U.N. Meeting Looks at Legal and Social Barriers to HIV/AIDS Prevention and Treatment in Asia-Pacific
The UN Economic and Social Commission for Asia and the Pacific (ESCAP) wraps up a three day meeting in Bangkok today on HIV/AIDS in the region. Though the overall infection rate in the Asia-Pacific region is dropping and more people living with HIV/AIDS have access to treatment, infection rates in some low-prevalence countries like Bangladesh and the Philippines are increasing and there are still many legal and social barriers to prevention and treatment. The meeting focused on these barriers and on how to reduce infection in high-risk groups including men who have sex with men (MSM), transgender people, sex workers, and injecting drug users.
Participants in the meeting, which included government officials, civil society leaders, and people living with HIV/AIDS from 34 countries, noted the importance of including HIV prevention strategies in overall Asia-Pacific development efforts. Some of the changes that might impact the spread of the epidemic include reducing social stigma, increasing gender equality, and removing the legal barriers to prevention and treatment that exist in an estimated 90% of the countries in the region.
While overall infection rates are down, certain populations are particularly at risk. MSM are an increasing percentage of the population living with HIV/AIDS, and laws that criminalize homosexuality both contribute to new infections and impede access to treatment. When homosexuality is illegal, it is difficult for service providers to reach MSM, unprotected sex is more common and getting tested less so, and MSM living with HIV/AIDS may have difficulty getting treated. Female partners of MSM are also put at risk by this combination of factors. Transgender people also experience disproportionate rates of infection in the region, and laws that criminalize trans people can have the same effects.
Other laws criminalize sex work and drug use, targeting vulnerable populations. Some countries in the region–including Cambodia, India, Myanmar, and Thailand–have successfully reduced infection rates by targeting prevention programs to sex workers. Of course, sex work is an area where women are particularly vulnerable, but female injecting drug users are also at a higher risk of HIV/AIDS than their male counterparts. Kios Atma Jaya, a program in Indonesia, was notably successful in targeting female sex workers who are also injecting drug users. As well as being particularly vulnerable due to the combination of risk factors, these women often did not seek treatment or access prevention programs because they work at night (when most clinics are closed) and avoided services due to stigma.
Gender may impact prevention and treatment in myriad ways. For example, another successful program, the Poz Home Center in Bangkok, found a number of concerns specific to gender and particular identities. Those included the concerns of transgender people around HIV and sex reassignment surgery (SRS), the intersections between the need for expensive SRS and sex work, and the difficulties MSM and kathoeys (third-gender people) face in trying to negotiate safe sex and avoid violence. The Center matches peer counselors to its clients based on gender and similar life situations, so that peers can share strategies that work for their specific situation.
Both in Asia and worldwide, it is recognized that efforts to increase gender equality are also effective in fighting HIV/AIDS. For example, repealing laws based on gender norms decreases stigma and increases the ability of programs to reach vulnerable populations, fighting gender-based violence reduces the risk of infection through unprotected rape, and reproductive health education efforts reduce mother-to-child transmission. As gender equality increases in a country, women may be more able to negotiate with their partners for protected sex, stigmas around LGBT people that contribute to the vulnerability of MSM and transgender people may decrease, and family dynamics that make female partners of at-risk men vulnerable to infection may shift.
In order to address the HIV/AIDS epidemic, development efforts in the Asia-Pacific region should focus on eliminating these legal and social barriers and addressing gender inequality wherever possible. The participants at this meeting have shown a commitment to change, and we will see in the coming years whether they put the strategies discussed into action.