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26 Jun 2007

the epidemic worsens

It has been highlighted that HIV infections among MSM in Hong Kong are those which concern health experts the most. Guest columnist Nigel Collett urges the community to act without delay in response to recent statistics which showed a sharp rise in new HIV infections among MSM in the territory.

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.

In February, our Department of Health released statistics for 2006 showing a 19 percent increase in all HIV infections. There were 98 new cases for the year, of which more this year were infected through MSM (Men who have Sex with Men) than through heterosexual contact, 30 to 23. The figures for MSM are probably higher than this, as 27 of the 98 cases remain unaccounted for, and it's not the heteros who are in the closet.

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.

Hong Kong

Reader's Comments

1. 2007-06-26 20:09  
What happens in Hong Kong, can easily happen in Singapore too.
2. 2007-06-26 20:12  
The message is a good one, but too bad there was so much resorting to lies damn lies and statistics.

There are broad assumptions based on little fact that add to normal con-founders to stress the alarmist point of view. Granted alarm may be called for but we need only look to Iraq to see where alarm-ism and half truths or outright distortions can get us.

For example it is spurious to suggest that gay men have more to hide in regards to HIV than heterosexuals. It is just a red herring argument.

And what the PRiSM study cited shows specifically that 4% of people who attended Gay Bars and Saunas at that time are infected. It did nothing to account with any certainty for the (many?) (myself included) gays who are not promiscuous and/or do not frequent such places, but are sexually active, (perhaps (dare I say?) even monogamous.

Certainly this issue needs attention, but how will distortion shed any useful light?

Comment #3 was deleted by its author
4. 2007-06-26 21:10  
Does anyone has the figures for Singapore? Is it 3% or 5%?

I think this is the longest time taken to find a cure for such an epidemic in human history. Even for SARS and bird flu, they have come out with a vacinne!

Does anyone of us have the guts to pray for a cure for AIDS? I think the barrier for many people to lack praying for a cure/ breakthrough in the medical field is that AIDS is sent by God to punish gay people, and that is 'God's will', "you deserve it", "shame on you" and "don't come to pray to Me for a cure".

It is a disease (NOT from God) to kill anyone of any race, gender, nationality, sexual orientation, etc. Change your mindset. Change your approach. Be thick skin and pray hard.

Get it over and done with. I am sure that even after a cure is found for this epidemic, there will be another worse epidemic coming along. And we will progress and find another cure.
5. 2007-06-26 22:14  
I did take notice how many guys I met in Hong Kong preferred going bareback, and actually didnt like the idea of using a condom at all. I must confess it felt nice and I fully realize I am fortunate that I only took some clean loads in me
6. 2007-06-27 00:14  
It is most likely just me. I am so scared of HIV now even I am top. I won't feel comfortable even for a blow job or kiss if I don't know the other person well. I would love to set me "free" but I just cannot. Besides HIV, some other STDs are not easy to notice, especially when he just got infected.
I think I just go to another extreme. But I really cannot understand why people risk their lives like that. I believe a monogamous relationship with a trustful HIV- lover will also help. But very few gays treasure a monogamous relationship. Fun vs life, most gays choose fun. What a surprise!
7. 2007-06-27 00:19  
Startling revelation. That's in Hong Kong, though. Are the statistics here equally startling? Any insights anyone?
8. 2007-06-27 00:42  
Oh, come-on...

Is it possible that the Hong Kong government is waiting for these "deviants" to get more infected so that the population of this group of deviants will decrease in size? That in turns further weaken their voice in the society... The hidden evil hearts can be found under the baby-kissing skins and faces.

They may be waiting for the highly pressured, despaired to walk and fall into the AIDs traps, or STDs traps or other self-destructive cycles.

Segregation, loneliness, low self-esteem, desperation, and etc often are strong causes to make the fool of the people by themselves.
So, under such societal circumstances, msm who want to survive better and live well, they've to find out their own worths and build up their own strength and self-esteem. How can one expect others to respect themselves when one doesn't even respect one's own self?

To be able to choose and decide if safer sex is necessary, understand the risk of infection for various relationship types and accept the potential outcomes is the start to self-respect.

Besides sex, msm youth may be provided more group activity other than just sex educations. Say, some exercises, sports, painting, etc... Probably, some TV programmes showing the true lifes of AIDs patients, STDs sufferers... in "true colours". Not only the youth needs those infos. Even the adults, and the elder ones do need those infos and moments to re-consider their lifestyle practices.
9. 2007-06-27 09:30  
watching pornos together, mutual masterbations, & watching each other getting off are the safest sex. no bodily fluid exchange.
10. 2007-06-27 10:01  
People worry about statistics. DONT FORGET, statistics refer to ENTIRE populations. A statistic is a Lottery number. You could have unprotected sex 10000 times with HIV +ve men and NOT get infected, or 1 time with a HIV +ve person and DO get infected. You play the Lottery/Lotto with a one in 3 million chance of winning AND you STILLL hope to win!? So when its 3 in 100 or 5 in 100, what do you think the prize is? It doesnt matter if its 3 or 5%. Each and every time you have sex there IS the risk then and there that the person you have sex with is HIV +ve AND that you will become infected too. You might get lucky, yeah. But keep playing, and you will win in the end, statistically.

As we all grow up to learn, the only person you can trust in this world, is ourselves. If you dont want HIV the only person that can CHOOSE that is yourself. You choose the degree of RISK (luck?) that you are comfortable with, and live with the consequences of that Lottery.

Love to all.
John
xxx

Comment #11 was deleted by its author
Comment #12 was deleted by its author
Comment #13 was deleted by its author
14. 2007-06-27 11:07  
i dun think god will condemn people of having fun

but be mindful
not jus having fun for urself
take care of ur partner(s) too

do it right
do it good
no regrets!


By the way,
dun curse each other
u never know how real
n powerful a curse
can really be.

B spiritually aware!
15. 2007-06-27 11:35  
Stressful looking at these figures.

Since late 90s, with the internet chatrooms becoming more and more famous and gay become more daring to come out and explore their sexuality and by early as 2002 whereby circuit parties around the region kick off with follow by the up trend of sex parties, EV sex and sauna...

never mind...no time to write anymore...well, wat i wanna say is it is always ok to fuck around....just make sure we live longer to fuck more....

safe sex with stranger :)
Comment #16 was deleted by its author
17. 2007-06-27 15:54  
I haven't been to HK but I heard from several friends of mine who live there, or Singapore or Thailand, that one of the reasons why the HIV infection spreads so quickly throughout Asia, is that a large number of Asian gays still believe that they can only get HIV from white guys... and therefore feel safe to go unprotected with other Asians.
Well, sorry if I sound bitter and sarcastic, but all I have to say to the guys who think that way and get the virus from another Asian is : SERVES YOU RIGHT for being such a bloody racist fool and having a chick pea instead of a brain!
18. 2007-06-27 17:43  
As a concerned member of the HK gay community and a representaive of one of HK's more prolific gay venues (Volume), it is imperative we continue to support HK Aids Concern with all its endevours.

This means keeping watch for any fundraising events by the Hong Kong Aids Conern, attending them and educating yourself, your friends and the community at large to help those who are working tirelessly to help us.

A good way to start is check Fridae's Agenda section regularly for upcoming Charity events, as well as picking up copies of the gay street press like DS magazine to look for advetisements that support this agenda.

Volume recently held a fund raiser called Bare @ Men @ Ten on Friday June 22. It was the venue's highest attendance on record of any Friday night since it's opening.

The bottom line is- people do go to these events- and so should you. They are for a very good cause- to raise funds to help protect you and the people you care about.

Let's be vigilant about fighting the continued spread of HIV and AIDS related diseases- and especially, help the younger members of our community to learn the rules that us older guys have been trained in to support the next generation and ensure they lead happy, healthy and enjoyable safe sex lives.

Evan Steer
AKA DJ Stonedog
Resident DJ and Marketing Director of Volume, HK
19. 2007-06-29 08:24  
Yes it is scary stuff all right and it is my bet that all communist/quasi communist and dictatorial countries are going to throw up similar statistics because of disinformation and the simple horror and drudgery of daily life where a fuck any kind of fuck is better than nothing.
Until we defeat communism and dictatorship and establish freedom world wide there will always be AIDS and it will be a boon to those who oppress us.
20. 2007-07-02 21:21  
I'm shocked by the sarcasm in several posts below, especially when applied to the attempts by commited, empathetic professionals as they toil to identify the scope of HIV infection. What would one prefer a responsible caring government resort to? Should 100% of the HK population be lined-up and tested for HIV? That approach certainly would remove any doubt conerning infection statistics, no? HIV is a terrible, devasting virus. It never has a "bad day"...it's genetic program isn't homophyllic or heterophobic...any bloodstream from any human donor will do. At it's current rate of mutation, it will probably become air-borne within a few years. Unless a cure is found, the infection rate will probably approach 100% shortly thereafter...does that sound alarmist? At that turning point in history, what will responsible governemnts do? Be kinder than you need to be...be 100% safe with all your sex partners...and pray for a cure.
21. 2007-08-27 23:08  
What are the signs when a person is HIV+? I wonder.

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