AIDS in Asia

The article below appeared in a Singapore free newspaper about 3 weeks ago.

1 in 5 Asian Homosexuals Has HIV

UNITED NATIONS — HIV infection rates among gay men in many parts of Asia are as severe as those which devastated homosexual communities in the United States in the late ’80s, said top officials of the United Nations Aids agency UNAIDS.

Launching his agency’s 2008 report on the global Aids epidemic, Mr Peter Piot, executive director of UNAIDS, urged more action to prevent the spread of the disease among gay men who have unsafe sex. He also stressed the importance of working with affected communities.

Mr Piot said: “All over Asia there are now epidemics of HIV in men who have sex with men, at the same magnitude that we saw in this country 25 years ago. That is something that has been detected fairly recently. There is not enough action yet but we are now starting programs,” he added.

Paul De Lay, director of Evidence, Monitoring and Policy at UNAIDS, said the HIV epidemic among gay communities in Asia was not new, but that it had recently reached the levels seen in cities such as San Francisco at the end of the 1980s when HIV infections reached their peak.

He said it could be due to a number of factors, including less funding for programs that target men who have sex with men and the fact that there were new groups who were less aware of the risks of unprotected sex.

“Asia has recognized populations of men who have sex with men for quite some time,” he told AFP. “The epidemic in these populations started in the mid-1990s. What we see now is a resurgence.”

“There are countries where the percentage of people infected are similar to what we were seeing in San Francisco or in Berlin or in London where up to 15 to 20 percent of men who have sex with men are HIV positive,” he added.

The report meanwhile noted that unprotected sex between men was a “potentially significant but under-researched aspect of the HIV epidemics in Asia,” citing countries such as Thailand and Vietnam.

“Recent study data from several major cities in the region, from Bangkok to Ho Chi Minh City, show increasing HIV prevalence among men who have sex with men,” the report said.

In China, unsafe sex between men could account for up to seven per cent of HIV infections, it noted.

De Lay said there were also high infection rates among gay populations in cities such as Chennai and Mumbai in India and in Indonesia’s capital Jakarta.

He added that these communities often faced homophobia from the wider population, as well as discrimination from health care providers, which discouraged them from seeking information and getting tested.

“Even without blatant national laws that criminalize homosexual behavior, you can still have a gradation of policies and practices that can be almost as bad,” he said.

De Lay pointed to a similar resurgence of HIV infections among gay populations in the US and western Europe, which he said showed the need for constant vigilance.

The report said higher risk unprotected sex among gay men in several countries in western Europe, such as Germany, appeared to be linked to the increasing numbers of new HIV diagnoses among that group.

“It’s disturbing because it’s this sense that we can never let our guard down as far as prevention, that the epidemic will come creeping back if there isn’t this constant attention being paid to it,” De Lay said. -AFP

I believe the same report appeared in quite a few other news publications as well.

But there was something that didn't seem quite right. Could you guess what it was?

Read the title again.

It wasn't mentioned anywhere in the article that 1 in 5 or 20% of gay Asian men is gay. It only said that up to 15 to 20% of gay men are HIV-positive.

I am not trying to nitpick here, but there is a difference. And a huge difference at that.

It's like a sale which says up to 20% discount, which could be only 5%, 10% or whatever amount below 20%, as compared to a sale of 20% discount, which means ALL items are 20% cheaper.

If someone were to read the title of the report only without reading further, he or she would have the wrong idea that one-fifth of gay men are HIV-positive.

I am not trying to underestimate readers intelligence, but stereotypes and discrimination abound. The human brain is programmed to categorise and pigeon-hole things neatly into little boxes. As such, reading the misleading title would likely lead readers to think that only gay men contract AIDS or that it is a predominantly a gay disease or straight people are less likely to contract the disease.

All of the above are not desirable or positive outcomes. It probably would have done some damage to the hard work and effort of HIV education programs to change public perception about the virus.

In my opinion, there are two concerns regarding such inappropriate headline:
1) it reinforces the misconception that it is a homosexual disease and only homosexuals get it. This would make other segments of society believe they are not at risk and thus may erroneously think that they do not need to take precautions like practicing safer sex

2) it paints a picture of doom and gloom for homosexuals, that one in five gays are likely to become infected. Being gay doesn't doom a person to a life of suffering and HIV. It is about being true to yourself and loving yourself for it. There is hope, optimism and happiness and those are not in the domain of heterosexuals only.

Actually, I had written in an email to the newspaper stating my concerns and the reasons, but it was not published. I have also sent it to Straits Times and it was also declined.

Just for readers information, the original headline reads "AIDS hitting Asian gays at high rates: UN".

So is it a case of deliberate anti-gay propaganda or just plain sensational reporting?

The HIV scourge

The issue of homosexuality is in the media again, thanks to Lee Kuan Yew's statement a last month where he said, "If in fact it is true, and I have asked doctors this, that you are genetically born a homosexual because that's the nature of the genetic random transmission of genes, you can't help it. So why should we criminalise it?"

Actually, the issue has been in the limelight since the review of the Singapore Penal Code, where the law now allows heterosexuals to have anal and oral sex, but that it is still a crime for two males to do so.

It is not a crime to be gay, but it is a crime if one indulges in anal sex.

It doesn't make sense, I know, but this is Singapore. Even though it has been said many times that the law is in not going to be actively enforced (which begs the question why is it retained?), it is there to appease the conservatives and the religious right.

But what makes it dangerous and in fact costing lives, just to appease these people are the obstacles involve in HIV and AIDS prevention for MSM (men who have sex with men).

At the AIDS Memorial on Sunday, the 34th edition of The Act, a publication by AfA (Action for AIDS) was given to all attendants. You can download it here.

There was a section on consequences of Sections 377 and 377A of the Penal Code on HIV prevention. The below is an extract, which I am deeply concerned about:

4 Inability to address the needs of young MSM
It has been very difficult to reach out to young MSM who are contemplating or already having sex. Young MSM are especially at risk of STI including HIV infection because they are less able to access sources of information and advice about safer sexual
practices for the following reasons –

a) School-based programs do not have information and materials that discuss homosexuality in an impartial and unbiased manner, including emotions, identity, sexual practices, safer sex techniques and negotiation skills

b) Young MSM may fear seeking professional advice (e.g. from doctors, teachers, youth workers) because to do so would be to admit having committed a crime;

c) Support groups and youth organizations for young MSM are practically non-existent; if they do exist they tend to keep a low profile to avoid drawing attention to themselves. Many young MSM will not know of sources of support and peer education;

d) MSM venues and clubs operate under clear age-restricted rules to comply with licensing laws. Young MSM are thus not exposed to AIDS education messages and campaigns; young MSM are also less likely to be able to afford the cover charges levied at these clubs and venues. They are also less exposed to the social climate within the organized gay community, which strongly supports "safer sex";

e) Young MSM may feel isolated and marginalized and regarded as not part of the broader society due to the criminalisation of their sexuality.

An application for funding of a program that included a component catering to young MSM was rejected because the government agency either did not think it was important or deemed that it was too sensitive a topic to address.

5 Censorship of MSM educational materials and events
Action for AIDS has on several occasions been asked to stop distributing materials containing information on homosexuality even though these materials were meant specifically for MSM venues and events. The reasons repeatedly given by the authorities was that because homosexual sex is illegal, it cannot be mentioned; therefore providing information on safe sex relevant to MSM is also illegal.

Because of the law, some young people are HIV positive because the relevant information and sexual education doesn't reach them. When something is thought of as bad, crime or sin, how does one expect it to be discussed and brought into the open?

It is a fact that young people, especially high school students are having sex with strangers from MIRC and personals websites. And this reality is borne by the testimonies of young MSMs in the publication.

Extracts (prints in bold are my own):
"It is hard to place a timeline on when I discover or realize I was a gay. Given that I had an interest in guys when I was 12 or 13 years old. My first sexual encounter started when I was like 15 years or so, when I got to know the MIRC, Internet chat rooms where I find out there is a gay channel and sgboy channel inside. Through there, I met my first sexual encounter and I had my first anal sex without protection...

From then on, I met guys out for fun and sex until I had a 6 – 7 months of so-called relationship with this guy purely based on sex, which has a term of buddy sex. During the ending period of this relationship, I fell sick a lot of times while he has some nose issue with himself and the doctor but we still continued having sex sometimes. Although we met up regularly, we still do meet other guys up for fun. But in this buddy sex thing, there was not any protection used and most of the time he would ejaculate inside me. But when I had fun outside, the guys would use condoms.

It was when I was 17 years plus, I had a month of prolonged illness of flu, cough and sore throat. I remember it was in near December, Christmas seasons. I started getting sick, and after each recovery I would get sick again. Every visit to the neighborhood
clinic made me spend more and more as each time the doctor would prescribe a stronger antibiotic for me. The last visit during that period cost about $90/-...

I do believe that, no matter what, I cannot let my parents find out about this. Each passing day, I would just live my life just as normally I have been doing, but sometimes thoughts that I am going to need medication brings confusion into my head. I did not really have a way of dealing with having HIV. But having thoughts about it running through my head here and there is kind of stressful. My family isn't really financially well off as one of my parents is retrenched. All I had in my mind is to soften my mother's burden and not letting her worrying over my condition...

I do believe that education to the young is the only way in helping us and the society in learning more about HIV, safe sex etc. No matter how young a person is we are exposed to the world in various ways which can influence us in some way. Educating the young in safe sex should be included with the various symptoms of all the sexually transmitted diseases like HIV." - Chinese 19 years, diagnosed at 18

Another one:
I knew I was gay when I was in secondary school. It was also during that time that I had my first sexual encounter. However I did not tell my friends in school about it. The first time I told a friend about my sexuality was when I was in junior college...

I believed I contracted HIV when I had unprotected sex with someone I knew over the Internet while I was serving the army. I had underestimated the importance of safer sex. I did not think I would be unlucky as to contract HIV. I had sexual encounters too early and the importance of safer sex did not hit me as being crucial. To me, it was more of a form of contraception than a protection against STIs at that time. HIV and other STIs were simply diseases which I thought were gory pictures showing infected genitals...

I am convinced that a better awareness of safer sex and the various STIs can protect individuals. They should be empowered with the necessary information in order to make an informed decision. I wished I knew the dangers of having unprotected sex as well as knowing how I could have protected myself. By casting sex as the forbidden fruit, it made me curious, and I am sure many others feel the same. Being open and honest about sex could be one way forward... - Chinese 23 years, diagnosed at 20

Even though the message for safe sex seems pretty common for me, it is quite obvious that it is quite uncommon for a lot of young people. The best way would be to reach them in school, through some campaign or awareness program.

But then, how relevant and how effective can it be, when even straight sex are still somewhat spoken in hush tones, what more homosexual acts. As you can read from the above, words like "homosexual" and "gay" can't even appear in print in reading materials for distribution.

There are many who doesn't have access to the internet, printed materials, etc. Even if they do, the importance of safe sex have to be emphasized and reinforced over and over to make sure they get. Especially for teenagers, where it is the phase of experimentation and rebellion, things like this might just whizzed past them. Seem like trivial. Like what are the chances?

If only humans are like the HIV virus - non-discriminatory. It does not care about one's race, religion, sex, sexual orientation, wealth, social status, whatever. It does not care who it infects.

And that is what makes it so dangerous and lethal.

AIDS Memorial 2007

Yesterday, Lloyd and I attended the AIDS Memorial Day, which is held every third Sunday of May. It was held indoors this year, in one of the lecture halls of Singapore Management University, unlike last year where there was a candlelight walk outdoors.

There were ushers to show us the way to the hall on the second floor. Even though we were 20 minutes early, there were a lot of people already seated. One can tell that a lot of them are gay, with some straight people. Both the right and left seats were taken up by the Red Cross, whose members are quite young, less than 15 years old.

There were representatives and religious leaders from the various faiths seated on the front row. I counted eight of them and I recognised one of them to be Reverend Yap, who used to be the pastor of the Methodist churches in Malaysia and Singapore. He is one of the few pastors who speaks out for homosexuals, as can be seen from his speech not too long ago.

Anyway, the memorial started about 15 minutes later than the scheduled 7 p.m. time. The service was started off by a short welcome note by the MC, who gave an introduction to what the AIDS memorial was all about and thanked the relevant parties.

This was followed by the opening address by the chairman of the organising committee, Dr Derrick (can't remember the surname). His speech was peppered by a lot statistics which basically drive home the fact that HIV infections among the gay community, not just in Singapore but in many Asian countries are on the rise again, outnumbering the heterosexual infections.

The next item was a song, sang by a duo called Flying Without Wings.

What came afterwards was the remembrance, where the 77 people who died of AIDS in Singapore last year had their names called out and volunteers would go on stage to place a name tag on this arrangement of flowers.



It was indeed a solemn affair. I was quite moved by this act to remember those who have passed on, to honour their courageous fight towards the end.

However, there was something that saddened me. The 77 people were not called by their name, but by their initials only. Two, three and four letter word combinations came up on the screen - LYK, BJB, SS, WSTK. I was wondering why on Earth can't these people be remembered properly, when it hit me ...

The stigma. The discrimination. Not to those who have died, but their living family members and friends.

That is something which society is at fault. As the Organising Committee Chairperson said, it's as if once a person has HIV, all his fine qualities and whatever good he has done are erased. He instantly becomes a bad person, who is to be avoided and shunned.

This point was made all the more clearly and painful when there was a sharing by a HIV infected person which was read out by a volunteer (again, to protect the person's anonymity).

She was infected by her husband. The night the news was broken to the rest of the family, she said her family crumbled. Her eldest daughter moved out and stayed with her in-laws that very same night. The youngest daughter moved out too.

Only the second child stayed. But he was forced to make the decision to stay with his parents or to move out, by his girlfriend. Either the parents or the girlfriend. How could one be made to choose, especially in such a situation. He was so stressed that he made the choice to move abroad to work.

The news spread to her relatives and neighbours. She was avoided like the plague and had to move to a new neighbourhood to start a new life. Fortunately, she was discovered by volunteers of FIRSTHAND (a volunteer group, can't remember what the acronym stands for) and was given the support and encouragement to face life's challenges and to realise that she can still lead a normal life.

Another interesting item of the evening was the recital of prayers by the various representatives of different faiths. Singapore has a Inter-Religious Organisation, which can never happen in Malaysia as long as the religious extremist and ignorant are around.

This is what I would call Muhibah, and not those artificial advertisements or posters showing one Malay, one Chinese and one Indian.

Each one of them recited a prayer for those who have passed on and for the living, that they may be fit, healthy and be blessed with a good life.



There was an observation of a minute of silence. Each of us were given a glowstick, instead of a candle.

Another song was sung, "That's What Friends are For", which is a song I love. Things become cheesy a little when the singers asked the audience to sing together and say "Thanks for being my friend" to their neighbours.

It was indeed a memorable event for me. The AIDS scourge is not going to end anytime soon, even with an optimistic theme for the 2007 AIDS Memorial of "Leading the way to a World Without AIDS".

But what we can do is to practice safe sex, remind people about safe sex and to treat people with HIV/AIDS without discrimination. No one deserves to be treated like the woman above, especially in their greatest time of need and support.


P/S I am not really sure how Malaysia commemorated this event, but it seems it was done very differently.