anger, frustration – and excitement

23
MSM & TG in the Asia Pacific & MSM & TG in the Asia Pacific & Global HIV epidemics: Global HIV epidemics: Anger, Frustration – and Anger, Frustration – and Excitement Excitement Don Baxter Don Baxter Executive Director, Australian Federation of AIDS Executive Director, Australian Federation of AIDS Organisations Organisations Co-Chair, Global Forum on MSM & HIV Co-Chair, Global Forum on MSM & HIV AFAO HIV Educator’s Conference, Novotel North AFAO HIV Educator’s Conference, Novotel North Wollongong Wollongong 27 May 2008 27 May 2008

Upload: australian-federation-of-aids-organisations

Post on 01-Nov-2014

15 views

Category:

Health & Medicine


3 download

DESCRIPTION

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.

TRANSCRIPT

Page 1: Anger, Frustration – and Excitement

MSM & TG in the Asia Pacific & Global MSM & TG in the Asia Pacific & Global HIV epidemics:HIV epidemics:

Anger, Frustration – and ExcitementAnger, Frustration – and Excitement

Don BaxterDon BaxterExecutive Director, Australian Federation of AIDS OrganisationsExecutive Director, Australian Federation of AIDS Organisations

Co-Chair, Global Forum on MSM & HIVCo-Chair, Global Forum on MSM & HIVAFAO HIV Educator’s Conference, Novotel North WollongongAFAO HIV Educator’s Conference, Novotel North Wollongong

27 May 200827 May 2008

Page 2: Anger, Frustration – and Excitement

In a snapshot In a snapshot

Asia Pacific RegionAsia Pacific Region– Epi snapshot; hot spotsEpi snapshot; hot spots– Developments: programming and investment; PSN; APCOMDevelopments: programming and investment; PSN; APCOM– Commission on AIDS in Asia reportCommission on AIDS in Asia report

Global overviewGlobal overview– Africa; Caribbean; Eastern Europe; MENA – Central AsiaAfrica; Caribbean; Eastern Europe; MENA – Central Asia– Global Forum on MSM & HIVGlobal Forum on MSM & HIV– UN-systemUN-system– Donor/funder interestDonor/funder interest– Decriminalization momentumDecriminalization momentum

Mexico City IAC & Satellite – SignificanceMexico City IAC & Satellite – Significance Australia’s response:Australia’s response:

– AusAID performance; Strategy reviewAusAID performance; Strategy review– HIV Capacity Building Consortium; one-off projectsHIV Capacity Building Consortium; one-off projects– An MSM & TG Strategy?An MSM & TG Strategy?– Implications for AFAO member organisationsImplications for AFAO member organisations

Page 3: Anger, Frustration – and Excitement

Asia Pacific OverviewAsia Pacific Overview

MSM HIV seroprevalence higher then MSM HIV seroprevalence higher then realized (‘masked’ + prejudice):realized (‘masked’ + prejudice):

» Most major cities 2%+Most major cities 2%+

» Rates 10-50 times higher than adult malesRates 10-50 times higher than adult males Eg Bangkok 31% - (equiv. Botswana)Eg Bangkok 31% - (equiv. Botswana)

» Evidence of rapid increasesEvidence of rapid increases

» Transgender higher ratesTransgender higher rates

» PNG & the Pacific not clear – surveillance deficitPNG & the Pacific not clear – surveillance deficit

Page 4: Anger, Frustration – and Excitement

17.6 TG

11.4 MSW

15.3 MSM

11.9 TG14.4 MSW

5.5 MSM10.5 MSW

6.7 MSW

11.5 TG20 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

Bangkok2003-5

Pattaya 2005

Phuket 2005

Had Yai 2005

Ho Chi Minh 2002-4

Phnom Penh2000-5

Battambang 2005

Siam Reap 2005

Beijing 2001-6Shiang 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

2225.3

MSM 2006-7

MSM 2000-3

MSW

TG

MSM 2004-5

Hanoi 20069.4 MSM

22.0 TG

Jakarta 2002

3.6 MSW2.5 MSM

31.0

33.0

Mandalay

19962006

Yangon

(Source: NBC, 2006; UNAIDS, 2006b, 2006b; FHI, 2006a, 2006b; Choi, 2003; MAP, 2005; van Griensven, 2005; MMWR, 2006; Ma, 2006, NCHADS, 2006)

Page 5: Anger, Frustration – and Excitement

India

Pakistan

Bangladesh

Nepal3.6 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 2002Mumbai

18.8 MSM 2003

9.6 MSM 2004

Karachi4.0 MSW 2004

2.0 TG 2004

1.7 MSW 20054.0 MSM 2005

HIV prevalence among MSM in Asia

Andra Pradesh

18.2 MSM 2005

(Source: UNAIDS, 2006a, 2006b; FHI, 2006)

0.2 MSM 2005Dhaka

Page 6: Anger, Frustration – and Excitement

HIV prevalence among MSM in China

Beijing

Shiang Hai

3.1

1.5

5.0

Shenzen

Hangzhou

3.0

China

2001-32004

2005

2005

20040.8

4.63.1

20052005

(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

200120022003Heilongjiang

Page 7: Anger, Frustration – and Excitement

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

Page 8: Anger, Frustration – and Excitement

28.3

1.4

8.9

1.6

9.3

0.5

5.8

0.25

31

1.30

5

10

15

20

25

30

35

40Prevalence (%)

MSM Adults

HIV Prevalence in MSM and Adults in South East Asian HIV Prevalence in MSM and Adults in South East Asian Capital CitiesCapital Cities2005 - 20062005 - 2006

HIV in MSM

HIV in Adults

(UNAIDS, 2006; MMWR, 2006; Ma et al, 2006; Phalkun et al, 2006; FHI, 2006; UNFPA, 2006)

Page 9: Anger, Frustration – and Excitement

Contribution to new HIV infections Contribution to new HIV infections by MSMby MSM

Under-estimated (surveillance gaps)Under-estimated (surveillance gaps) ProjectionsProjections Sex with women partnersSex with women partners

Page 10: Anger, Frustration – and Excitement

30.3

8.3

27.9

34.8 35.7

05

101520253035404550

Prevalence (%)

% MSM of adults

Percentage of Adult HIV Prevalence Attributable to MSM Percentage of Adult HIV Prevalence Attributable to MSM in South East Asian Capital Cities, 2005 - 2006in South East Asian Capital Cities, 2005 - 2006

(UNAIDS, 2006; MMWR, 2006; Ma et al, 2006; Phalkun et al, 2006; FHI, 2006; UNFPA, 2006)

Page 11: Anger, Frustration – and Excitement
Page 12: Anger, Frustration – and Excitement

Current Prevention investments & Current Prevention investments & Program CoverageProgram Coverage

Most less than 2% of National Prevention Most less than 2% of National Prevention expenditureexpenditure– Some = 0%Some = 0%– Best 4% (in 31% seroprevalence)Best 4% (in 31% seroprevalence)

Donor funds rather than governmentDonor funds rather than government Coverage = less than 5%Coverage = less than 5%

– Desirable to reverse epidemic = 60%Desirable to reverse epidemic = 60%

Page 13: Anger, Frustration – and Excitement

Includes peer education and outreach, IEC materials, media messages on behavior Includes peer education and outreach, IEC materials, media messages on behavior changechange

Complementary activities (VCT, STIs) among MSM are not generally reported as Complementary activities (VCT, STIs) among MSM are not generally reported as MSM expenditureMSM expenditure

ESTIMATING RESOURCE LEVELS: METHOD 1—

Secondary SourcesExpenditure ranges from a high of 4% in

Thailand to a low of

0% in a province in China

1313

Page 14: Anger, Frustration – and Excitement

Coverage of at-risk populationsCoverage of at-risk populations

Figure 5.3 – page 131 “Redefining AIDS Figure 5.3 – page 131 “Redefining AIDS in Asia”in Asia”

Figure 5.3 – page 131 “Redefining AIDS in Asia”

Page 15: Anger, Frustration – and Excitement

Hot spots & Program problemsHot spots & Program problems Philippines; Burma; LaosPhilippines; Burma; Laos Developed Asia: Tokyo, Osaka, Seoul, Singapore, KLDeveloped Asia: Tokyo, Osaka, Seoul, Singapore, KL 30 Chinese ‘middle’-cities30 Chinese ‘middle’-cities TransgenderTransgender Male sex workersMale sex workers PNGPNG The PacificThe Pacific

Progammatic problems:Progammatic problems:– Community development/mobilisation strategies – inadequateCommunity development/mobilisation strategies – inadequate– ‘‘Donor dominated’ programmingDonor dominated’ programming– (In)Visibility of poz MSM(In)Visibility of poz MSM– Condom and Lube availabilityCondom and Lube availability– MSM advocacyMSM advocacy– IllegalityIllegality

Page 16: Anger, Frustration – and Excitement

Some Bright SpotsSome Bright Spots

Governments acknowledging – not resistingGovernments acknowledging – not resisting– In National Strategies and Plans & surveillanceIn National Strategies and Plans & surveillance

Regional momentumRegional momentum– ‘‘Re-Defining AIDS in Asia’ reportRe-Defining AIDS in Asia’ report– Purple Sky Network (Mekong countries)Purple Sky Network (Mekong countries)– APCOM (all Asia Pacific; early stages)APCOM (all Asia Pacific; early stages)– Indonesian MSM Working GroupIndonesian MSM Working Group– Pacific Sexual Diversity NetworkPacific Sexual Diversity Network– Some investment by gov’t (Thai; China)Some investment by gov’t (Thai; China)

Energy on the groundEnergy on the ground

Page 17: Anger, Frustration – and Excitement

Global ContextGlobal Context

Asia – momentum developed, but . . . Asia – momentum developed, but . . . – AfricaAfrica– CaribbeanCaribbean– Eastern EuropeEastern Europe– MENA & Central AsiaMENA & Central Asia

But 5 years ago Asian governments But 5 years ago Asian governments were . . .were . . .

Page 18: Anger, Frustration – and Excitement

Global Forum on MSM & HIVGlobal Forum on MSM & HIV

Establishment – early daysEstablishment – early days Scope & ObjectivesScope & Objectives

– Info exchangeInfo exchange– NetworkingNetworking– Advocacy at the global levelAdvocacy at the global level

Governance & StaffingGovernance & Staffing

Page 19: Anger, Frustration – and Excitement

MSM Global Forum: achievementsMSM Global Forum: achievements

Global South & NorthGlobal South & North MEX IAC SatelliteMEX IAC Satellite Interventions in Global discourseInterventions in Global discourse

– Gender guidance; UNGASS; UN-system; Gender guidance; UNGASS; UN-system; Violence & MSM; P.Piot replacementViolence & MSM; P.Piot replacement

Degree of accountabilityDegree of accountability SecretariatSecretariat Donor interestDonor interest

Page 20: Anger, Frustration – and Excitement

Global developmentsGlobal developments

UN-system & MSM:UN-system & MSM:– New!! – UNDP ‘Leadership’New!! – UNDP ‘Leadership’

– Global strategy for MSM & HIV [for UN]Global strategy for MSM & HIV [for UN]

DecriminalizationDecriminalization– France; Netherlands; now UKFrance; Netherlands; now UK

– Judicial momentum: Nepal; Hong Kong; India?Judicial momentum: Nepal; Hong Kong; India?

Donor & Multi-lateral agency [MSM] leadersDonor & Multi-lateral agency [MSM] leaders– Gates; IAS; ICASO; GNP+; etc.Gates; IAS; ICASO; GNP+; etc.

– ‘‘Guilt’? – but evidence previously not assembledGuilt’? – but evidence previously not assembled

Page 21: Anger, Frustration – and Excitement

Mexico City AIDS ConferenceMexico City AIDS Conference

MSM focusMSM focus– Opening; plenary; session stream; SatelliteOpening; plenary; session stream; Satellite

Momentum buildingMomentum building– Recalcitrant governmentsRecalcitrant governments– Flow-on to Regional ConferencesFlow-on to Regional Conferences

» ICASA (Africa, Dec 08); ICAAP (Bali; July 09)ICASA (Africa, Dec 08); ICAAP (Bali; July 09)

Page 22: Anger, Frustration – and Excitement

Australia’s responseAustralia’s response

AusAID fundingAusAID funding» Minimal; $100K, $189KMinimal; $100K, $189K» Caveat: Rationale for ‘injecting / harm reduction’ priorityCaveat: Rationale for ‘injecting / harm reduction’ priority

AusAID HIV StrategyAusAID HIV Strategy» Current reviewCurrent review» AFAO submissionAFAO submission

Emphases: MSM Strategy; MSM advocacyEmphases: MSM Strategy; MSM advocacy

HIV Capacity Building ConsortiumHIV Capacity Building Consortium» Protracted gestationProtracted gestation» Pacific network; Indonesian networkPacific network; Indonesian network

One-off projects packageOne-off projects package PNG discussionsPNG discussions

Page 23: Anger, Frustration – and Excitement

Implications for AFAO member Org.sImplications for AFAO member Org.s

Expansion of available fundsExpansion of available funds» Expertise soughtExpertise sought

» Chiefly through organisational partnershipsChiefly through organisational partnerships

Balance with careBalance with care» Not stressing domestic responseNot stressing domestic response

» Opportunity for refreshmentOpportunity for refreshment