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Recognizing and confronting the epidemic of HIV among men who have sex with men in Southeast Asia

Recognizing and confronting the epidemic of HIV among men who have sex with men in Southeast Asia. Frits van Griensven, PhD, MPH Thailand MOPH – U.S. CDC Collaboration XVI International AIDS Conference, Toronto, Canada, August 13-18, 2006

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Recognizing and confronting the epidemic of HIV among men who have sex with men in Southeast Asia

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  1. Recognizing and confronting the epidemic of HIV among men who have sex with men in Southeast Asia Frits van Griensven, PhD, MPH Thailand MOPH – U.S. CDC Collaboration XVI International AIDS Conference, Toronto, Canada, August 13-18, 2006 With help of Tim Brown, Philippe Girault and Jan Wijngaarden

  2. Southeast Asia – Mekong basin countries

  3. MSM have a long and rich cultural history in Southeast Asia

  4. Prevalence of male same-sex behavior, Southeast Asia 4% Adult men Hong Kong 2000 18% Young males Vientiane 2004 9% Male adolescents Chiang Mai 2002 16% Military conscripts Thailand 1993 Myanmar China Viet Nam Cambodia N.A. 3% National survey Thailand 1990

  5. Male same-sex identities and behaviors in Southeast Asia are enormously diverse • Traditional and modern identities • Katoey, transgender, long hair, short hair etc • Homosexual, gay, MSM • Sexual role Identities • Man, woman, male, female • Top, bottom, both, king, queen • Compensated versus non-compensated • Increased manifestation, political organization and commercialization • Almost endless variety of meeting places

  6. So many men – and so little time: sexual risk happens

  7. Risk behavior data among MSM in Southeast Asia

  8. And when there is risk, there are sexually transmitted infections

  9. 13.5 MSM Shiang Hai 2004-5 7.8 MSM Hangzhou 2004 6.9 MSM Thailand Jiangsu 2003 6.8 MSM Bangkok 2005 Cambodia 5.5 MSM 7.0 MSM Phnom Penh 2000 Ho Chi Minh 2000 Syphilis prevalence among MSM in Southeast Asia

  10. And when there is risk and sexually transmitted infections there is HIV

  11. 1.5 MSM 11.4 MSW 3.1 MSM 17.6 TG Shiang Hai 2004-5 15.3 MSM Beijing 2001-3 5.0 MSW Chiang Mai 2005 3.0 MSM Shenzen 2005 Hangzhou 2004 28.3 25.3 22 Battambang 2005 Thailand 20 MSW MSM 17.3 Siam Reap 2005 11.5 TG 36.7 TG Bangkok 2003-5 0.8 0.8 6.7 MSW Cambodia 8.7 Pattaya 2005 8.0 MSM 5.8 TG MSM 14.0 Phnom Penh 2000-5 Ho Chi Minh 2002-4 MSW 14.4 MSW 11.9 TG 5.5 MSM MSM 2004-5 10.5 MSW Phuket 2005 MSM 2000-3 Had Yai 2005 HIV prevalence among MSM in Southeast Asia

  12. Summary • Male same-sex behavior common in Southeast Asia • High levels of unprotected intercourse • High prevalence of sexually transmitted infections, e.g., syphilis • Serious epidemics of HIV infection among MSM in Thailand and Cambodia, similar epidemics can still be averted in other countries, e.g., China, Vietnam, Laos • Continued monitoring and interventions are necessary

  13. Positive action steps • MSM are now politically recognized and/or included in the National Plans for the Alleviation of HIV/AIDS in all countries • Repeated cross-sectional assessments of HIV prevalence in MSM are available in Thailand and Cambodia; inclusion of MSM in regular surveillance is planned for Myanmar, China, Vietnam and Laos • MSM friendly clinics for HIV VCT and STI services have been initiated in Bangkok • First MSM cohort study in preparation for evaluation of biomedical interventions has been started in Bangkok • Regional network for preventive interventions among MSM is operational and has representatives from throughout the region • Peer driven and internet based sexual health interventions for MSM are now being implemented in all countries

  14. คลินิก ชุมชน สีลม Bangkok MSM Cohort STUDY at the Silom Community Clinic BANGKOK MEN WHO HAVE SEX WITH MEN

  15. “The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention, National Center for HIV, STI and TB Prevention."

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