amfAR, The Foundation for AIDS Research

Report Finds Risk of HIV Rising Sharply Among MSM in Asia


October 2006—HIV infections are spreading rapidly in Asia among men who have sex with men (MSM), according to a special report released by TREAT Asia on 11 August in advance of the XVI International AIDS Conference in Toronto.

The report, MSM and HIV/AIDS Risk in Asia: What Is Fueling the Epidemic Among MSM and How Can It Be Stopped?, presents the most complete analysis to date of key factors behind the epidemic among MSM in Asia, where 8.3 million people are living with HIV. It generated considerable discussion at the Toronto conference and attracted the attention of journalists in the U.S. and throughout Southeast Asia, India, and Europe.

HIV prevalence among MSM has been found to be as high as 14 percent in Phnom Penh, Cambodia; 16 percent in Andhra Pradesh, India; and 28 percent in Bangkok, Thailand. More alarming, according to the report, dramatic increases in some areas have been seen in just the past two years—the result of such factors as a lack of appropriate prevention education, services, and funding, government inaction, diverse populations and behaviors, stigma, and societal pressures.

“Given the difficulty of surveillance in these populations, true rates of HIV infection could actually be far worse,” said TREAT Asia Director Kevin Frost. “This report shines a light on the extent of high-risk MSM behavior and serves as a wake-up call for Asia. Governments in the region and international donors need to support appropriate prevention, care, and treatment efforts for MSM populations or face a spiraling epidemic.”

In some countries in Asia, large-scale HIV prevention campaigns focusing on injecting drug users and female sex workers have led many MSM to conclude that heterosexual sex poses a greater risk for HIV infection than sex between men. In Phnom Penh, for example, 78 percent of MSM used condoms consistently when visiting female sex workers but only 47 percent did so when visiting male sex workers. In Beijing, half of the MSM studied reported unprotected anal sex in the past six months, but only 15 percent perceived themselves to be at risk for HIV.

MSM and HIV/AIDS Risk in Asia identifies several trends behind the rising HIV infection rates in MSM. Sexual activities among Asian MSM are conducted largely underground and there has been little community mobilization. Many Asian MSM are married, compartmentalize their male-male sexual behavior, and are rarely tested for HIV. In nearly half of the countries surveyed, male-male sex is illegal, making it difficult to reach these populations since encounters must often be conducted clandestinely. Other factors ranging from family and social pressures to stigma, misunderstanding, and fear contribute to the epidemic’s spread.

The report’s findings are based on in-depth interviews with those on the front lines of the fight against HIV/AIDS in this overlooked at-risk population. The authors spoke with researchers, counselors, NGO leaders, human rights activists, and several government officials in 19 countries. The experts discussed a wide range of cultural, religious, and socioeconomic dynamics.

To address the problem and implement effective prevention and education measures, the report outlines a number of concrete policy initiatives. Most urgently, political leadership is required along with government funding. Experts cited in the report called on international donors such as the Global Fund to support MSM-specific programs that will prioritize prevention education, provide accurate information about risk factors, make condoms and lubricants widely available, and increase the availability of HIV testing facilities. The report also calls for MSM to be included in routine HIV surveillance on local, regional, and international levels.

“Governments and societies in Asia know that everyone is at risk for HIV,” said Frost. “The time has come to educate, deploy political capital, and deliver the financial resources needed so that the continent can minimize a rapidly emerging and devastating epidemic in its MSM populations.”