You can download the powerpoint presentation from http://www.gnpplus.net

1. THE LANDSCAPE OF SEXUAL
HEALTH FOR HIV-POSITIVE
GAY MEN
Jack Arayawongchai, APN+

2. Outline
 What’s available
 What are the barriers
 What’s still needed
 Recommendations

3. What’s available…..
 APN+ surveyed available services for positive MSM
in the Asia Pacific
 All 11 countries have specific services for pos MSM
 VCT, treatment, referrals, psychosocial support, ect.
 Most MSM CBOs also provide services for positive
MSM
 Many government hospitals now provide similar
services

4. Available tools….
 Condom
 Lube
 Basic ART & STI drugs
 Basic IEC materials

5. So what does access look like?
 APN+ access to treatment research for pos MSM &
TG
 Research methodology
• 897 questionnaires and 17 FGDs
• 6 countries
India (5) Myanmar (4)
Singapore (1) Malaysia (6)
Indonesia (8) Nepal (9)
• 897 participants
India (424) Myanmar (44)
Singapore (50) Malaysia (83)
Indonesia (128) Nepal (168)

6. HIV Counseling & Testing
 59.3% of the participants receive HIV test in government
hospitals
 13.1% reported having tested for HIV without consent
 Nepal (36.9%) vs. Indonesia (1.6%)
 81.6% received post-test counseling
 Among these, 81% disclosed their sexuality to counselor
 Among participants who disclosed their sexuality to counselor,
41.6% reported that counselors were neutral in terms of
friendliness (friendly attitude) towards MSM.

7. Access to ART
 In total, nearly half (46.4%; n=412/887) are in need of ART
 Among those who are in need of ART, 71.4% are currently on
ART
 Barriers included:
 Lack of adequate knowledge about ART (15.3%)
 Fear of side effects (16.1%)
 Denial of service by doctors (11.9%)
 Unfriendly HIV service providers (17.8%)

8. Access to HIV-related Services
Barriers:
 Cost of services (34.2%)
 Legal issues (11.4%)
 Travel (53.7%)
 average travel time: 2.78 hrs
 Lack of adequate information about services (18.6%)
 Stigma and discrimination (35.2%)

9. Attitudes of Health Care Providers
 Participants reported that HCPs disclosed their HIV status (12.4%)
and sexuality (14.5%) to others without consent.
 Fear of discrimination by HCPs for being girlish or being positive
prevent some participants from accessing services
 Participants reported denial of services (21.1%) and physical
assault (9.6%) by HCPs.
 Nepal: denial of services (30.8%) and physical assault (37.7%)
by health care providers.
 Transgender (53.7%) and being out to HCPs (44.4%) about
one’s sexuality are the risk factors that expose respondents to
the risk of refusals of healthcare services

10. Other issues….
 Employment and poverty
 Type of jobs, joblessness and recruitment
 Disclosure
 Some fears their partner (male or female) might come to know their HIV
status prevents initiating, accessing or adhering to treatment
 Alcohol and drug use
 ARV side effects related to skin and physical appearance
 Lack of peer counselors for positive MSM and TG
 Access to services by rural based positive MSM and TG
 Some said clinic opening hours is not suitable for them as they are
being involved in sex work
 MSM specific support groups

11. What if some NPTs become available?
 Cost – a mean is more important
 Trust – long term or casual, even condoms don’t
work……
 Stigma – you’re backdooring someone tonight?
 Availability – when condom & lube are not
available everywhere?
 Accessibility – if you do not live in Bangkok,
Jakarta or Kuala Lumpur?

12. What’s needed?
 Scale-up of services in all sectors
 Funding
 Skills
 Education
 Political commitment

13. Sample of resource for PLHIV networks

14. What else…?
 MIMA
 More concerted efforts
Thank You