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19 Feb 2009

Immediate action needed to avert growing AIDS crisis among MSM: WHO

The proportion of HIV infections being transmitted among MSM is larger and more significant than originally believed, says World Health Organization adviser Massimo Ghidinelli as a 3-day conference is underway in Hong Kong to consider strategies to deliver better services to MSM communities.

The World Health Organization (WHO) warned this week that the HIV/AIDS epidemic may take a major turn for the worse in Asia unless countries urgently expand access to services to men who have sex with men (MSM).

Evidence shows that unprotected male-to-male sex is again fueling the spread of HIV. The importance of this re-emerging mode of transmission has prompted WHO's Regional Office for the Western Pacific, in collaboration with the United Nations Development Programme, UNAIDS and the Hong Kong (China) Department of Health, to call for swift action to address this growing health crisis.

HIV/AIDS specialists from Asian governments, regional experts and representatives from non-government organisations are meeting at a WHO conference Hong Kong from 18 to 20 February to consider strategies to deliver better services to MSM communities.

"Studies show that at present, the proportion of HIV infections being transmitted among men who have sex with men is larger and more significant than we had originally believed," said Dr Massimo Ghidinelli, WHO Regional Adviser in HIV/AIDS and Sexually Transmitted Infections. "Action needs to be taken now if a major increase in HIV/AIDS cases is to be averted. We need to target HIV prevention strategies, together with better access to health services, for men who have sex with men."

Strengthening surveillance and implementing effective interventions for HIV prevention and care among men having sex with men should be prioritised to prevent the further spread of the virus, WHO said. Enacting or enforcing legislation outlawing discrimination against people living with HIV and members of other vulnerable groups would enhance the effectiveness of the response to HIV.

Men who have sex with men have been identified as one of the most-at-risk populations for HIV/AIDS. A review in December 2007 showed that in Cambodia and Vietnam, men who have sex with men are more likely to contract HIV compared to the general population. And in China, the risk of infection by men who have sex with men is 45 times higher than for men in general. Asia is believed to have the world's largest number of men having sex with men, estimated at 10 million.

Despite this, a recent UNAIDS report showed that targeted prevention interventions are reaching only 1 percent of the MSM population. The report also showed that in most countries in Asia and the Pacific, national strategic plans for HIV/AIDS do not cover interventions for MSM and transgender individuals.

The lack of better access to HIV/AIDS services can be traced to the stigma and discrimination associated with male-to-male sex, which is frowned upon in some societies, and to breaches of human rights, including the right to better health. In addition, discrimination prevents men who have sex with men from disclosing their sexual orientation or utilising HIV services, resulting in increased vulnerability.

Participating countries in the conference, which will take place in Hong Kong, are Australia, Cambodia, China, Fiji, Hong Kong (China), Japan, the Lao People's Democratic Republic, Malaysia, Mongolia, New Zealand, the Philippines, Singapore and Vietnam.

Source: World Health Organization press release dated Feb 17, 2009 with minor edits.

Related articles (external):

Group sex and low condom use among gay and bisexual men are spreading HIV rapidly in Asia, making male-to-male intercourse the region's fastest-growing means of transmitting the deadly virus, health officials said "We're really in for big trouble. There's still time to do something, but we need to act rapidly," warns Frits van Griensven, who's tracking the epidemic in Asia for the U.S. Centers for Disease Control and Prevention. - Group Sex, Trysts Without Condoms Fuel Raging HIV in Asian Men (Bloomberg)

"We are facing an emerging catastrophe," said Asia Pacific Coalition on Male Sexual Health representative Shivananda Khan. "Unless we intervene now, the level of infection over the next 20 years will double every year and the number of [affected] MSM and trans-gender people will be more than any other population in this region." - Asia facing gay sex AIDS explosion (The Standard, Hong Kong)

York Chow, Hong Kong's secretary for food and health, said most MSM do not know their HIV status and that an "important factor" contributing to the spread of HIV among the population is unprotected sex. He said, "Globally, risks and vulnerability to HIV infections are reinforced by a lack of knowledge, denial, inadequate access to treatment as well as social pressure arising from discrimination and even criminalisation of sex among men." - MSM Given High Priority in HIV Prevention Strategy, Hong Kong Official Says (Kaiser Network)

Reader's Comments

Comment #1 was deleted by its author
2. 2009-02-20 01:50  
A possible potential cure ( in the distant future) for AIDS has been announced in the last few days after a bone marrow transplant from someone with natural genetic immunity to the virus resulted in the donee remaining clear of the virus.

Hundreds of billions of pounds/dollars in bonuses are still being paid out to banking executives of failed banks, the same people who have caused the worldwide economic crash.

If all those bonuses were shifted to creating a cure sooner, rather than later, millions of lives could be saved.

3. 2009-02-20 02:25  
Here's an extract:

"Word first surfaced last November that a man had been "cured" of HIV through a bone marrow transplant, but this wasn't confirmed until last week, when the full results were published in The New England Journal of Medicine (vol 360, p 692). "It's now almost exactly two years ago that we treated him, and the virus is nowhere to be seen," says Gero Htter of the Charit University of Medicine in Berlin, head of the team that treated the man."

If the link works you can read the article here in the New Scientist:-

http://www.newscientist.com/article/mg20126964.400-gene-therapy-promises-oneshot-treatment-for-hiv.html
4. 2009-02-20 03:10  
I believe people need to be more protective of their bodies and to learn how to approach sex in a safer, more respectable way! Unfortunately, too many people do not get the sex education they need to make intelligent choices.
5. 2009-02-20 08:00  
Besides HIV/AIDS, there are herpes, hepatitis, syphilis, gonorrhea, ect... Be careful. There are crazy people out there.
6. 2009-02-20 13:20  
thanks steveuk for the link below...if this report is true; if the results are true and applicable to the world's population then there is real hope. The ONLY SOLUTION to this HIV pandemic is a CURE. Until that moment in time that the CURE is available to 100% of the world's population, fighting the spread of HIV, elongating survival rates and improving the quality of life for the victims will remain a losing battle. But, this is a losing battle worth fighting, and fighting this losing battle is better than giving up.
7. 2009-02-20 16:07  
Aids is just a lie.
There is no so-called HIV in the earth.
Even if indeed there is a virus named as "HIV", NO relationship ever exists between the virus and the so-called AIDS.
AIDS is just a meaningless panic. People need it as kinda fear to repress homesexulity, free sex or stuff like these morally. They scares them with a false dealy disease. They invented the illness.
The truth will be told someday, as DR. Peter Duesberg claimed.
8. 2009-02-20 17:25  
I hope more in the gay community will come out to help. It is our own battle.
9. 2009-02-20 23:42  
Maybe if they started compiling a DNA database of everyone with the appropriate genetic mutation it could save time later.
Comment #10 was deleted by its author
11. 2009-02-22 02:06  
Instead of talking about the possible cures or that "AIDS is a lie" as some posters below have suggested, isn't it about time that queer people started addressing a root cause of HIV-AIDs amongst MSMs in Asia, besides unsafe sex, and that is: "the closet".

Yes, sad as it seems, the fact is that there are few places in Asia where a critical mass of gay men have had the spine to openly come out to their friends, families and co-workers. This means that queer people themselves may be afraid of the stigma of being gay or being positive everytime they go for a test. Plus not being out doesn't exactly create an incentive to talk openly about one's partners or one's health before meeting a new partner....

And yes, the closet also creates many pressures because being gay remains a repressed, hidden secret. It only makes sense that with such repression comes the riskier behaviours and dangers of needing sex secretly or urgently---quickie gratifications where risks are greater: ONS, Saunas, Sex Parties, etc., not to mention associated drug uses.

Why else would otherwise intelligent guys put themselves in such risky situations ? So, while we can continue to blame the bigots (religious or otherwise) or the pressures of our culture, or our traditional families, we eventually need to show the courage to come out first and foremost if we want to be safer. This might not only increase people engaging in safe sex, and talking openly to our partners and getting tested regularly, it might make our world a better, safer place to live in, as difficult as that step might be for some.

How can so many of us ignore the deaths of so many who have died from AIDs, or for fighting for GLBT rights over the years, to not have the spine to come out of the closet? It is truly pathetic and shameful.
12. 2009-02-22 16:58  
@Islandgayguy -- I think fighting for gay liberation is a good thing to do in its own right, but your argument is utterly wrong. The highest rates of infection are seen in cities with very dense community of openly gay men, like Sydney and San Francisco. There is no root cause of HIV/AIDS transmission "besides" unsafe sex.

@Caesar2003 -- that's fatalistic rubbish. If someone reads it here and thinks "oh well why should I bother with condoms" will you then take responsibility for their infection? Very large research projects have shown that properly funded prevention education programs are highly effective in decreasing the spread of HIV. The challenge is reducing spread to a point where the epidemic will eventually die out.
13. 2009-02-22 23:05  
It is sad to read some of these comments. HIV causes AIDS=fact. Safer sex prevents HIV infection=fact. So say no to drugs. Use condoms always. Have a long gay life.
14. 2009-02-23 00:14  
@livewire--- I do agree that unsafe sex is the critical causal factor in new infections, however, as the research from the UNAIDs folks has shown, open communication amongst partners is critical. Over the long-term being "out" surely makes a significant difference here. And no, the highest numerical rates (not %) of new HIV infections are not in Sydney or SF; but rather in Jakarta, Bangkok, and yes even, in Shenzhen. Don't forget that getting data from men who are not out is also notoriously difficult---so there is likely significant underreporting where men are not openly gay.

My argument is that "being out" can make a big difference, particularly in terms of the velocity and trajectory of communicating to/amongst openly gay/men who have sex with men, about reducing HIV infections, especially in the long-run.

Yes, high density gay communities in both Asia and the West have both seen horrifically dramatic % rises in HIV infections recently; however, the raw data (WHO, 2007) show that the actual numbers of new infections in S/SE Asia are 7-10 times higher than in North America or Western/Central Europe. Similarly, new HIV infections in East Asia were 2-3 times higher than in North America or Western/Europe...

My point is that while there is a serious problem in dense (perhaps more 'out') gay communities, at least the issue can be dealt with faster via gay media, gay 'hoods, and tight social networks. If the closet is the only way of life available, then it makes fighting, tracking and communicating about the virus that much slower and more arduous.
15. 2009-02-25 17:34  
@Islandgayguy -- this is a really important and topical debate to be having, so kudos to Fridae for creating the space for it, and I wonder if we can persuade Shinen Wong, Fridae's resident queer thinker to join in. (Shinen?)

I think it's a mistake to promote coming out as a necessary antecedent of HIV prevention strategies. As Chou Wah-Shan has argued, coming out is a very Western tactic which has poor cultural fit with Chinese cultures in particular. Dragging all its cultural baggage and overcoming all the obstacles posed by the culture clash simply takes too long when an effective educational response is required - as you point out - right now.

Couple of quick points: I don't see how coming out improves communication between sexual partners, and I don't think you need to "come out" before you can access gay-operated sources of information, services and support - as Fridae itself amply demonstrates.
16. 2009-02-27 09:06  
My two cents:

Perhaps a distinction should be made between what has been deemed to be the most effective tactic to address the reduction of new HIV-transmissions from both a healthcare provider's point of view, as well as from an individual gay/bisexual/queer person's point of view.

Australia has been a leader in the world in terms of significant reduction of new HIV cases since the epidemic first arose in the 1980s, because Australia was swift to immediately proliferate information about the high risk activities which increased the likelihood of HIV transmission, and was also quick to approve targeting these messages at men who have sex with men.

Part of the reason that many Asian countries have been slow to tackle this issue is because of the hesitation among those in power to grant approval for HIV-care and prevention workers to engage in this very method of providing information to those most at risk, instead preferring the ineffective method of moralizing and a self-imposed blindness toward the reality of the situation in the region.

As for the individual lay gay/bi/queer person's response to this issue, this is where things get a little bit fuzzier. On the one hand, it is easy to keep preaching to each other to use condoms, avoid drug use, and only have sex with people we know or whose status we know, but perhaps we here who would read/respond to each other on fridae are a choir that has been preached to enough.

The reality is that some of us prefer condoms, and some of us don't, and that those people who do not use condoms may or may not know the impact of their individual decisions on affecting the statistical rates of HIV transmission. It is therefore equally important to address the WHAT of what people are doing sexually as well as the WHY of what people are doing sexually.

It is in the WHY that we can promote the importance of coming out as gay. Though there is no proof or evidence to show why this may lower the likelihood of HIV transmission, coming out does almost necessarily put you in the company of other like-minded individuals with whom a more open conversation about sex and sexuality can occur, as Islandgayguy has mentioned here on the message board, creating an outcome that is more conducive to HIV prevention.

Another alternative may be to acknowledge the reality of condomless sex occuring, and then suggesting other harm reduction techniques if we are going to choose NOT to use condoms, for example,
1. Only penetrating ("dipping") but not full on fucking,
2. Fucking, but not cumming inside someone, or
3. Fucking but with a strap-on dildo instead of with one's own cock (so u can still explore certain sexual fantasies of insertion/penetration/domination/submission/etc. but without the same risk for an exchange of fluids), etc. etc.

It is the reality that underlying social issues will always ALWAYS impact a person's ability or willingness to practice safer sex. Level of income or employment status, level of education, relative local access to safer sex materials or information, level of sexual stigma/shame in self and community, and certainly how "out" someone is to their friends, family, and even to their partners (are they anonymous partners? long time partners? someone who one is having an affair with? etc.) will influence sexual practice, and will hence also impact rates of HIV transmission in the Asian-Pacific region.

Instead of just fixating on a top-down approach to the epidemic (which is of course necessary), we may well also acknowledge and honour the power of grassroots, interpersonal discourse in influencing the future of HIV in Asia. Should we judge, moralize, and condemn people's current sexual behaviours? Does that not smack of the same homophobic, anti-sexual prejudice that is the very reason why safer sex messages are not being effectively communicated to the public?

It requires multiple directions...
17. 2009-02-27 09:23  
Additionally, I think it sometimes get easily to get trapped in monolithic ideas of what "Asian culture" or "Chinese culture" is, which influences our ability to see what it COULD be.

The reality, of course, is that many people in Asia are "in the closet," so to speak, or may even not have the vocabulary to articulate being out or not in indigenous languages. It may be that many people may continue to prioritize personal silence and social security over being "out" and be ostracized from the larger culture.

But then again, this conundrum was also true and remains very true for many people who live in "the West," and yet it is not seen as a quintessentially "Western" issue, precisely because many Western countries have taken steps NOT to construct themselves as culturally unchanging entities. If Asia is holding steadfast to archaic and, frankly, quite arbitrary ideas of ourselves as "traditional," and hence, silent about sexuality, one may wonder about the relevance of holding on to tradition if this means the eradication of a significant population of this very culture due to death by AIDS-related conditions.

I believe that local cultures SHOULD be accounted for in speaking about sex, but that ultimately, any serious attempt to address the reduction of new HIV cases will almost always require compromise on both sides of the equation. The outcome, of course, will be understanding that there never was an unchanging "tradition" to begin with, and that there was never One Right way to address the HIV/AIDS epidemic either.
18. 2009-03-02 18:51  
@Shinen -- from a prevention strategy viewpoint it's a really bad idea to talk about harm minimisation before you've communicated the condom message almost to the point of saturation. Also, if you can identify how men are meeting for sex, you can target them with the condom message, whether or not they're in the closet. That may require some advocacy with the government for the legalisation of gay sex or at least official sanction of health promotion activities, but it doesn't require the population to start coming out of the closet. As Prof Chou points out, plenty of gay men in Chinese cultureS have chosen "Coming Home" instead of Coming Out, and it's not because of shame/secrecy - the end product is still family knowledge of their sexuality, albeit tacit rather than explicit.
19. 2009-03-03 20:19  
Interesting discussion 'Shinen' and 'Livewire'.

I believe your comment below still misses my original point about being 'out', whether explicitly/'way out' or softly/'coming home'. For instance you (livewire) suggested:
"That may require some advocacy with the government for the legalisation of gay sex or at least official sanction of health promotion activities, but it doesn't require the population to start coming out of the closet"...

My point is that if there isn't a critical mass of individuals (in a city or society) or people are way too afraid to be 'out' then straight people cannot/will not identify with "the other" the gay brother, mother, father or co-worker. This in turn means that the chances of family, institutional and societal change (eg. gov't legislation) are very unlikely. This would not be an environment to talk about health amongst MSMs.

If there are no or very few 'out' people it will be hard to form social movements, or organizations for gay people, and it will remain more difficult to do health and/or HIV education (although not impossible). No, not everyone needs to be out, however, my original argument that a critical mass of individuals who are out and unafraid to be queer advocates will make a difference in fighting for the needed array of queer friendly legislation, including legislation to fight the virus.
20. 2009-03-04 12:39  
@Islandgayguy -- we're talking about public health here, and it's all about regulations and service provision, not legislative change. In Australia, an effective community-based response to HIV/AIDS actually preceded public support and acceptance of homosexuality. As Paul Senziuk pointed out in his book Learning to Trust, it was through the responsibility demonstrated by the gay community in responding to the crisis that government learnt it could trust (and fund!) homosexual community organisations. But the cultural setting in South East Asia - particularly developed nations like M'sia and Sg - is totally different, and if governments get the idea that HIV prevention campaigns are the vanguard of wider social acceptance of homosexuality, they're more likely to crack down on the change and constrain the prevention initiatives. In conclusion I'd like to make the point I started with -- prevention requires clear thinking about the causes of epidemic spread, and that means a primary focus on unsafe sex, leaving the broader distal causes for later.
Comment #21 was deleted by its author
22. 2009-03-12 07:51  
"@Shinen -- from a prevention strategy viewpoint it's a really bad idea to talk about harm minimisation before you've communicated the condom message almost to the point of saturation."

livewire, stressing the importance of using condoms IS a harm reduction method, which is precisely why it is often first rejected, because it ASSUMES sex is taking place to begin with.

Once again, I reiterate the need to address what people are ALREADY doing in order to implement the most effective harm reduction strategy. Hence, my postulates about additional harm reduction strategies are simply about allowing more room for people who may quite adamantly either refuse to use condoms or who are unable to use condoms (lack of access, $$, or the shame attached to purchasing/obtaining condoms, etc.).

At the very least, giving a vocabulary for the actions that people may ALREADY be engaging in (ex: "dipping") may be a crucial factor in the way that people REPORT their behaviours and their impact on HIV-transmission. To my knowledge, many HIV+ men already engage in dipping practices (inserting penis into rectum without condom for the feel of penetration, but then not necessarily going onto full-on fucking) with partners who may not themselves be HIV+. It may be important to gather information about the impact this has on seroconversion.

Also, livewire: "regulations and service provision, not legislative change." I am not sure what the difference here is between 'regulations' and 'legislative change.' I agree with your principle of grassroots organising being the precedent for later legislative change, but I am also of the stance that this legislative change (ex: laws enacted to prevent vilification of people living with HIV/AIDS) have made things incrementally easier for HIV-prevention strategising by these very grassroots organisers.
23. 2009-03-12 07:56  
Islandgayguy: "If there are no or very few 'out' people it will be hard to form social movements, or organizations for gay people, and it will remain more difficult to do health and/or HIV education (although not impossible). No, not everyone needs to be out, however, my original argument that a critical mass of individuals who are out and unafraid to be queer advocates will make a difference in fighting for the needed array of queer friendly legislation, including legislation to fight the virus."

Yes, Yes, Yes!
It is not necessary, of course, to come out AS GAY. It is at least as important, if not more important (in the specific case of working toward the goal of minimising or eliminating HIV) to come out AS SOMEONE WHO CARES about HIV. To come out as someone who is, or who knows someone who is living with HIV/AIDS. To come out about our ignorance about HIV/AIDS. To come out and to be willing to engage with each other in learning, educating ourselves, come out in THAT sense.

Almost inevitably, most people who DO come out in this way will find themselves in queer-spaces.

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