peripheries

Global vs. targetted HIV prevention: Building on sound ground

August 6th, 2008 | by User Image

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It is revelation’s time for AIDS Inc. Two months ago Kevin de Cock, the epidemiologist heading the HIV-AIDS program with the World Health Organisation, briefly acknowledge, before recanting, that the threat of an heterosexual AIDS pandemic outside of Africa had disappeared and this month at the XVII International AIDS conference in Mexico, it was finally recognised that “a giant wave of infections moved like a tsunami through communities of gay men in Asia, Africa and Latin America” as The Sidney Morning Herald puts it.

“Men who have sex with men are now nearly 20 times more likely to be infected with HIV than the general population, yet they often receive as little as 1 per cent of global funding.”

Quoting Kevin Frost, the chief executive of the American Foundation for AIDS Research (amfAR), The SMH adds that “The story is one of abject failure on the part of the institutions that have been charged with leading the response to HIV/AIDS at local, national and international levels” and that “Men who have sex with men continue to have little or no access to HIV services of any kind and as a result are plagued by high rates of infection.”

A giant step towards a better understanding of the HIV epidemic but still a small step towards long-awaited programmes targeted at Men who have Sex with Men, and this for many reasons. One being that most countries where the HIV epidemic is moving like a giant Tsunami wave are still in complete cultural denial of the existence of MSM, from government to civil society and to MSM themselves. The other being that there is no such thing as an MSM community at least in the sense we understand it in the West.

This really is big problem that has yet to be recognized because throwing money in the air hoping the wind will blow in the right direction won’t be very much effective. Indeed there is no “Castro” in Bangkok where HIV prevalence amongst MSM recruited in MSM venues is over 30%. There is no “Soho” in Kuala Lumpur, no “Marais” in Phnom Penh. No Pink Paper in Singapore, no Gay Times in Shanghai. No Elton John in Luang Prabang. In short, there are not many “Gay lighthouses” in the East, not as we can identify them in the West.

Instead, as reported in 2003 in a review of knowledge about the sexual networks and behaviours of men who have sex with men in Asia by Dowsett, Grierson and McNally from Latrobe Uiiversity,

“The literature reveals that there are no socially or self-defined groups of men that fit into an overarching category of MSM. What the review shows is that there are just men!! Fishermen, students, factory workers, military recruits, truck drivers, and men who sell sex, and so on: all these categories of men are to be found in the studies and programmes reviewed.”

There were no similar traits in all of the MSM population studied other than them being males, and engaging in sex with other men.

In other words, for those familiar with the London scene: MSM in Asia don’t go for a drink in Soho reading QX before going for a meal in Balans and clubbing in G.A.Y or Vauxhall or to see Kilye in concert. Not all Gay men in London (here we can use Gay instead of MSM) have this lifestyle but many had or will and were or will be accessible at this point in there life.

The question and the challenge is “How does one design programmes specifically targeting or aimed at MSM in Asia when they don’t exist only as such?” Could it be that general prevention could be more efficient? The jury is not out yet because there is little to judge on. But the coming years will be crucial.

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