In Asia and the Pacific alone, an estimated 7.1 million people are living with HIV/AIDS, which means that this region has the second-largest number of people living with the virus after Sub-Saharan Africa. In this context, men who have sex with men (MSM) constitute a vulnerable group because of the risk associated with their sexual practices, and related HIV transmission is particularly significant in the more developed sub-regions of Asia and the Pacific.
The term "men who have sex with men" - frequently shortened to MSM - describes a behaviour rather than a specific group of people. It includes self-identified gay, bisexual, transgendered or heterosexual men. Many men who have sex with men do not consider themselves gay or bisexual. They are often married, particularly where discriminatory laws or social stigma of male sexual relations exist. Largely because of the taboo, the female partners of men who have sex with men are often unaware of their partner's other liaisons, and the threat posed to themselves. Forced sex among men is not uncommon, especially in men-only environments such as prisons. Men who have sex with men are found in all societies, yet are largely invisible in many places. In terms of HIV, sex between men is significant because it can involve anal sex, which when unprotected carries a very high risk. Sex between men is thought to account for between 5 and 10% of global HIV infections, although the proportion of cases attributed to this mode of transmission varies considerably between countries. It is the predominant mode in much of the developed world. Globally less than one in twenty men who have sex with men have access to the HIV prevention and care services they need. Many factors contribute to this situation including denial by society and communities, stigma and discrimination, and human rights abuse. Vulnerability to HIV infection is increased where sex between men is criminalised, as men are either excluded from, or exclude themselves from, sexual health and welfare agencies out of fear. A range of interventions to reduce risk behaviours among men who have sex with men have proven successful, including: condom promotion, safer-sex campaigns and skills training; peer education with outreach programmes; and programmes tailored to subpopulations such as male sex workers and men in prisons. Specific policy measures are crucial for making prevention, care and support available to men who have sex with men. First and foremost, they must be included in national HIV programming and funding priorities. The governments must support organisations of men who have sex with men, enabling them to promote HIV prevention and care programmes and to participate in HIV planning and policymaking. Legislation should be changed, decriminalizing same-sex acts and providing protective laws against discrimination based on sexual orientation.
Same-sex behavior is identified in all societies. However, in the South-East Asia Region, the majority of men who have sex with men and transgender persons are highly stigmatized and discriminated against. There are an estmated 4-5 million men who have sex with men; among the transgender population, the number is less clear. Many of them are involved in high risk sexual behaviors that put them at risk for HIV infection, resulting in a high and increasing HIV prevalence in several countries of the Region. Control of HIV infections among these populations is thus an urgent public health priority. The countries included in this review are Bangladesh, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. Though most of them have some form of interventions for men who have sex with men and transgender populations, the majority of these populations do not have access to various HIV services due to widespread stigma and discrimination, and punitive laws in most countries. This report provides information on the status of the epidemic among these populations in the South-East Asia Region. It highlights the need for improved advocacy efforts and a greater national response to save the lives of these populations who are at risk for HIV infection.
Here is an important work that uniquely focuses on both gay/queer-self-identified men from diverse minority communities (African American, Latino, Native American, Asian and Pacific Islander) and men of these ethnic communities who have sex with men but are not gay/queer-self-identified. Each section of this edited book is devoted to a particular health issue affecting minority MSM, and consists of one or more scholarly chapters that address the particular issue.
