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Anger, Frustration – and Excitement

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A discussion of HIV prevalence among men who have sex with men (MSM) and transgenders in the Asia Pacific & Global HIV epidemics and the implications of this data for the region and for AFAO members. This presentation was given at the 2008 AFAO HIV Educators Conference.

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Anger, Frustration – and Excitement

  1. 1. MSM & TG in the Asia Pacific & Global HIV epidemics: Anger, Frustration – and Excitement Don Baxter Executive Director, Australian Federation of AIDS Organisations Co-Chair, Global Forum on MSM & HIV AFAO HIV Educator’s Conference, Novotel North Wollongong 27 May 2008
  2. 2. In a snapshot <ul><li>Asia Pacific Region </li></ul><ul><ul><li>Epi snapshot; hot spots </li></ul></ul><ul><ul><li>Developments: programming and investment; PSN; APCOM </li></ul></ul><ul><ul><li>Commission on AIDS in Asia report </li></ul></ul><ul><li>Global overview </li></ul><ul><ul><li>Africa; Caribbean; Eastern Europe; MENA – Central Asia </li></ul></ul><ul><ul><li>Global Forum on MSM & HIV </li></ul></ul><ul><ul><li>UN-system </li></ul></ul><ul><ul><li>Donor/funder interest </li></ul></ul><ul><ul><li>Decriminalization momentum </li></ul></ul><ul><li>Mexico City IAC & Satellite – Significance </li></ul><ul><li>Australia’s response: </li></ul><ul><ul><li>AusAID performance; Strategy review </li></ul></ul><ul><ul><li>HIV Capacity Building Consortium; one-off projects </li></ul></ul><ul><ul><li>An MSM & TG Strategy? </li></ul></ul><ul><ul><li>Implications for AFAO member organisations </li></ul></ul>
  3. 3. Asia Pacific Overview <ul><li>MSM HIV seroprevalence higher then realized (‘masked’ + prejudice): </li></ul><ul><ul><ul><li>Most major cities 2%+ </li></ul></ul></ul><ul><ul><ul><li>Rates 10-50 times higher than adult males </li></ul></ul></ul><ul><ul><ul><ul><li>Eg Bangkok 31% - (equiv. Botswana)‏ </li></ul></ul></ul></ul><ul><ul><ul><li>Evidence of rapid increases </li></ul></ul></ul><ul><ul><ul><li>Transgender higher rates </li></ul></ul></ul><ul><ul><ul><li>PNG & the Pacific not clear – surveillance deficit </li></ul></ul></ul>
  4. 4. 17.6 TG 11.4 MSW 15.3 MSM 11.9 TG 14.4 MSW 5.5 MSM 10.5 MSW 6.7 MSW 11.5 TG 20 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 Bangkok 2003-5 Pattaya 2005 Phuket 2005 Had Yai 2005 Ho Chi Minh 2002-4 Phnom Penh 2000-5 Battambang 2005 Siam Reap 2005 Beijing 2001-6 Shiang 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 22 25.3 MSM 2006-7 MSM 2000-3 MSW TG MSM 2004-5 Hanoi 2006 9.4 MSM 22.0 TG Jakarta 2002 3.6 MSW 2.5 MSM 31.0 33.0 Mandalay 1996 2006 Yangon (Source: NBC, 2006; UNAIDS, 2006b, 2006b; FHI, 2006a, 2006b; Choi, 2003; MAP, 2005; van Griensven, 2005; MMWR, 2006; Ma, 2006, NCHADS, 2006)‏
  5. 5. India Pakistan Bangladesh Nepal 3.6 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 2002 Mumbai 18.8 MSM 2003 9.6 MSM 2004 Karachi 4.0 MSW 2004 2.0 TG 2004 1.7 MSW 2005 4.0 MSM 2005 HIV prevalence among MSM in Asia Andra Pradesh 18.2 MSM 2005 (Source: UNAIDS, 2006a, 2006b; FHI, 2006)‏ 0.2 MSM 2005 Dhaka
  6. 6. HIV prevalence among MSM in China Beijing Shiang Hai 3.1 1.5 5.0 Shenzen Hangzhou 3.0 China 2001-3 2004 2005 2005 2004 0.8 4.6 3.1 2005 2005 (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 2001 2002 2003 Heilongjiang
  7. 7. 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
  8. 8. HIV Prevalence in MSM and Adults in South East Asian Capital Cities 2005 - 2006 Prevalence (%)‏ MSM Adults HIV in MSM HIV in Adults (UNAIDS, 2006; MMWR, 2006; Ma et al, 2006; Phalkun et al, 2006; FHI, 2006; UNFPA, 2006)‏
  9. 9. Contribution to new HIV infections by MSM <ul><li>Under-estimated (surveillance gaps)‏ </li></ul><ul><li>Projections </li></ul><ul><li>Sex with women partners </li></ul>
  10. 10. Percentage of Adult HIV Prevalence Attributable to MSM in South East Asian Capital Cities, 2005 - 2006 Prevalence (%)‏ % MSM of adults (UNAIDS, 2006; MMWR, 2006; Ma et al, 2006; Phalkun et al, 2006; FHI, 2006; UNFPA, 2006)‏
  11. 12. Current Prevention investments & Program Coverage <ul><li>Most less than 2% of National Prevention expenditure </li></ul><ul><ul><li>Some = 0% </li></ul></ul><ul><ul><li>Best 4% (in 31% seroprevalence)‏ </li></ul></ul><ul><li>Donor funds rather than government </li></ul><ul><li>Coverage = less than 5% </li></ul><ul><ul><li>Desirable to reverse epidemic = 60% </li></ul></ul>
  12. 13. <ul><li>Includes peer education and outreach, IEC materials, media messages on behavior change </li></ul><ul><li>Complementary activities (VCT, STIs) among MSM are not generally reported as MSM expenditure </li></ul>ESTIMATING RESOURCE LEVELS: METHOD 1 —Secondary Sources Expenditure ranges from a high of 4% in Thailand to a low of 0% in a province in China
  13. 14. Coverage of at-risk populations <ul><li>Figure 5.3 – page 131 “Redefining AIDS in Asia” </li></ul>Figure 5.3 – page 131 “Redefining AIDS in Asia”
  14. 15. Hot spots & Program problems <ul><li>Philippines; Burma; Laos </li></ul><ul><li>Developed Asia: Tokyo, Osaka, Seoul, Singapore, KL </li></ul><ul><li>30 Chinese ‘middle’-cities </li></ul><ul><li>Transgender </li></ul><ul><li>Male sex workers </li></ul><ul><li>PNG </li></ul><ul><li>The Pacific </li></ul><ul><li>Progammatic problems: </li></ul><ul><ul><li>Community development/mobilisation strategies – inadequate </li></ul></ul><ul><ul><li>‘ Donor dominated’ programming </li></ul></ul><ul><ul><li>(In)Visibility of poz MSM </li></ul></ul><ul><ul><li>Condom and Lube availability </li></ul></ul><ul><ul><li>MSM advocacy </li></ul></ul><ul><ul><li>Illegality </li></ul></ul>
  15. 16. Some Bright Spots <ul><li>Governments acknowledging – not resisting </li></ul><ul><ul><li>In National Strategies and Plans & surveillance </li></ul></ul><ul><li>Regional momentum </li></ul><ul><ul><li>‘ Re-Defining AIDS in Asia’ report </li></ul></ul><ul><ul><li>Purple Sky Network (Mekong countries)‏ </li></ul></ul><ul><ul><li>APCOM (all Asia Pacific; early stages)‏ </li></ul></ul><ul><ul><li>Indonesian MSM Working Group </li></ul></ul><ul><ul><li>Pacific Sexual Diversity Network </li></ul></ul><ul><ul><li>Some investment by gov’t (Thai; China)‏ </li></ul></ul><ul><li>Energy on the ground </li></ul>
  16. 17. Global Context <ul><li>Asia – momentum developed, but . . . </li></ul><ul><ul><li>Africa </li></ul></ul><ul><ul><li>Caribbean </li></ul></ul><ul><ul><li>Eastern Europe </li></ul></ul><ul><ul><li>MENA & Central Asia </li></ul></ul><ul><li>But 5 years ago Asian governments were . . . </li></ul>
  17. 18. Global Forum on MSM & HIV <ul><li>Establishment – early days </li></ul><ul><li>Scope & Objectives </li></ul><ul><ul><li>Info exchange </li></ul></ul><ul><ul><li>Networking </li></ul></ul><ul><ul><li>Advocacy at the global level </li></ul></ul><ul><li>Governance & Staffing </li></ul>
  18. 19. MSM Global Forum: achievements <ul><li>Global South & North </li></ul><ul><li>MEX IAC Satellite </li></ul><ul><li>Interventions in Global discourse </li></ul><ul><ul><li>Gender guidance; UNGASS; UN-system; Violence & MSM; P.Piot replacement </li></ul></ul><ul><li>Degree of accountability </li></ul><ul><li>Secretariat </li></ul><ul><li>Donor interest </li></ul>
  19. 20. Global developments <ul><li>UN-system & MSM: </li></ul><ul><ul><li>New!! – UNDP ‘Leadership’ </li></ul></ul><ul><ul><li>Global strategy for MSM & HIV [for UN] </li></ul></ul><ul><li>Decriminalization </li></ul><ul><ul><li>France; Netherlands; now UK </li></ul></ul><ul><ul><li>Judicial momentum: Nepal; Hong Kong; India? </li></ul></ul><ul><li>Donor & Multi-lateral agency [MSM] leaders </li></ul><ul><ul><li>Gates; IAS; ICASO; GNP+; etc. </li></ul></ul><ul><ul><li>‘ Guilt’? – but evidence previously not assembled </li></ul></ul>
  20. 21. Mexico City AIDS Conference <ul><li>MSM focus </li></ul><ul><ul><li>Opening; plenary; session stream; Satellite </li></ul></ul><ul><li>Momentum building </li></ul><ul><ul><li>Recalcitrant governments </li></ul></ul><ul><ul><li>Flow-on to Regional Conferences </li></ul></ul><ul><ul><ul><li>ICASA (Africa, Dec 08); ICAAP (Bali; July 09)‏ </li></ul></ul></ul>
  21. 22. Australia’s response <ul><li>AusAID funding </li></ul><ul><ul><ul><li>Minimal; $100K, $189K </li></ul></ul></ul><ul><ul><ul><li>Caveat: Rationale for ‘injecting / harm reduction’ priority </li></ul></ul></ul><ul><li>AusAID HIV Strategy </li></ul><ul><ul><ul><li>Current review </li></ul></ul></ul><ul><ul><ul><li>AFAO submission </li></ul></ul></ul><ul><ul><ul><ul><li>Emphases: MSM Strategy; MSM advocacy </li></ul></ul></ul></ul><ul><li>HIV Capacity Building Consortium </li></ul><ul><ul><ul><li>Protracted gestation </li></ul></ul></ul><ul><ul><ul><li>Pacific network; Indonesian network </li></ul></ul></ul><ul><li>One-off projects package </li></ul><ul><li>PNG discussions </li></ul>
  22. 23. Implications for AFAO member Org.s <ul><li>Expansion of available funds </li></ul><ul><ul><ul><li>Expertise sought </li></ul></ul></ul><ul><ul><ul><li>Chiefly through organisational partnerships </li></ul></ul></ul><ul><li>Balance with care </li></ul><ul><ul><ul><li>Not stressing domestic response </li></ul></ul></ul><ul><ul><ul><li>Opportunity for refreshment </li></ul></ul></ul>

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