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MSM & TG in the Asia Pacific & Global MSM & TG in the Asia Pacific & Global HIV epidemics:HIV epidemics:
Anger, Frustration – and ExcitementAnger, Frustration – and Excitement
Don BaxterDon BaxterExecutive Director, Australian Federation of AIDS OrganisationsExecutive Director, Australian Federation of AIDS Organisations
Co-Chair, Global Forum on MSM & HIVCo-Chair, Global Forum on MSM & HIVAFAO HIV Educator’s Conference, Novotel North WollongongAFAO HIV Educator’s Conference, Novotel North Wollongong
27 May 200827 May 2008
In a snapshot In a snapshot
Asia Pacific RegionAsia Pacific Region– Epi snapshot; hot spotsEpi snapshot; hot spots– Developments: programming and investment; PSN; APCOMDevelopments: programming and investment; PSN; APCOM– Commission on AIDS in Asia reportCommission on AIDS in Asia report
Global overviewGlobal overview– Africa; Caribbean; Eastern Europe; MENA – Central AsiaAfrica; Caribbean; Eastern Europe; MENA – Central Asia– Global Forum on MSM & HIVGlobal Forum on MSM & HIV– UN-systemUN-system– Donor/funder interestDonor/funder interest– Decriminalization momentumDecriminalization momentum
Mexico City IAC & Satellite – SignificanceMexico City IAC & Satellite – Significance Australia’s response:Australia’s response:
– AusAID performance; Strategy reviewAusAID performance; Strategy review– HIV Capacity Building Consortium; one-off projectsHIV Capacity Building Consortium; one-off projects– An MSM & TG Strategy?An MSM & TG Strategy?– Implications for AFAO member organisationsImplications for AFAO member organisations
Asia Pacific OverviewAsia Pacific Overview
MSM HIV seroprevalence higher then MSM HIV seroprevalence higher then realized (‘masked’ + prejudice):realized (‘masked’ + prejudice):
» Most major cities 2%+Most major cities 2%+
» Rates 10-50 times higher than adult malesRates 10-50 times higher than adult males Eg Bangkok 31% - (equiv. Botswana)Eg Bangkok 31% - (equiv. Botswana)
» Evidence of rapid increasesEvidence of rapid increases
» Transgender higher ratesTransgender higher rates
» PNG & the Pacific not clear – surveillance deficitPNG & the Pacific not clear – surveillance deficit
17.6 TG
11.4 MSW
15.3 MSM
11.9 TG14.4 MSW
5.5 MSM10.5 MSW
6.7 MSW
11.5 TG20 MSW
28.3
MSM 17.3
0.8 0.8
8.7 MSM
MSM 14.0
36.7 TG
5.8 8.0 5.3 MSM
Thailand
Chiang Mai 2005
Bangkok2003-5
Pattaya 2005
Phuket 2005
Had Yai 2005
Ho Chi Minh 2002-4
Phnom Penh2000-5
Battambang 2005
Siam Reap 2005
Beijing 2001-6Shiang Hai 2004-5
0.8, 3.1, 3.1, 4.6, 5.8 MSM 1.5 MSM
5.0 MSW
Shenzen 2005
Hangzhou 2004
3.0 MSM
HIV prevalence among MSM in Asia
2225.3
MSM 2006-7
MSM 2000-3
MSW
TG
MSM 2004-5
Hanoi 20069.4 MSM
22.0 TG
Jakarta 2002
3.6 MSW2.5 MSM
31.0
33.0
Mandalay
19962006
Yangon
(Source: NBC, 2006; UNAIDS, 2006b, 2006b; FHI, 2006a, 2006b; Choi, 2003; MAP, 2005; van Griensven, 2005; MMWR, 2006; Ma, 2006, NCHADS, 2006)
India
Pakistan
Bangladesh
Nepal3.6 MSM 2005 4.8 MSW 2005
Kathmandu
Chennai
Tamil Nadu
6.5 MSM 2001
4.0 MSM 2000 2.4 MSM 2002
Goa
1.7 MSW 2001
24.0 MSM 2002Mumbai
18.8 MSM 2003
9.6 MSM 2004
Karachi4.0 MSW 2004
2.0 TG 2004
1.7 MSW 20054.0 MSM 2005
HIV prevalence among MSM in Asia
Andra Pradesh
18.2 MSM 2005
(Source: UNAIDS, 2006a, 2006b; FHI, 2006)
0.2 MSM 2005Dhaka
HIV prevalence among MSM in China
Beijing
Shiang Hai
3.1
1.5
5.0
Shenzen
Hangzhou
3.0
China
2001-32004
2005
2005
20040.8
4.63.1
20052005
(Choi et al, 2003; Shenzen Dpt of Public Health, 2005; Zhang & Chu, 2005; Li et al, 2006; Ma et al 2006)
5.8
2006
1.3 1.4 1.4
200120022003Heilongjiang
15.3
5.5
28.3
17.3
Bangkok
HIV prevalence among MSM in Thailand
Chiang Mai
Thailand
Phuket
2003
2005
2005
2005
(Source: van Griensven, 2005; MMWR, 2006
28.3
1.4
8.9
1.6
9.3
0.5
5.8
0.25
31
1.30
5
10
15
20
25
30
35
40Prevalence (%)
MSM Adults
HIV Prevalence in MSM and Adults in South East Asian HIV Prevalence in MSM and Adults in South East Asian Capital CitiesCapital Cities2005 - 20062005 - 2006
HIV in MSM
HIV in Adults
(UNAIDS, 2006; MMWR, 2006; Ma et al, 2006; Phalkun et al, 2006; FHI, 2006; UNFPA, 2006)
Contribution to new HIV infections Contribution to new HIV infections by MSMby MSM
Under-estimated (surveillance gaps)Under-estimated (surveillance gaps) ProjectionsProjections Sex with women partnersSex with women partners
30.3
8.3
27.9
34.8 35.7
05
101520253035404550
Prevalence (%)
% MSM of adults
Percentage of Adult HIV Prevalence Attributable to MSM Percentage of Adult HIV Prevalence Attributable to MSM in South East Asian Capital Cities, 2005 - 2006in South East Asian Capital Cities, 2005 - 2006
(UNAIDS, 2006; MMWR, 2006; Ma et al, 2006; Phalkun et al, 2006; FHI, 2006; UNFPA, 2006)
Current Prevention investments & Current Prevention investments & Program CoverageProgram Coverage
Most less than 2% of National Prevention Most less than 2% of National Prevention expenditureexpenditure– Some = 0%Some = 0%– Best 4% (in 31% seroprevalence)Best 4% (in 31% seroprevalence)
Donor funds rather than governmentDonor funds rather than government Coverage = less than 5%Coverage = less than 5%
– Desirable to reverse epidemic = 60%Desirable to reverse epidemic = 60%
Includes peer education and outreach, IEC materials, media messages on behavior Includes peer education and outreach, IEC materials, media messages on behavior changechange
Complementary activities (VCT, STIs) among MSM are not generally reported as Complementary activities (VCT, STIs) among MSM are not generally reported as MSM expenditureMSM expenditure
ESTIMATING RESOURCE LEVELS: METHOD 1—
Secondary SourcesExpenditure ranges from a high of 4% in
Thailand to a low of
0% in a province in China
1313
Coverage of at-risk populationsCoverage of at-risk populations
Figure 5.3 – page 131 “Redefining AIDS Figure 5.3 – page 131 “Redefining AIDS in Asia”in Asia”
Figure 5.3 – page 131 “Redefining AIDS in Asia”
Hot spots & Program problemsHot spots & Program problems Philippines; Burma; LaosPhilippines; Burma; Laos Developed Asia: Tokyo, Osaka, Seoul, Singapore, KLDeveloped Asia: Tokyo, Osaka, Seoul, Singapore, KL 30 Chinese ‘middle’-cities30 Chinese ‘middle’-cities TransgenderTransgender Male sex workersMale sex workers PNGPNG The PacificThe Pacific
Progammatic problems:Progammatic problems:– Community development/mobilisation strategies – inadequateCommunity development/mobilisation strategies – inadequate– ‘‘Donor dominated’ programmingDonor dominated’ programming– (In)Visibility of poz MSM(In)Visibility of poz MSM– Condom and Lube availabilityCondom and Lube availability– MSM advocacyMSM advocacy– IllegalityIllegality
Some Bright SpotsSome Bright Spots
Governments acknowledging – not resistingGovernments acknowledging – not resisting– In National Strategies and Plans & surveillanceIn National Strategies and Plans & surveillance
Regional momentumRegional momentum– ‘‘Re-Defining AIDS in Asia’ reportRe-Defining AIDS in Asia’ report– Purple Sky Network (Mekong countries)Purple Sky Network (Mekong countries)– APCOM (all Asia Pacific; early stages)APCOM (all Asia Pacific; early stages)– Indonesian MSM Working GroupIndonesian MSM Working Group– Pacific Sexual Diversity NetworkPacific Sexual Diversity Network– Some investment by gov’t (Thai; China)Some investment by gov’t (Thai; China)
Energy on the groundEnergy on the ground
Global ContextGlobal Context
Asia – momentum developed, but . . . Asia – momentum developed, but . . . – AfricaAfrica– CaribbeanCaribbean– Eastern EuropeEastern Europe– MENA & Central AsiaMENA & Central Asia
But 5 years ago Asian governments But 5 years ago Asian governments were . . .were . . .
Global Forum on MSM & HIVGlobal Forum on MSM & HIV
Establishment – early daysEstablishment – early days Scope & ObjectivesScope & Objectives
– Info exchangeInfo exchange– NetworkingNetworking– Advocacy at the global levelAdvocacy at the global level
Governance & StaffingGovernance & Staffing
MSM Global Forum: achievementsMSM Global Forum: achievements
Global South & NorthGlobal South & North MEX IAC SatelliteMEX IAC Satellite Interventions in Global discourseInterventions in Global discourse
– Gender guidance; UNGASS; UN-system; Gender guidance; UNGASS; UN-system; Violence & MSM; P.Piot replacementViolence & MSM; P.Piot replacement
Degree of accountabilityDegree of accountability SecretariatSecretariat Donor interestDonor interest
Global developmentsGlobal developments
UN-system & MSM:UN-system & MSM:– New!! – UNDP ‘Leadership’New!! – UNDP ‘Leadership’
– Global strategy for MSM & HIV [for UN]Global strategy for MSM & HIV [for UN]
DecriminalizationDecriminalization– France; Netherlands; now UKFrance; Netherlands; now UK
– Judicial momentum: Nepal; Hong Kong; India?Judicial momentum: Nepal; Hong Kong; India?
Donor & Multi-lateral agency [MSM] leadersDonor & Multi-lateral agency [MSM] leaders– Gates; IAS; ICASO; GNP+; etc.Gates; IAS; ICASO; GNP+; etc.
– ‘‘Guilt’? – but evidence previously not assembledGuilt’? – but evidence previously not assembled
Mexico City AIDS ConferenceMexico City AIDS Conference
MSM focusMSM focus– Opening; plenary; session stream; SatelliteOpening; plenary; session stream; Satellite
Momentum buildingMomentum building– Recalcitrant governmentsRecalcitrant governments– Flow-on to Regional ConferencesFlow-on to Regional Conferences
» ICASA (Africa, Dec 08); ICAAP (Bali; July 09)ICASA (Africa, Dec 08); ICAAP (Bali; July 09)
Australia’s responseAustralia’s response
AusAID fundingAusAID funding» Minimal; $100K, $189KMinimal; $100K, $189K» Caveat: Rationale for ‘injecting / harm reduction’ priorityCaveat: Rationale for ‘injecting / harm reduction’ priority
AusAID HIV StrategyAusAID HIV Strategy» Current reviewCurrent review» AFAO submissionAFAO submission
Emphases: MSM Strategy; MSM advocacyEmphases: MSM Strategy; MSM advocacy
HIV Capacity Building ConsortiumHIV Capacity Building Consortium» Protracted gestationProtracted gestation» Pacific network; Indonesian networkPacific network; Indonesian network
One-off projects packageOne-off projects package PNG discussionsPNG discussions
Implications for AFAO member Org.sImplications for AFAO member Org.s
Expansion of available fundsExpansion of available funds» Expertise soughtExpertise sought
» Chiefly through organisational partnershipsChiefly through organisational partnerships
Balance with careBalance with care» Not stressing domestic responseNot stressing domestic response
» Opportunity for refreshmentOpportunity for refreshment