the Internet) that unsafe sex is better sex, that condoms impede pleasure and that bare-back sex with groups of complete strangers is preferable to being rejected and left alone at the end of the night in a sauna or a bar. Barry points, too, to the state of denial amongst many of the young that this disease won't touch them and that if it does, what does it matter?
So what should be done? Education, at the root of it, to bring it home to everyone that the more unprotected sex you have with others the more likely you are to get infected, to ruin your life and ultimately to die. But how can we launch such a programme in a society where to have sex with other men is a taboo which cannot be spoken of and where the government will not take a lead to end the rampant discrimination which keeps gay men abject in their closet? Prejudice is the wall which locks out the light of understanding of this disease, which creates the discrimination that prevents gay men from realising its danger and destroys the self-esteem which will allow them to act upon this knowledge. We will not defeat this epidemic until our government leads our society to face down its prejudices. Hong Kong's Government faces a growing number of seriously ill and dying young men. It is not responding. It needs to act now.
As do we. We cannot escape the fact that we need to do this ourselves. Those of us who lived through the last few decades of horror need to act to prevent it happening again. As the American poet Paul Monette wrote in his poem 'Manifesto' in 1988:
I warn you now joy alone
will not protect you have it all you can
… we laughed for years on end
and the dark fell anyway
It is happening again in Hong Kong. Let it not be our laughter that lets this darkness fall here now.
Nigel Collett is an English biographer and businessman living in Hong Kong. Author of several books, including The Butcher of Amritsar, he has written for GMagazine and reviews for the Asian Review of Books. He is a moderator for the Hong Kong Man International Literary Festival.