ZONE:

Today, on World AIDS Day 2007, hundreds, perhaps thousands, of men who have sex with men (MSM) will become infected with HIV in cities across the Asia Pacific, becoming the latest statistics in an almost unrecognised but ever-growing crisis that many governments in the region are only just beginning to grapple with. As these efforts take shape, the Asia Pacific Coalition on Male Sexual Health (APCOM) - a regional coalition of civil society groups, government representatives and the United Nations system - is offering its partnership to develop and support new strategies aimed at tackling this regional challenge.

Top and above: In conjunction with World AIDS Day, the Taiwan Tongzhi Hotline Association, AIDS care (Taichung) and Love and Hope Association (Kaoshiung) in association with Taipei's Department of Health have made some 7,000 safe sex kits available. Each kit comprise a wrist/ankle pouch, 2 packs of lube and 3 condoms. The kits can be ordered by party organisers and gay venues for distribution to its patrons at no charge.

Paradoxically, it may be more challenging for APCOM to draw attention to the MSM HIV issue. The recent adjustment downwards of global HIV and AIDS figures has been construed in some quarters as an indication that the AIDS crisis has been "exaggerated" all along. However, APCOM and the stakeholders it represents are urging the Asia Pacific region, and indeed the world, not to confuse the true picture.

Most MSM who contract HIV today in city after city in the Asia Pacific region will never know they harbour the virus until they become ill with advanced symptoms. Without that knowledge, they probably will not change the very behaviours that put them, as well as their partners and loved ones, at risk. A recent survey in a major Asian capital suggested as many as 32 percent of MSM there are HIV positive. In other cities across the region, HIV infection rates for MSM range from estimates anywhere from 5 percent to 15 percent or 20 percent and higher.

"Despite MSM having higher infection rates than the general adult population, the financial investment for HIV prevention, care and support services for this marginalised group across the Asia Pacific is abysmally low in national HIV and AIDS programme planning, usually between zero and four percent," says Shivananda Khan, APCOM Chairperson and CEO of Naz Foundation International.

"Less than one in ten MSM in the region have access to any sort of HIV services, woefully short of the eight in ten that UNAIDS describes as optimal coverage necessary for high-risk groups. Is it any surprise then that we really don't have a clear picture of the true extent of the HIV crisis affecting men who have sex with men?"

Edmund Settle, HIV/AIDS Programme Manager for UNDP China, concurs: "You've got these really alarming statistics of ten, 20, 30 percent HIV infection rates among MSM in some major cities, but when you ask whether this picture holds true across other urban centres, or even in suburban or rural areas, the answer's not at all simple. It ranges from `Yes, it's somewhat likely' to `Well, we're not really certain.' Still, we do know more today than just a couple of years ago."

That growing clarity comes from a recent review of available data, soon to be released by UNAIDS, that describes the epidemiology of HIV and sexually transmitted infections (STI), and behaviours of MSM in the Asia Pacific region that put them at considerable risk of HIV and STI. As the paper states: "Severe and established HIV epidemics are found among MSM in some countries while imminent or beginning HIV epidemics were observed in others." The review also recommends ways to change policy and programming that would confront this challenge and help improve the situation.

"This collection of data in the upcoming review allows us to highlight more accurately than before the extent of the HIV scenario vis-�-vis MSM in our region," according to Geoff Manthey, Regional Advisor on MSM for Asia Pacific UNAIDS Regional Support Team (RST-AP). "It also comes at a most opportune time, with the recent creation of the Asia Pacific Coalition on Male Sexual Health. We hope that the work of APCOM, and its strength in bringing together representatives from governments, the UN system, donors and NGOs side by side with affected communities will finally make the difference in creating a truly regional strategy to address the MSM HIV crisis -- and yes, even though it's an overused word or sounds like a clich�, this is a crisis, make no mistake about that."

In 2006, a year before APCOM's creation, JVR Prasada Rao, director of UNAIDS RST-AP, had warned that "data in Asia show that without interventions, male to male sex will become one of the main sources of new HIV infections in the region."

He added, "We are facing a public health crisis, but you would never know it from the region's almost invisible response so far" - a fact supported by a UNAIDS report published this past August, Men who have sex with men - the missing piece in national responses to AIDS in Asia and the Pacific.

The China Center for Disease Control and Prevention (CCDC) recently stated that HIV prevention for MSM was the latest hurdle for the government's drive to curb a fast-rising AIDS epidemic. In fact, China - the world's most populous nation - was the first country in the region to issue a specific national framework on MSM and HIV, which calls for urgent efforts to engage civil society in a concerted effort to reach out to men who have sex with men. China recently reported that male to male sexual transmission now accounts for 12.5 percent of new HIV cases in 2007, up from 2.5 percent in 2005.

Reflecting the growing regional awareness for enhanced surveillance that incorporates epidemiology as well as socio-cultural awareness, the Center for HIV/AIDS/STI (CHAS) in Laos PDR has conducted the first survey of HIV among MSM in Laos and will soon be releasing the results. As governments and health partners across the Asia Pacific wake up to the realisation that national HIV prevention strategies must include a significant MSM component, APCOM and its partners stand ready to support and strengthen such approaches.

"All of these surveys, these papers, these data and statistics represent hope that our region is making a breakthrough," says Dede Oetomo, who sits on APCOM's interim governing board and is a noted long-time gay activist in Indonesia, a country with limited but successful and well-documented results in HIV and STI prevention among MSM.

"However, the good work that's emerged in recent times also serves as a warning that the hard work now really begins. With the multi-sectoral strength that APCOM provides, we are poised to finally reach out to MSM groups in a way that hasn't been possible before. It's an important, exciting time - full of challenges, yet full of promise. Let's go forward now and get the work done."

The APCOM website, scheduled to be online in early 2008, will be located at www.msmasia.org.