ICAAP9: 90 per cent of men having sex with men in Asia Pacific have no access to HIV prevention and care

By Syed Akbar
Bali, Aug 12: More than 90 per cent of men having sex with men (MSM) in Asia Pacific do not have access to HIV prevention and care services, and if interventions are not urgently intensified the spread of HIV in this vulnerable population will escalate sharply in the very near future.

Moreover, legal frameworks across the region need a dramatic and urgent overhaul to allow public health and community sectors to reach out to MSM, or the consequences could be dire and stretch well beyond MSM to affect the general population.

This warning came at a high level and ground breaking symposium – “Overcoming Legal Barriers to Comprehensive Prevention Among Men who have Sex with Men and Transgender People in Asia and the Pacific” -- held at the 9th International Congress on AIDS in Asia and the Pacific (ICAAP) today, and hosted by the United Nation Development Programme (UNDP) and the Asia Pacific Coalition on Male Sexual Health (APCOM).

Speakers discussed how effective and comprehensive HIV prevention among MSM and transgender (TG) people can occur only when a conducive and enabling legal environment is created that allows unimpeded dissemination of prevention messages and services; appropriate provision of treatment, care and support services; and confidence-building measures among the most marginalized and vulnerable to seek essential information and access services.

“In order to achieve universal access to HIV prevention, treatment, care and support and realize the Millennium Development Goals, we must facilitate an enabling legal environment and human rights based HIV policies and programmes for MSM and TG,” said Jeffrey O’Malley, Global Director of UNDP’s HIV Group, among the speakers at the symposium. “This will mean stepping up our investment in legal and social programmes which effectively address stigma and discrimination directed at MSM and TG.”

Due to the increased availability in recent years of epidemiological data on HIV among MSM, there is a better understanding of the magnitude and nature of the HIV epidemic amongst MSM and TG within the Asia Pacific region. However, there remains a dangerous lack of interventions which comprehensively address HIV prevention, treatment, care and support needs for MSM and TG.

A 2006 survey of the coverage of HIV interventions in 15 Asia Pacific countries estimated that targeted prevention programmes reached less than 8% of MSM and TG, far short of the 80% coverage that epidemiological models indicate is needed to turn the HIV epidemic around.

“A strategy of prevention requires bold and effective legal and policy measures to reach out to vulnerable communities and individuals at risk,” stated the Honourable Michael Kirby of Australia. “It is here that reform of laws concerning MSM must be seen as an imperative step in the path of reducing the isolation, stigma and
vulnerability felt by MSM communities and individuals. This will help enhance their self-respect and dignity as citizens and protect their legal rights, including receiving information on safer sex practices.”

Currently 22 countries in the Asia Pacific region criminalize male to male sex, and these laws often taken on the force of vigilantism, leading to abuse and human rights violations. Even in the absence of criminalization, other provisions of law violate the rights of MSM and TG along with arbitrary and inappropriate enforcement, thereby obstructing HIV interventions, advocacy and outreach, and service delivery.

These structural barriers significantly increase the vulnerability of MSM and TG to HIV infection and have an immense adverse effect on their health and human rights.
Developing strategic partnerships and alliances between affected communities, the legal profession, human rights bodies, parliamentarians and policy makers is critical.

This very debate was at the heart of the recent landmark ruling by the Delhi High Court that Section 377 of the Indian Penal Code unfairly discriminates against MSM and consenting adults in general.

“The Delhi ruling is a shining example of such an approach, where education and sensitization of these different sectors was central to the success of the case,” said Shivananda Khan, Interim Chair of APCOM.

“Other key rulings in the region include the 2007 Nepal Supreme Court ruling recognizing the rights of sexual minorities, and the June 2009 Pakistan Supreme Court ruling that hijras or transgendered individuals, are a minority community in the legal sense of the term.”

Given the current global economic crisis and the ever-mounting bill for life-saving anti-retroviral treatment, the impetus for effective comprehensive HIV prevention becomes even stronger. Only a strategy of comprehensive, rights-based prevention, supported by an enabling legal environment, offers a possibility of reducing the numbers of persons infected with HIV each year.

In this context, it is both cost-effective and imperative that governments and other key players introduce and implement legal and social frameworks and programmes which counter discrimination and stigmatization that have long targeted MSM and TG.