The Commission on AIDS in Asia has predicted that half of future HIV infections would be caused by male to male sex during the next decade, a concept paper issued by the Congregation of International Organisations working across Asia said yesterday.

The concept paper issued by the United Nations Development Programme (UNDP), Naz Foundation International (NFI) and the Asia Pacific Coalition on Male Sexual Health (APCOM), said that the continuing and rapid rise of HIV infection among men who have sex with men (MSM); marginalisation of sexual minorities and their extremely low access to information and services regarding prevention and treatment, the presence of punitive laws across the region are among the complex challenges raised by the ever-growing AIDS epidemic in the Asia Pacific.

Highly concentrated, severe HIV epidemics have been reported among MSM in urban areas across the region: The estimated HIV prevalence rate in Bangkok is a staggering 30.7%; Phnom Penh, 8.7%; Mumbai, 9.6% and Beijing - 5.8%. The Report of the Commission on AIDS in Asia, notes the spread of HIV among MSM as a "fast growing epidemic". According to the Report, high partner turnover with low condom use, has led to a rapid rise of HIV prevalence. Social taboos and discrimination against same-sex relationships push the majority of MSM in the region underground and outside the reach of prevention and treatment services.

The Commission on AIDS in Asia, further notes that in the worst case scenario, 50% of all new infections would be caused by male to male sex by 2020, little over a decade from now. The main high risk behaviours for MSM are the frequency of unprotected sex with regular and commercial male partners. In addition, it’s well documented that a high number of MSM throughout the region also consists of female sex partners.

Yet, investments in HIV programming for MSM remains severely limited, ranging from 0% to 4% of the total spending for HIV programming in countries region-wide. A 2006 survey of the coverage of HIV interventions in 15 Asia-Pacific countries estimated that targeted prevention programmes reached less than 8% of MSM, far short of the 80% coverage that epidemiological models indicate as needed to turn the HIV epidemic around.

Another worrying aspect of the epidemic is the hostile legal and social environment in the region; highly discriminatory stereotypes and myths; any violation of the rights of MSM and sexual minorities. Currently, 20 countries in the Asia Pacific Region criminalise male to male sex behaviour and these laws often border on vigilantism, leading to severe human rights violations. Even in the absence of criminalisation, other provisions of law that violate the rights of MSM and Transgender (TG) communities are arbitrarily and inappropriately used, obstructing HIV interventions, advocacy, outreach, and service delivery. These structural barriers significantly increase the vulnerability of MSM and TG to HIV and have an immense adverse effect on their health and human rights. This debate was at the heart of the recent landmark ruling by the Delhi High Court that Section 377 of the Indian Penal Code unfairly discriminates against MSM, consenting adults in general. According to the United Nations Secretary General, Ban Ki-moon, "in countries without laws to protect sex workers, drug users and men who have sex with men, only a fraction of the population has access to prevention. Conversely, in countries with legal protection and the protection of human rights for these people, many more have access to services. As a result, there are fewer infections, less demand for antiretroviral treatment and fewer deaths. Not only is it unethical not to protect these groups; it makes no sense from a health perspective. It hurts all of us."