Diverse Pacific voices: MSM and transgender people in the Pacific

Culturally, there are a range of names and identities for transgender people – including Fa’afafine in Samoa, Fakaleiti in Tonga, Akavaine in Cook Islands, Palopa in Papua New Guinea, Vakasalewalewa in Fiji, and Transgenres in Vanuatu – with socially accepted roles in the family and community.

This is in strong contrast to men who have sex with men (MSM), who are largely invisible and hidden in most Pacific communities. However, there is an emerging consciousness of gay and lesbian identities in the Pacific, which is often tied to experiences of migration and travel outside the region.

With this emerging consciousness has come the mobilisation of individuals to advocate for rights and access to health and HIV services. This movement is stronger in some Pacific countries than others, but overall it has achieved some successes in raising awareness, linking communities to services, and engaging with government, the church and various community leaders.

The number of confirmed diagnoses of HIV is low across most of the Pacific except for Papua New Guinea. However, rates of sexually transmitted infections are high in many settings, and barriers to testing, community stigma, fear about HIV and AIDS and lack of confidentiality mean there are likely to be additional unconfirmed HIV cases.

There is limited data on rates of HIV among MSM and transgender people. Within health care settings, it is often not feasible for MSM or transgender people to be open about their sexual activities due to fear of gossip or family connections.

Across the region, only a few national strategic plans address issues related to MSM and transgender people and funding for dedicated MSM and transgender people programming and community mobilisation is limited.

At a meeting in May 2013, key stakeholders in the HIV response in Pacific – including New Zealand AIDS Foundation (NZAF), Pacific Sexual Diversity Network (PSDN), Oceania Society for Sexual Health and HIV Medicine (OSSHHM), Asia Pacific Coalition on Male Sexual Health (APCOM), and Australian Federation of AIDS Organisations (AFAO) – identified key areas needing continued support in the Pacific.

These key areas include:

• STI reduction: Reduction of the very high prevalence of other sexually transmitted infections, particularly chlamydia, which increases the risk of HIV transmission, requires more attention.
• Accessible and user-friendly HIV prevention, treatment and care: To achieve the UNAIDS ‘Three Zeros Strategy’, the Pacific needs to maintain investment in prevention, treatment and care while working to remove barriers to MSM and transgender people. Given the high levels of stigma, issues of criminalisation, and the great distances involved in the Pacific, this will require ongoing funding support for the short to medium term.
• Community mobilisation and advocacy: To overcome the key barrier of stigma and advocate for law reform and human rights, adequate investment in civil society organisations and networks in the region is crucial, particularly given the lack of investment from many domestic governments.

Reliable data: Current reports of low HIV prevalence in the Pacific should not encourage complacency. With limited testing of other key affected populations it is likely that there is under-reporting of HIV in the Pacific region. More targeted surveillance and testing of potential high risk groups is required, as is the expansion of voluntary counselling and testing sites.

Fia’ailetoa Ken Moala is Technical Advisor and Co-founder of the Pacific Sexual Diversity Network.

Pacific Sexual Diversity Network (PSDN) is a regional network of men who have sex with men (MSM) and transgender community organisations and projects and is the first of its kind in the Pacific.

It formed in 2007 in recognition of the need to develop an effective regional response to the actual and potential threat of HIV to MSM and transgender people across the Pacific.

Currently, PSDN includes representation from Samoa, Papua New Guinea, Fiji, Tonga, Cook Islands and Vanuatu, and aims to expand to include other Pacific countries.

PSDN coordinates regional communication, capacity development of MSM and transgender organisations, and advocacy and representation on behalf of Pacific MSM and transgender people.