The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming

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.

Advances and challenges in sexually transmitted infections prevention among men who have sex with men in Asia

“…In Central Asia and the Caucasus, prevalence of HIV, HCV, and HBV remains exceedingly high among MSM, with 6.6% and 13.2% HIV prevalence reported in two Kyrgyz studies [ 9 ▪▪ ]. In the Association of Southern Asian Nations (ASEAN) region, a decrease in HIV prevalence was detected among MSM in Bangkok, but it was stable or increasing in the other cities [ 10 ▪ ]. In Asia, which consists of many middle-low incomes countries, the prevalent trends of STIs have not been controlled well yet.…”

Factors associated with testing for HIV and other sexually transmitted infections in men who have sex with men and transgender women in Bangkok, Thailand

“…Despite this, PrEP uptake has been low [ 46 , 47 ]. While HIV incidence among MSM in Bangkok appears to be declining, data suggest increasing HIV diagnoses among TGW since 2014 [ 48 ]. MSM and TGW in Bangkok also have a high burden of predominantly asymptomatic chlamydia and gonorrhea infections that would go undetected without routine testing [ 49 , 50 ].…”

Time trends in the risk of HIV infection among men who have sex with men in Chiang Mai, Thailand: an observational study

“…The recent Southeast Asia review under IBBS finds varied HIV prevalence widely among urban MSM from 3.6% in Phnom Penh to 43.3% in Kuala Lumpur. 16 Thailand is considered one of the countries with lower HIV infection rates, like Singapore, while in some countries HIV infection rates are rising rapidly, such as the Philippines. HIV prevention services coverage among MSM in Thailand was around 40%.…”

“…15 While MSM in Bangkok has achieved >50% of HIV prevention services they need, such as PrEP, TasP, and the attenuation of stigma and discrimination, which explains the declining path of the HIV pandemic. 15,16 Nowadays, the rate of new HIV infections is decreasing in Thailand, but no such report in Chiang Mai is available. 17,18 Most studies of prevalence and sexual risk behaviors focus on MSM in Bangkok.…”