BY Danton Remoto
Views and analysis
BALI, INDONESIA – If you think that having an intimate partner will always keep you safe from contracting HIV, better think again.
More women from the Asia-Pacific region – housewives and career women –are contracting HIV from their intimate partners. These women are either married, or have long-term relationships with men who engage in high-risk sexual behavior. These behavior are found in men who have sex with men (MSM), injecting drug users, and clients of female sex workers.
These findings are contained in a new report by UNAIDS, its co-sponsors and civil society partners entitled HIV Transmission in Intimate Partner Relationships in Asia, released at the 9th International Congress on AIDS in Asia and the Pacific, being held in the island resort of Bali until tomorrow.
Men who buy sex are the largest infected population group. Many of them are married – or are about to get married. This puts a significant number of women, often perceived as “low risk” because they only have sex with their husbands or long-term partners, at risk of HIV infection. In the Philippines, data from the AIDS and HIV Registry of the Dept. of Health show that male Overseas Filipino Workers constitute one-third of reported HIV infections every month. Some of them have infected their home-bound wives as well.
The United Nations report estimates that more than 90% of the 1.7 million women living with HIV in Asia got it from their husbands or partners in long-term relationships. By 2008, women constituted 35% of all adult HIV infections in Asia, up from 17% in 1990.
“HIV prevention programs focused on the female sex partners of men with high-risk behaviors still have not found a place in the national HIV plans and priorities of Asian countries,” said Dr. Prasada Rao, Director, UNAIDS Regional Support Team for Asia and the Pacific. “Integration of reproductive health programs with AIDS programs and the delivery of joint services to rural and semi-urban women is the key to reducing HIV transmission among female partners.”
To prevent HIV transmission among intimate partner relationships, the UNAIDS report outlines four recommendations. First, HIV prevention interventions must be scaled up for MSM, injecting drug users, and clients of female sex workers, and should emphasize the importance of protecting their regular female partners.
Second, structural interventions should address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programs to include services for male sexual health.
Third, HIV prevention interventions among mobile populations and migrants should be scaled up and include components to protect intimate partners. And last, operational research must be conducted to better understand the dynamics of HIV transmission among intimate partners.
In the Philippines, men who have sex with men (MSM) who practice unsafe sex alternate with OFWs as the groups most vulnerable to contracting HIV. This situation is also found in the rest of Asia, where 90% of MSM in the Asia-Pacific have no access to HIV prevention and care.
If nothing is done about this situation, the spread of HIV in this vulnerable population will escalate sharply in the very near future. Moreover, legal frameworks across the region need a dramatic and urgent overhaul to allow public-health sectors to reach out to MSM. The consequences could very well go beyond MSM to affect the general population.
This warning came at a high level symposium, “Overcoming Legal Barriers to Comprehensive Prevention Among Men who have Sex with Men and Transgender People in Asia and the Pacific” held at the 9th ICAAP. It was co-hosted by the United Nations Development Programme (UNDP) and the Asia Pacific Coalition on Male Sexual Health (APCOM).
“In order to achieve universal access to HIV prevention, treatment, care and support and realize the Millennium Development Goals, we must facilitate an enabling legal environment and human rights based HIV policies and programs for MSM and transgender (TG),” said Jeffrey O’Malley, Global Director of UNDP’s HIV Group, among the speakers at the symposium. “This will mean stepping up our investment in legal and social programs that address stigma and discrimination directed at MSM and TG.”
Professor Vitit Muntharbrhorn of Chulalongkorn University and one of the convenors of the 2006 Yogyakarta Principles of Lesbian, Gay, Bisexual and Transgender (LGBT) Rights said: “One of the challenges for overcoming barriers to prevent HIV is to promote the formulation of humane laws and policies that enable people to participate in addressing the disease in a cooperative manner, rather than driving those living with HIV underground. The latter approach is counterproductive, since it makes the disease more difficult to control. Thus, it is essential to advocate the adoption of laws that do not lead to discrimination and marginalization, and to provide space to respect sexual activities between consenting adults in the private sphere in their diversity.”
Currently 20 countries in the Asia-Pacific criminalize male-to-male sex, and these laws often lead to abuse and human-rights violations. Even in the absence of criminalization, other legal provisions violate the rights of MSM and TG along with arbitrary and inappropriate enforcement, thus obstructing HIV interventions, advocacy and outreach, and service delivery.
Happily, the Philippines is not one of these countries, since its criminal codes are silent on male-to-male sex. But as one Filipino participant in the international conference said, “But silence does not always mean consent. Sometimes, it can be like the silence of the lambs.”