ZONE:

Jan Wijngaarden currently works as the HIV/AIDS Advisor at United Nations Educational, Scientific and Cultural Organization (UNESCO) in Bangkok. In this interview, we get to know more about Jan and his expertise in the public health sector, and the pressing need for more effective HIV prevention programmes in the face of sharply increasing rates of new HIV infections among MSM in many Asian countries / cities and around the world. Jan's "Men's sexual health" column will start next week and will be posted twice monthly.

æ: Age, sex, location?

I am a 39-year-old gay man, born in the Netherlands but currently based in Bangkok, Thailand.

æ: Tell us more about your work as the Regional HIV/AIDS Advisor at the HIV/AIDS Coordination, Adolescent Reproductive and School Health Unit at UNESCO Bangkok.

Jan: UNESCO is tasked with improving sex, relationships and HIV education in schools. That is the main focus of our work. Besides that, we have projects working on men who have sex with men, jointly with UNDP, and on HIV and trafficking prevention among ethnic minority populations in the greater Mekong subregion. In fact a lot of the work I do deals with improving and scaling up UNESCO's response to HIV in the Asia Pacific region.

æ: How did you get into this public health industry?

Jan: Probably it was largely because I am gay and I was worried about having or getting HIV myself. I think there is a disproportionate number of gay men working in HIV prevention, care and support. It is because gay men have been disproportionally affected by AIDS. Gay men are much more likely to have HIV than 'general' men in the population, in all countries around the globe.

æ: Many regions in Asia and elsewhere in the world are reporting a sharp increase in new HIV infections. Can you give us the latest update on what's happening in MSM communities in Asia?

Jan: HIV epidemics are growing among MSM everywhere, without exception. The situation is going from bad to worse. The epicenter of the epidemic seems to be in Thailand, but other Asian countries / cities are catching up. I feel that our responses are well intended, but way too small and ineffective to make even a small dent in the epidemic. Our approaches and responses need to be thoroughly evaluated, and we need to check the extent to which these responses are based on the reality of the lives of men who have sex with men. Only a minority of all men who have sex with men who need HIV prevention, care and support have access to these services.

æ: Many AIDS activists say complacency among gay men has become the greatest threat (next to insufficient resources and will dedicated to address MSM-specific issues in HIV education and prevention by the relevant governmental agencies). Do you think so?

Jan: I disagree. I think nobody wants to become infected with HIV. Saying that gay men are complacent is similar to blaming them for the epidemic. Doing so conveniently covers up our own failure to truly reach out to them and work with them to change their behavior and remain safe. I think our interventions are often of poor quality and do not relate to the contexts in which men who have sex with men live their life. Rather than blaming this on gay men themselves, we should learn from our failures, study the lives of the men we are trying to reach and come up with better, more comprehensive and more intensive prevention interventions.

æ: If gay men/MSM are tired of the safe sex message, what do think HIV/AIDS groups and public health agencies can do to revitalise the campaigns?

Jan: I think they should realise that HIV is just one aspect in a much wider set of interrelated health problems. These include feelings of isolation, rejection and despair, problems with having or maintaining loving relationships, addiction to sex, drugs and alcohol, depression, and so on. I think HIV vulnerability is closely linked to these mental and social problems. This helps explain why gay adolescents are extremely vulnerable to HIV when they just 'enter the market' - adolescence is characterised by mental and emotional turmoil, with many problems taking priority over HIV, from the perspective of adolescents, that is.

æ: With regards to education and awareness campaigns, do you think gay-identified men and MSM (non-gay-identified) need to be addressed separately?

Jan: I think there is no simple answer to this question. Certain messages can be directed at a more general audience, including gay and non-gay-identified men, whereas specific messages could be designed for sub-groups. It depends on the context and on the specific situation in a city or even neighborhood. Key to answering this and other implementation-related questions is that proper research is conducted, almost like marketing research, to find out which messages are effective and appropriate for which audience. I think HIV prevention workers still have a lot to learn from marketing experts!

æ: How can the gay communities/individuals help themselves/ourselves?

Jan: That is hard for me to say. I do not think I can speak on behalf of all gay communities or individuals! But it surely would help if HIV and related risk behaviours and social and mental health problems would become more mainstream topics for discussion. It often surprises me how little this serious health threat is discussed among my Thai friends, even when a third of them are already infected with HIV! It would also help if social workers would be better equipped to deal with social and mental health problems of men who have sex with men, whether they are gay identified or not.

æ: What are the greatest challenges in Asian MSM communities today?

Jan: The challenge is to make HIV prevention efforts more comprehensive and intensive. They should be more linked to social work, legal reform, stigma reduction and to general education efforts.

æ: Given your experience and expertise as regional HIV advisor at UNESCO Bangkok, what are the best and worst case studies you've come across about HIV education in schools?

Jan: I find very few best practices, I have to say. HIV prevention education is often entirely focused on the biological aspects of HIV transmission and on sex organs and the mechanism of sex and transmission. There is not enough attention to the social aspects of HIV transmission, in other words, how feelings of love and a longing to belong and 'surrender' to love or romance, or fear of rejection or a broken heart may be related to reluctance to use condoms, for instance. I am not entirely sure whether schools and teachers are the right channels to discuss this. But in any case, UNESCO thinks we need to set standards for ministries of education on the content of sex education - for instance, by age - and on how sex education should be delivered in the classroom. UNESCO and UNFPA are working on the development of such standards. I have not seen them, but I hope the issue of homosexuality or sexual diversity and how schools should deal with this will also be part of these guidelines.

æ: Gay groups are known to shy away from championing issues faced by gay youths especially when it comes to sexual rights and health. Any thoughts on how the situation can be improved?

Jan: I am not sure if it is true that they shy away from the issue of youth. Most HIV intervention projects for gay men seem 'age-blind' - they deliver a package of services and messages that do not distinguish between a 16-year old boy who just had his first sexual experience or a 57-year-old man who just ended his 213th relationship! The needs of these individuals would be vastly different. The latest data from Bangkok show that 10% of 15- to 22-year-old gay youths get infected every year, and that 22% of them are currently living with HIV - it shows how vulnerable adolescents are, being ill equipped with negotiating and other skills, having little knowledge about HIV, and often having very naive ideas about love and trust. Life teaches them lessons about love - but many of them get infected with HIV before they understand. It is imperative that we reach young adolescents before they become sexually active, and prepare them for reality. I am not sure how this can be done, if not via schools! But for the moment, we have more questions than answers about how to do this.

Jan's "Men's sexual health" column will start next week and will be posted twice monthly.

Jan represents UNESCO as a board member in the Asia-Pacific Coalition on Male Sexual Health and in the Purple Sky Subregional MSM and TG network. He also moderates an information network on men who have sex with men, HIV and human rights called MSM-Asia, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at jwdlvw@gmail.com.