the need for targeted
city-based responses.”
sUccess stories in six cities: new ways of reachinG oUt
Building on examples of proven and effective men who have sex with men programming from Hong Kong and Singapore, the ‘Six city Initiative’ sought to highlight innovative responses and underline that city‑based action can have a critical impact on tackling HIV among men who have sex with men and transgender people.
Examples of good practice were showcased at a gathering of the ‘Six city Initiative’ representatives in Hong Kong in late 2010. One example was developed by Jethro Patalinghug, who used the success of his video campaign and widening networks of contacts to create “Take the Test”, a project that provides free and rapid HIV testing at big gatherings of men who have sex with men across the Philippines.
“The death of my friend from HIV and the diagnosis of others around me strengthened my resolve to bring the message of taking the HIV test to gay men in the Philippines,” he says.
The project has been hailed for reaching large number of city‑dwelling men who have sex with men, and is now part of a new wave of savvy projects that try to protect men who have sex with men and transgender people from HIV.
let’s Go online
The Internet has become central to the social lives of many men who have sex with men and transgender people. More and more men who have sex with men are using online social networking sites to date and network, which is not surprising in a region where Internet use has increased more than five‑fold since 2000.
Love auditions, an online safe‑sex mini‑series, is tapping into these social trends. “If we are to reach gay teens and young people effectively, we need to provide them with something new,” says director Vittaya Saeng‑Aroon, who produced the mini‑series in collaboration with his production company, Cyberfish Media, as well as the Rainbow Sky Association of Thailand and the Thai Ministry of Health. The series focuses on gay teenagers and has attracted thousands of Thai viewers who follow the exploits of three gay characters.
show soMe style
City environments enable community gatherings of large groups of men who have sex with men and transgender people and provide ideal opportunities to publicize HIV and human rights issues. (continued on page 56)
“if we are to reach gay teens and young people effectively, we need to provide them with something new.”
Vittaya saenG-aroon filM director, thailand
HIV IN ASIA AND THE PACIFIC : GETTING TO ZERO 54
hiv amonG men Who have sex With men in the cities
The most recent data from the six cities participating in the ‘Six city Initiative’ show alarmingly high rates of HIV among men who have sex with men:
BanGKoK—HIV prevalence in cross-sectional surveys of men who have sex with men increased rapidly from 17% in 2003 to 31% in 2010. HIV prevalence among men who have sex with men attending the Silom Community Clinic increased from 25% in 2005 to 35% in 2010. HIV incidence in a cohort study of men who have sex with men averaged 6%
over four years. Incidence was highest among young men who have sex with men aged 18–21 years, 30%
of whom acquired HIV in those four years.
chenGdU—HIV prevalence among men who have sex with men in Chengdu was over 10% in 2011 according to the Government of China.
ho chi Minh city—HIV prevalence among men who have sex with men almost tripled between 2006 and 2009, rising from 5.3% to 15%. In the same period, HIV prevalence among men who have sex with men in Hanoi increased from 9.4% to 17%.
jaKarta—HIV prevalence among men who have sex with men in Jakarta increased fourfold from 2% in 2003 to 8.1% in 2007. Over the same period,
HIV prevalence among transgender people increased from 25% to 34%.
Manila—Newly-reported HIV and AIDS cases among men who have sex with men more than quadrupled between 2006 and 2009, and men who have sex with men accounted for approximately 70%
of all new HIV case reports in 2008–2009.
yanGon—In 2007, HIV prevalence among men who have sex with men in the HIV Sero-Surveillance Survey was 23.5%. In the 2009 survey, prevalence was 12.5%.
A wider sample of men who have sex with men was surveyed in 2009, which may explain the lower prevalence. Intensifying prevention efforts needs to be continued.
Data from the following cities also supports these findings.
honG KonG, japan, sinGapore and taiwan—Following rapid increases in newly diagnosed HIV infections among men who have sex with men in the early 2000s, new HIV case reports have leveled off in recent years.
source: Men Who Have Sex With Men and Transgender Populations Multi-City HIV Initiative in Six cities: Bangkok, Chengdu (China), Ho Chi Minh City, Jakarta, Manila, and Yangon. United states agency for international development asia, UNdP asia-Pacific Regional Centre, hong Kong department of health, UNaids, who, asia Pacific Network of People living with hiV, asia Pacific Coalition on male sexual health, Family health international, 2011.
MsM
In Yangon, Myanmar, the 2011 Sedona Township Transgender Fashion Contest thrilled thousands with its competitive heats held at shopping centres across the city. The events were used to promote public awareness of HIV and advocate greater acceptance of transgender people.
Demand for tickets to the grand finale was so high that they were touted on the black market at three times the cover price. Among the 1800 guests was the chief of the city’s health department, who addressed the crowd and accepted a large donation for HIV services.
positiVe partnerships
In some Asian cities, partnerships between public health providers and community organizations are beginning to improve HIV and sexual health services for men who have sex with men and transgender people.
China’s Chengdu Infectious Diseases Hospital has developed a partnership model for HIV treatment adherence counselling that relies on people living with HIV (many of whom are men who have sex with men) working as lay counsellers.
The arrangement also refers patients to HIV support groups and community organizations led by men who have sex with men.
In Bangkok, the Poz Home Centre, a small organization led by men who have sex with men and transgender people, has set up partnerships with primary clinic sites and the outpatient sections of major hospitals. The aim is to ensure continuity of treatment and care for men who have sex with men and transgender people once they leave the clinic or hospital.
chaMpions to oVercoMe challenGes
The ‘Six city Initiative’ has shown that progress continues to be hampered by restrictive legal environments and policies, selective enforcement practices, and a lack of coordination between local health and law enforcement officials and community‑based organizations.
Urban HIV services tend to work best when they have champions in city governments who support them. In Ho Chi Minh City, the local harm‑reduction department is helping remove barriers while cultivating the support of higher
“i recognized that... i may have the power to help my friends and others realize the importance of taking the [hiV] test”
jethro patalinGhUG
taKe the test camPaiGn, the PhiliPPines
HIV IN ASIA AND THE PACIFIC : GETTING TO ZERO 56
authorities. Alongside that, the Chengdu Centre for Disease Control and Prevention is supporting the coordination of medical and community‑based HIV services for men who have sex with men. The centre is also helping to remove legislative hurdles that make it difficult for community organizations to assist with HIV counselling and testing.
UnsolVed issUes
Despite such progress, significant challenges remain. Innovative activities are increasing, but they are still too few to halt the epidemic among men who have sex with men and transgender people.
According to a recent UNDP report, Towards universal access: examples of municipal HIV programming for men who have sex with men and transgender people in six Asian cities, most community‑generated actions are not adequately resourced to scale up their potentially valuable work.
Shivananda Khan, chair of the Asia‑Pacific Coalition on Male Sexual Health, agrees: “the innovative projects we are seeing are encouraging; however, too often these are scattered with individual projects that are effective in small numbers”.
“We need a more strategic approach,” he believes.
Meanwhile, HIV services for transgender people remain scarce.
HIV programming usually merges transgender people into programmes for men who have sex with men, often with little insight into their particular service‑delivery needs.
The contradictions between policing practices and public health campaigns are another barrier to effective implementation.
Police often regard possession of condoms as evidence that a person sells sex.
At the same time, local public health services are promoting and distributing condoms to prevent HIV and other sexually transmitted infections. Young men who have sex with men, and transgender people trying to access HIV services, can find the path blocked by age‑of‑consent requirements and the need to obtain parental consent for HIV testing .
“There seems to be resistance to new ideas and innovations that [may] threaten long‑established approaches,” warns Jethro Patalinghug.
"But determination and collaboration can get past those obstacles," he adds. ■