Waves of Change - Waves of Hope

8th Iinternational Congress on AIDS in the Asia Pacific

Colombo, Sri Lanka,19^th – 23^rd August 2007

The annual ICAAP conference aims to enhance the local, regional and global response to HIV/AIDS.

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Mark Bebbington, AFAO Policy & International Manager, provides an overview of the issues raised and David Traynor, AFAO International Program Officer, calls for more analysis and reflection.

 Or download reports as a PDF (5 pp)

Overview: trends, research, achievements

Mark Bebbington, AFAO Policy and International Manager

Opening Plenary

Prasada Rao (Director, Regional Support team, UNAIDS) got the conference underway with a plenary speech providing an overview of the regional epidemic during the past two years since the last ICAAP in Kobe, Japan.

• There have been 1 million new infections in the past 2 years with rising numbers of new infections in China, Vietnam, Indonesia, Nepal, Pakistan and Bangladesh.
• Thailand and Cambodia continue to show a decline in the incidence of HIV. No increase in Sri Lanka and Philippines. Some decline in Myanmar. Strong evidence of a decline in South and West India.
• Estimates of number of people with HIV in the region have been revised down from 8.3 million to 5.4 million. This is due to the increasing access to data from household surveys, more sentinel surveillance sites, and improvements in data collection and quality control of data.
• But … the overall trend has remained the same. So program needs still remain the same. The number of people needing care and treatment is still too large and the numbers of people who are at risk of infection has not changed.

Newly emerging threats

• 8 Countries have slipped into political instability or intensified conflict since 2005. This has the potential to impact on national AIDS responses.
• Condom promotion and sex education is limited across the region and is not being scaled up.
• Stigma against people with HIV continues.

Minor victories

• Universal Access targets are being taken seriously. 14 countries have set ambitious targets and 9 countries have developed costed national plans.
• Better political commitment
• Major scale up of resources. Funding for programs has increased through GFATM, World Bank, DFID and AusAID.
• ART coverage has increased by three times during the past few years.
• Emerging new networks of marginalised groups including networks of men who have sex with men, sex workers and injecting drug users.

Critical gaps in the response

• There is an over reliance on external donor funding. Countries need to commit more of their own resources.
• There is a mismatch between strategy and resource allocation. Most countries direct prevention resources to general population rather than populations that are at greatest risk.

Prasada Rao concluded the presentation with eight major challenges that need to be addressed

• Fighting denial and complacency
• Promoting and sustaining continued AIDS activism
• Prioritising resources for reducing new infections
• Universalising coverage of ART services
• Promoting sex education programs for youth
• Addressing the needs of orphans and vulnerable children
• Addressing the needs of monogamous women who are infected or at risk of infection by their partners
• Scaling up interventions

MSM

There were a significant number of conference sessions focusing on gay men and men who have sex with men. Here’s a quick overview of a few that I attended.

Advancing an agenda for HIV prevention for MSM in Asia and the Pacific.

This session was hosted by ARCSHS and focused on the importance of research to build evidence to inform programs, policy and prevention efforts. There were presentations from Japan, Myanmar, Singapore and ARCSHS.

• There is now good data on prevalence among MSM across Asia. This was not the case prior to 2000.
• Longitudinal cohort studies are needed.
• More studies which examine vulnerability and risk are needed.
• 64% of HIV cases in Japan are among MSM. HIV knowledge is high and 70% of gay men use condoms consistently.
• There is a lack of reliable prevalence data in Myanmar
• An internet based survey in Singapore showed decreased risk behaviours among MSM.
• The research shows that MSM at risk are not necessarily ‘gay’ but are, in fact, men who also have sex with women, yet the types of programs that are implemented are usually gay community development programs.
• ‘Network structure’ research can show where men who we think of as ‘hard to reach’ actually fit into various social networks.
• More evaluation research is needed on prevention responses.

LGBT/MSM and HIV/AIDS in Asia and the Pacific

This session was organised by Asia Pacific Rainbow, the regional network of lesbian, gay, bisexual, transgender and queer individuals and organisations. AFAO provided funding of $2000 to support the meeting. The meeting was co-chaired by Andy Quan and Masao Kashiwazaki from Japan.

Inensius Oparnus Da Silva from the organisation Gaya Nusantara in Indonesia spoke of the challenges of conducting outreach work when faced with police harassment and demands for bribes.

Thuan Nguyen from Vietnam reported that, although the National AIDS Law includes men who have sex with men, the response is limited to simple condom promotion. Voluntary Counselling and Testing programs are designed towards heterosexuals and issues of stigma prevent MSM from forming groups.

Kaushalya from Sri Lanka spoke of the work of her group to promote women’s sexual health and how they include same sex issues within broad discussions of women’s sexuality.

Glenn Cruz from the Philippines gave an overview of the work of the Library Foundation, a gay group in the Philippines.

The presentations were followed by some questions and discussion, but unfortunately this was only an hour session and the discussion time was too short.

Philippines research

Professor Laufred Hernandez from the University of the Philippines reported on a behavioural and serological study of MSM in the Philippines. Of the 520 participants, HIV prevalence was 0%. However, there were several findings that indicated this group may be at risk of HIV.

• 32% had an STI
• They have diverse sexual networks and multiple partners.
• High levels of unprotected sex with multiple partners.
• High level use of oil based lubricants
• Low knowledge of HIV prevention.

Vietnam research

Donn Colby from the Vietnam-CDC-Harvard Medical School AIDS Partnership reported on a study on homosexual behaviour and HIV risk among a rural population in Khanh Hoa province, Vietnam

• 295 participants recruited through social networks
• 46 % identified as bisexual; 9% heterosexual; 35% homosexual
• Condom use is high - approx 80%
• Lubricant use low (water-based only a few percent.) Saliva is the most commonly used lubricant
• Median number of partners in the last month was 1; 27% had three or more partners in the past month
• HIV prevalence was 0% (of the 295 particpants none tested positive). This is different to urban settings - prevealence is 9% in Hanoi and about 5% in Ho Chi Minh. However, many MSM with HIV in urban locations also inject drugs so that the mode of transmission is unclear. Injecting use in Khanh Hoa province is low and this may account for the 0% prevalence.

Sri Lanka Research

During 2006 the National Centre in HIV Social Research worked on a joint behavioural research project with the Sri Lankan Government. The first phase of the study was a mapping exercise to identify groups likely to be at highest risk. These groups were identified as three-wheel taxi drivers, garment factory workers (primarily women from rural areas who move to Colombo for work), injecting drug users, Colombo based gay men and men who have sex with men, and beach boys (young men who exchange sex for money or gifts with men and women - primarily tourists - at coastal beach resorts).

The research with these groups consisted of an interviewer administered behavioural survey. The results of this study were presented.

• Somewhat surprisingly, three-wheel taxi drivers and factory garment workers are not at high risk for HIV transmission as there are very low levels of risk behaviours among these groups.
• Only 14% of drug users injected, however needle sharing was common.
• There are low levels of testing among gay men and MSM in Colombo and beach boys. Condom use was low with both casual and regular (male and female) partners.

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More analysis please!

David Traynor, AFAO International Program Officer

I attended a variety of sessions over the three days (see list following). While, for the most part, the presentations were interesting and informative there was the usual tendency towards ‘program/project showcasing’ and ‘process’, with limited analysis or discussion on ‘effectiveness’ and/or the underlying and complex challenges faced in developing programmatic and policy responses to HIV and AIDS. For example, numerous presentations provided detailed explanation of currently operating programs/projects - that is, ‘what’ they were doing, ‘where’ they were doing it, and amongst ‘which’ ‘target’ communities. Lacking, however, was discussion on how effective these programs/projects have been in ameliorating the impact of HIV and AIDS on communities, or any acknowledgement of the limitations and challenges they may face.

I attended a number of sessions on “Universal Access”. With the exception of Andy Quan’s (eloquently concise, interesting and engaging) presentations on Minimum Standards for Civil Society Engagement in UA Target Setting process, virtually all the speakers failed, at any stage, to actually discuss barriers or challenges to UA or explore what actually constitutes “UA”. This failure was most apparent in a session on the role of Intergovernmental Agencies in Monitoring progress towards Universal Access. Representatives of ASEAN and the PIF spoke at length during this session about the structure and broad objectives of their respective organisations, but not once did they mention how they might exercise influence over and/or hold their member governments accountable to UA commitments. In fact, from memory, neither representative actually mentioned universal access at all!

Overall/General Impressions:

• The Pacific region rated little mention or discussion throughout. While there were a few sessions and speakers relating to HIV and AIDS across the Pacific region it would have been good to have seen (at the very least) a Pacific focused caucus/discussion forum.

• The ‘regional’ map Prasada Rao presented in his opening plenary overview of HIV and AIDS across Asia and the Pacific reduced the Pacific to PNG…….with the remainder of the region omitted.

• The first speaker at the opening plenary COULD AND SHOULD HAVE BEEN A REPRESENTIVE FROM THE POZ COMMUNITY

• The venue and Conference program structure facilitated excellent opportunities to meet and talk with a range of people from across the sector and region…..ie; community reps, Government, NGOs, INGOs etc etc

• Sessions were a bit of a lucky dip. Presentations within oral abstract sessions often had little (or no!) relevance to the conference track or suggested primary topic.

• (As usual) there was limited opportunity to engage in meaningful debate within sessions….with ‘discussion’ reduced to mere question/answer.

Sessions attended

Monday 20^th August

Oral Abstract Sessions

• Education and Knowledge: for Prevention and Care

 Symposia

• Infrastructure, Mobile Populations and HIV; What’s at Stake

• Monitoring the Impact of Responses to the HIV Epidemic

 Satellite Meetings

• Monitoring Progress in Commitments to Universal Access; Role of Inter-Governmental Bodies

• Mitigating the risk of HIV infection in the Infrastructure Sector

Tuesday 21^st August

Oral Abstract Sessions

• Migration, Cross Border and HIV Vulnerability

Satellite Meetings

• LGBT/MSM and HIV in Asia and the Pacific: Leadership and Challenges in communities

Symposia

• Methodology and Results of the First large Scale Behavioural Surveillance Survey in Sri Lanka

Wednesday 22^nd August

Satellite Meetings

• Unblocking the Barriers to Universal Access: The Role of national Human Rights Institutions

• Increasing the Involvement of Regional Civil Society Actors in the Implementation and Monitoring of National Targets for Universal Access to Prevention, Treatment, care and Support 

Symposia

• Gender Violence in the Pacific: Breaking the Silence

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