Failure to earmark sufficient funds for HIV/AIDS prevention among men who have sex with men is a 'crime against humanity', sparked by bias, that could have fatal consequences, experts say.
THE government's failure to provide adequate HIV/AIDS prevention for men who have sex with men (MSM) could plunge Cambodia's gay community into an epidemic tantamount to "genocide", experts have warned.
Out of almost US$4 billion invested in Asia over the past five years, less than $100 million has been allocated to the MSM community, according to Dr Sawarup Sarkar of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "There's a whole political and social bias against this population," he told the Post.
The Commission on AIDS in Asia has estimated that Cambodia needs to spend $500,000 per year on prevention efforts in order to reach 80 percent of the most at-risk portion of its gay community, but the country spent nothing last year, Sarkar said.
"Cambodia is the highest-invested country in the region, with almost $5 per capita [allocated by donors for HIV-prevention efforts], but there is zero allocation to the MSM population," he said. "We are not funding enough the most at-risk communities."
Teaching MSM about AIDS in Battambang
IN SEVEN years as an outreach coordinator for the Battambang-based NGO Men's Health Social Services (MHSS), Bin Samnang has met eight gay men who later died from AIDS.
"Everybody is afraid of AIDS, and so am I," said the 30-year-old, who is gay himself. "That is why we are trying to educate people about it."
Bin Samnang said he began wearing women's clothes as a teenager in 1996. Shortly thereafter, he decided to leave home to live in an apartment with a group of gay friends, all of whom, he said, were attempting to escape derision from their families and neighbours.
He became sexually active after he started dancing for street bands in 1997.
"I was happy when I could go out dancing," he said. "I started to go out a lot with my group, and we started to have lots of sexual partners."
But he did not learn about the importance of wearing condoms to prevent the spread of HIV/AIDS until he took the job with MHSS in 2002.
As a result of his experiences in the field, Bin Samnang has committed himself to educating other gay men in Battambang about the threat of HIV/AIDS.
He said recently that he believed outreach efforts to gay men in the province had been effective.
"Almost all gays use a condom when they have sex," he said.
"They know now about the threats because they have been educated by other gays. Only very few gays now say they do not use condoms."
He acknowledged, though, that some men still do not believe they can contract HIV/AIDS by having sex with other men.
"Education about reproductive health has been scattered in Battambang, so we don't know for sure how many gays have been educated in the province," he said.
Shivananda Khan, chairman of the Asia Pacific Coalition on Male Sexual Health (APCOM), said the failure of national governments to allocate resources to their MSM and transgender communities constitutes "a crime against humanity".
Addressing a forum on HIV in gay communities in Bali, Indonesia, at the International Congress on AIDS in Asia and the Pacific, Khan said: "194 MSM and transgender people are getting infected with HIV every day. With the level of services and with the level of coverage, what hope do they have in terms of accessing treatment, care, support or even prevention? That is not only shocking, it is shameful: It is a form almost of genocide. It is a crime against humanity.
"The only way we can win this battle is if we work together and stand shoulder to shoulder to address the crisis so this genocide stops. We have the technology and the evidence to stop it, and enough is enough. What we are dealing with is a crisis in human lives."
Although the HIV prevalence rate among MSM in Cambodia is lower than in neighbouring Thailand and Myanmar, the country is nearing a crucial tipping point, the UN has warned.
New infections could rapidly spiral out of control unless the government does more to educate the community about how to prevent the spread of HIV/AIDS, according to UNAIDS, the UN's joint programme on AIDS and HIV.
"Asia and the Pacific is on the brink of a large increase in new infections among MSMs if risk behaviours of low condom use and many concurrent male partners stay at current levels," JVR Prasada Rao, Asia and the Pacific regional director for UNAIDS, told the forum.
"The [Commission on AIDS in Asia] has predicted that if business as usual continues, by 2020, men who have sex with men and transgenders will be the largest segment of infected people in Asia."
Frits Van Griensven, chief of behavioural research at the US Centre for Disease Control, said the Cambodian government must "act now" to avert catastrophe. "If you are late acting, it will be too late, and the prevalence will be too difficult to bring down," he told the forum.
Prevention efforts should also address the social challenges facing MSM and transgender people, said Griensven, citing links between binge drinking, drug use, a history of coercive sex, suicidal thoughts and social isolation with failure to use condoms during sex.
"We shouldn't be targeting HIV in isolation, but in the context of the social conditions people live in," he said.
Funding should be allocated to peer education, treatment of non-HIV sexually transmitted infections, distribution of condoms and lubricants, and advocacy to decriminalise the community and remove the stigma surrounding MSM, said Global Fund's Sarkar.
He said the people most at risk, which represent up to 25 percent of the MSM community, are male sex workers and transgender people, who are most likely to have receptive sex. People who frequent cruising spots are also considered high-risk.
The latest statistics suggest that 8.7 percent of MSM in Phnom Penh are HIV-positive. The study, which dates from 2007, estimates prevalence among the transgender community to be as high as 17 percent. HIV prevalence among people ages 15-49 in Cambodia stood at 0.9 percent, or 67,200 people, in 2007. This was down from 1.2 percent in 2003, UNAIDS figures show.
One of the most alarming trends in the epidemiological data is the high rate of infection among the youngest segments of the MSM and
transgender communities. A recent study in Thailand followed 1,000 HIV-negative MSM for three years. During that time, 20 percent contracted
HIV. Among those aged between 18 and 22, the infection rate was 30 percent.
The Commission on AIDS in Asia estimated that $3 billion was needed every year in Asia to reach 80 percent of positive people, 80 percent of people at high risk of contracting HIV and 80 percent of affected families. However, just $1 billion was available last year from major public sources, leaving a $2 billion shortfall.
Programmes targeting MSM required $300 million per year, it said, but only $20 million to $40 million was spent, mostly from the Global Fund.
The government could not be reached for comment on Sunday.
Nathan Green, who has been reporting from Bali since last Monday, travelled to Indonesia on a UNAIDS-funded trip.