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

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 CountryYearSampleBehaviorReference China – Beijing China – online Jiangsu 2001-3 2001 2003 Snowball 482 MSM Internet 353 MSM Convenience 144 MSM 49% unprotected sex with male past 6 mo 46%-57% unprotected sex with male ever 46% unprotected sex with male in past 3 mo Choi et al, 2003 Wang et al, 2002 Jiang et al, 2006 Vietnam – HCMC2001 2004 Outreach 219 MSM Snowball 600 MSM 78% Unprotected sex with casual male past year 49%-57% Unprotected sex with casual male past 6 mo Colby et al, 2003 NIHE, 2004 Laos – Vientiane L Prabang, S’ket 2004TLS 281 TG and 401 male partners 61% unprotected sex with casual male past 3 mo PSI, 2004 Cambodia – PP PP, BTBG, SRP 2000 2002 TLS 206 MSM/MSW Snowball 370 MSM 67% unprotected sex with casual male past mo 83%-100% unprotected sex with casual male past mo Girault et al, 2004 Catalla et al, 2002 Thailand – Bangkok 2003-5VDTS 1,121, 821 MSM 45% unprotected sex across all partner types van Griensven, 2005, 2006

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

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

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

11. 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 8.7 MSM 14.0 36.7 TG 8.0 MSM 5.8 Thailand Cambodia 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 2001-3 Shiang Hai 2004-5 3.1 MSM 1.5 MSM 5.0 MSW Shenzen 2005 Hangzhou 2004 3.0 MSM HIV prevalence among MSM in Southeast Asia 22 25.3 MSM 2004-5 MSM 2000-3 MSW TG

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 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

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."