China announced in 2008 plans for an extensive programme to tackle sharply rising rates of HIV amongst men who have sex with men (MSM)
Credit: UNAIDS
China announced in 2008 plans for an extensive programme to tackle sharply rising rates of HIV amongst men who have sex with men (MSM), in the latest sign that the country may be starting to face up to a crisis which long seemed taboo.
Announcing the MSM campaign, the ministry of health said that risky sexual behaviour was the biggest single factor behind the spread of HIV in mainland China, excluding Hong Kong, and that men who had sex with men were now the group most likely to become infected with the virus. In China there are around 700,000 people living with HIV, and 11.1 percent of these are MSM.
“In the past between 1 and 3 percent of MSM on the mainland had HIV; Now it is anywhere from 2.5 to 6.5 percent”, Hao Yang, deputy chief of the ministry’s disease prevention and control bureau, was quoted as saying by the China Daily.
The campaign involved targeted prevention measures for the estimated 5-10 million- Chinese MSM, including stronger promotion of condom use, expanded coverage and quality of HIV prevention activities, increased access to voluntary HIV counselling and testing services, and improved access to treatment for sexually transmitted infections.
As a starting point for its new large-scale campaign to reduce HIV among MSM, China is aiming for some 21,000 MSM to be HIV-tested in order to be able to establish a clearer statistical baseline for the infection rate. This is the largest such study undertaken anywhere in the world and the first of its kind in Asia.
Its prevention effort will involve MSM community based organizations (CBOs) and civil society at all levels. Community-based organisations are carrying out AIDS awareness campaigns, VCT referrals, peer education, safer sex promotion and condom distribution; hot-lines are being run and internet chat rooms and websites used.
UNAIDS, the joint United Nations programme on HIV/AIDS, sees the empowering of MSM and other marginalized groups to protect themselves from HIV as one of the main elements of the global AIDS response.
"The Chinese government has made addressing HIV prevention among MSM a priority and that is something which UNAIDS welcomes," said Bernhard Schwartlander, UNAIDS Country Coordinator in China.
In most Asian countries MSM remains an uncomfortable subject: in many of them, sex between men is illegal and reports of harassment are frequent.
Credit: UNAIDS
But despite progress in China, a number of shortcomings remain, with stigma and discrimination still all too prevalent amongst the general population and even within the MSM community itself.
It is estimated that by late 2007, only 8 percent of MSM had been reached by comprehensive HIV prevention interventions. Furthermore, more than half of China's MSM have more than one sexual partner but only between 10 and 20 percent of them use condoms, according to health ministry estimates.
“It is critical that the government and the many MSM working groups find ways to improve their ability to work together in open and nondiscriminatory partnerships", said Schwartlander.
Largely ignored
Developments in China come amidst indications that governments elsewhere in the Asia-Pacific region are also becoming more willing to acknowledge an epidemic that many had previously largely ignored.
In most Asian countries MSM remains an uncomfortable subject: in many of them, sex between men is illegal and reports of harassment are frequent. As a result, there has been little in the way of specific support for programmes for MSM.
“A lot of attention is being drummed up, but a lot more needs to happen,” said Paul Causey, a Bangkok-based consultant working with the Asia Pacific Coalition on Male Sexual Health (APCOM) and the United Nations on MSM-related issues.
Most Asian men who have sex with other men are not open about their sexual behaviour. Social taboos and discrimination mean that many opt to disguise their sexual preferences; for many others, their sexual practices with other men may only be a small part of social roles they play or their sexual lives. Given that many men who have sex with men also have sex with women, high HIV rates among MSM can also translate into substantial numbers of women at risk of exposure to HIV.
The combination of high numbers of partners with high-risk behaviour such as unprotected anal intercourse has been a key factor behind the accelerating HIV infection rate in many Asian cities.
It said that hardly any Asian country is devoting significant resources to MSM, despite the fact that prevention costs a lot less than treatment. According to the commission, $1 invested in effective prevention can save up to $8 in treatment expenditure for expanding epidemic countries.
Most Asian men who have sex with other men are not open about their sexual behaviour. Social taboos and discrimination mean that many opt to disguise their sexual preferences.
Credit: UNAIDS
Engaging community groups
The tipping point in awakening to the dimension of the MSM crisis was the convening of a special conference in New Delhi in September 2006 entitled “Risks and Responsibilities: Male Sexual Health and HIV in Asia and Pacific”.
The conference was truly tripartite, bringing together governments, donors and 380 members of community groups. As important as the event itself was the run-up, with 16 countries holding UNAIDS-sponsored preparatory meetings. In some cases, including that of China, it was virtually the first time that government officials and representatives from the wider MSM community groups met to assess the situation and discuss solutions.
One of the other lasting achievements of that conference was the decision to launch APCOM, which brings together civil society groups, government sector representatives, donors, technical experts and the United Nations to push for an effective response to the rising HIV incidence amongst MSM.
Its efforts complement those of a United Nations technical working group on MSM and HIV/AIDS in China launched in mid-2006. The group is led by the United Nations Development Programme (UNDP).
“The technical working group is working with government, MSM community groups and donors to improve co-ordination and communication, build government capacities to involve civil society organisations (CSOs) in policy-making and public service delivery, and develop the institutional and professional capacities of CSOs,” said Edmund Settle, HIV manager for UNDP in China.
