Backing the community response

It is hard to believe that it has been 30 years since the beginning of the HIV/AIDS epidemic, an epidemic that was initially very much concentrated on gay men. A lack of political will and poor response from the health care sector meant that the community began to organise and mobilise for their own rights.  The right to access treatment and espouse prevention, rather than do nothing and simply watch their friends and partners die.  Now, ironically, 30 years later the very same communities are still not getting the attention and the resources that the epidemiological data clearly indicate are vital to curb the epidemic and save lives.

A high and rising HIV prevalence among populations of men who have sex with men (MSM) and transgender people has now been documented throughout much of Asia and the Pacific region.  By 2015, it is projected that up to 40 percent of Asia’s epidemic will be constituted by transmissions attributed to male-to-male sex, sharply rising from an estimated 13 percent in 2008.¹ Sex between men already accounts for approximately a third of HIV transmission in Asia and the Pacific, although this is very likely to be under-reported.²

MSM are up to 19 times more likely to be living with HIV than the general population.³ However, the proportion of MSM reached by HIV prevention, treatment, care and support interventions remains low. In fact, funding levels are usually far from adequate in meeting the challenge depicted by the epidemiological data and serving the needs of MSM and transgender people.

Despite irrefutable evidence establishing male-to-male sex as one of the main driving forces of HIV transmission in the Asia and Pacific region, few strategic interventions have addressed male-to-male and transgender sexualities and related HIV vulnerabilities. To address this, a regional consultation was called for in 2006 titled, ‘Risk and Responsibilities’. It brought together 380 community leaders, researchers and policy makers from 22 countries across Asia and the Pacific to urgently discuss the need for greater coordination, advocacy and investment in the region, and to swiftly convert talk into action.

“those in power or with the ability to make a difference have failed to see that saving lives is paramount regardless of our fellow human beings’ sexual orientation or gender identity”

The Asia Pacific Coalition on Male Sexual Health (APCOM) grew out of this consultation and was tasked with a region-wide coordinated agenda to advocate for policy change, social justice, human rights, an equitable allocation of public resources for HIV interventions, greater services for care and treatment and most of all prevention services for MSM and transgender people. The coalition represents a partnership approach with community groups and networks, government departments, multi-government organisations like the United Nations, as well as donor support organisations, bringing all relevant stakeholders to the table at the same time and fostering transparent and strategic dialogue that helps establish and strengthen policies and plans for action.

At APCOM, we advocate for issues relating to the needs of MSM and transgender people by pushing for greater commitments from national governments to include interventions targeted at these vulnerable populations within the National Strategic Plans (NSPs) in consultation with front-line community organisations in an equal partnership and with adequate funding based on the epidemiological data, thereby helping ensure a supportive environment.

Utilising the membership of our unique coalition, we work with UN agencies to call on national governments to repeal laws that criminalise sex between consenting adults and to implement anti-discrimination laws in relation to sexual orientation and transgender status.

As I reflect on the epidemic that the world has lived with for three decades now, I cannot help but think about the missed opportunities to effectively tackle HIV/AIDS because many of those in power or with the ability to make a difference have failed to see that saving lives is paramount regardless of our fellow human beings’ sexual orientation or gender identity. As well, many of us engaged in advocacy have often failed to forge coalitions and come together in a strategic and transformative way.

I also fear that in an age when so many promising advances have been made and are being made in HIV prevention, treatment and care, we are also about to miss yet another opportunity to stem the tide of this epidemic if adequate and concentrated investments are not made NOW. There’s enough evidence – but where is the sustained, long-term financial commitment that is so vital to ensuring our gains are not squandered away?  Where is the political willingness?  Where is the action? APCOM calls upon all players regionally and globally to push back at “AIDS fatigue” and fully realize the golden opportunity that is before us. Let us not, to invert a familiar adage, snatch defeat from the jaws of victory.

Midnight Poonkasetwattana is the Executive Director for the Asia Pacific Coalition on Male Sexual Health (APCOM) – APCOM works with regional and sub regional networks in the field of health issues and human rights for MSM and transgender communities.

For more information on HIV in Asia, see AVERT's page.

Images: 'Transgender person in Bangladesh', copyright: Nir Nussbaum. 'Midnight Poonkasetwattana', courtesy of author. 

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All opinions expressed in 'Reflections on the Epidemic' do not necessarily represent those of AVERT.