Abstract
Men who have sex with men (MSM) in Western urban areas have seen substantive decreases in new diagnoses of HIV infection. This paper explores whether such declines are present among MSM and transgender women (TGW) in Southeast Asia and discusses implications for HIV policies and programming. A scoping review was conducted of scientific publications and selected documents regarding the spread of HIV infection among MSM and TGW in major urban centres of the Association of Southeast Asian Nations (ASEAN) region. Continued high HIV prevalence and incidence among MSM are found in integrated behavioural and biological surveillance (IBBS) and research studies. HIV prevalence among MSM under IBBS decreased only in Bangkok from 28.6% in 2014 to 10.3% in 2018, whereas it was increasing in Kuala Lumpur, Ho Chi Minh City, Vientiane, and Phnom Penh. HIV/AIDS case reports regarding new HIV infection diagnoses among MSM have started to decrease in Singapore since 2011 and have been plateauing in Metropolitan Manila since 2017. Where data were available, it was found that HIV prevalence among TGW was high and if IBBS was conducted, it was increasing. HIV prevalence among TGW under IBBS in Jakarta had risen to 34.0% (2015) and 14.0% (2019) in Phnom Penh. These findings suggest that most ASEAN member states have so far failed to effectively implement and scale-up scientifically proven biomedical HIV prevention measures and counter stigma and discrimination that impedes access to appropriate HIV prevention and treatment services for MSM and TGW.
Highlights
In recent years, impressive declines in reports of new HIV infection diagnoses have been observed among men who have sex with men (MSM) residing in urban areas of the Western world.1–4 By and large, these population-level reductions haveJournal compilation Ó CSIRO 2021 Open Access CC BY been attributed to the introduction and scale-up of HIV preexposure prophylaxis (HIV PrEP) and antiretroviral treatment (ART) for prevention.3 HIV PrEP pertains to a daily oral dose of one or two antiretroviral drugs as chemoprophylaxis against infection, whereas ART for www.publish.csiro.au/journals/shSexual Health prevention refers to reduced risk of onward transmission after initiation of ART with a subsequent reduction in HIV viral load
Men who have sex with men Estimated HIV prevalence in integrated behavioural and biological surveillance Figure 1 depicts HIV prevalence over time among MSM included in IBBS in seven major cities in the region
The first IBBS among MSM was conducted in Bangkok in 2003, where HIV prevalence increased from 17.3% in that year to over 30% in 2007.14 HIV prevalence remained between 25% and 30% until 2014, after which a decline was observed
Summary
Sexual Health prevention refers to reduced risk of onward transmission after initiation of ART with a subsequent reduction in HIV viral load Both approaches have been found efficacious in preventing HIV infection in phase III clinical trials.. Both approaches have been found efficacious in preventing HIV infection in phase III clinical trials.5,6 Their successful roll-out among MSM and other key populations in Western countries has led to hopes and speculations about the possibility of eradication of HIV, an example of which is the Joint United Nations Programme on HIV/AIDS (UNAIDS)’s mantra of ‘Getting to Zero’.1,7–10. This refers to a global campaign to achieve zero new HIV infections, zero HIVrelated discrimination and zero HIV-related deaths by 2030.10 Both approaches have been found efficacious in preventing HIV infection in phase III clinical trials. Their successful roll-out among MSM and other key populations in Western countries has led to hopes and speculations about the possibility of eradication of HIV, an example of which is the Joint United Nations Programme on HIV/AIDS (UNAIDS)’s mantra of ‘Getting to Zero’.1,7–10 This refers to a global campaign to achieve zero new HIV infections, zero HIVrelated discrimination and zero HIV-related deaths by 2030.10
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