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Activism, research and a concrete plan of action: APCOM's "Beyond Numbers" Forum proves a dynamic curtain-raiser to the 10th ICAAP

Coalition and key stakeholders chart a roadmap to stemming the HIV epidemic among men who have sex with men and transgender people in Asia and the Pacific

August 25, 2011 - Busan, South Korea - A call for activism to combat stigma and discrimination, the sharing of new research on HIV, and a blueprint for renewed action to address the epidemic in the most vulnerable populations in the world's most populous region. These led the agenda at "Beyond Numbers", the day-long forum organized by the Asia-Pacific Coalition on Male Sexual Health (APCOM) as a curtain-raiser to the 10th International Congress on AIDS in Asia and the Pacific.

The meeting was subtitled "Getting to Zero: The forces driving HIV among men who have sex with men and transgender people in Asia Pacific" reflecting the theme of one of the day's major presentations in which the various concurrent epidemics, or "syndemics", that contribute to the challenges of these vulnerable populations were examined in terms of their impact on individuals and the epidemic itself.

"We cannot view HIV in isolation," explained Shivananda Khan, APCOM Chairperson and Chief Executive of Naz Foundation International. "There are so many factors at play -- self-stigma and depression, alcohol and drug abuse, sexual exploitation. All of these contribute to an individual's risk to HIV infection, and must be taken into account when designing effective outreach and intervention strategies."

That point was driven home in an extensive presentation of research carried out by Dr. Frits Van Griensven of the U.S. Centers for Disease Control's office within the Ministry of Public Health of Thailand. "Syndemics are quite simply a set of multiple epidemics acting synergistically or together, producing an extra burden of morbidity and mortality in a population," Dr. Griensven said. "Our research focuses on the nexus of these epidemics, where they meet to interact with and reinforce each other. A study carried out among MSM in Bangkok clearly shows a direct correlation between these factors and increased risk of HIV infection. It may sound obvious, but you've got to provide solid data to substantiate what's long been suspected. MSM and transgendered persons are vulnerable on so many fronts, right from childhood through sexual maturity. We're only at the beginning of what is already proving to be a vital approach in understanding what really drives the HIV epidemic in these populations who for so long have been denied health as a human right."

The material covered will build on work from the most recent APCOM-involved regional and global initiatives that have specifically looked at factors affecting HIV among MSM and transgender people, and others, in Asia Pacific:

The emphasis on understanding syndemic issues in a rights-based context was supported by senior United Nations officials present. "In order to prevent and control the spread of HIV, we must protect and promote the human rights of those most vulnerable, typically also the most marginalized parts of our societies," noted Clifton Cortez, Regional Practice Leader, HIV/AIDS Health and Development for the United Nations Development Programme. "It's encouraging that key UN resolutions have called for promoting social and legal environments that are supportive of and safe for vulnerable communities, including this year's UN General Assembly resolution that for the first time specifically included MSM but unfortunately ended up excluding transgender persons. While progress is being made, we clearly have a lot of work left to do."

A lot of work remains to be done in South Korea as well, where the 10th ICAAP is being held, when it comes to ensuring the rights of MSM and other sexual minorities. Earlier this year, the government of South Korea withdrew official support for the conference, and community organizations and other stakeholders eventually helped organize the event, which is expected to draw some 2,000 delegates from the region and around the world. "South Korea is part of APCOM's Developed Asia sub-region," observed Dr. Stuart Koe, APCOM co-chairperson, who is from Singapore. "But merely because a country is developed from an economic perspective doesn't necessarily mean that it offers its LGBT citizens equal rights in an enabling environment."

That view was expanded by Jeong Yol, one of the leaders of the coalition Solidarity for LGBT Human Rights of Korea and Co-chair of the LGBT sub-committee, that played a key role in rescuing the 10th ICAAP. "For us, making ICAAP happen is just the beginning," he said. "There has been frustration, there has been sorrow, and for the LGBT community in my country there are many obstacles to be overcome. But the very fact that we're here today with all of you at ICAAP, with APCOM, makes it all worthwhile."

The Korean organizers joined APCOM forum delegates in six important breakout sessions that discussed ways forward in addressing syndemic issues, MSM and transgender rights, and universal access to HIV prevention, treatment and care services.

One session focused on faith and religion, and their impact on how MSM and transgender persons view their sexuality and their access to health. Participants recommended that communities find ways to gain support among faith-based organizations and religious leaders, drawing upon successful examples that are already occurring in India and other places where faith leaders are helping reduce stigma and discrimination by working together with vulnerable populations and persons living with HIV.

Another session discussed how stigma and discrimination in the health care sector, a long-running challenge in Asia and the Pacific region, could be addressed successfully. Participants recommended that APCOM, whose membership includes the Western Pacific Regional Office of the World Health Organization, push member states to include sensitization towards marginalized populations in the curricula of medical schools and colleges, with the support of community leaders who could better inform the process.

A particularly lively session focused on how social media and the Internet, which have strengthened MSM networks but also impacted the spread of HIV, could be used innovatively within a behaviour change model aimed at safer sex practices and community empowerment. Such work is already underway in various parts of the world, and participants called upon the APCOM membership to help lead the way for such approaches and research in the region.

The transgender health breakout session focused on the particular needs of the community. "For far too long we've been clumped together with MSM, but that needs to change, otherwise HIV and health interventions for our people will remain less than optimal," emphasized Laxmi Narayan Tripathi of India, an APCOM Governing Board member representing the Asia-Pacific Transgender Network. "It should be so obvious that we are very different from MSM, but governments, funders and even civil society organizations alike have ignored this, to the detriment of my people. We appreciate the support APCOM has given us by including us and strengthening our capacity to grow and advocate for our rights, but we need to truly stand on our own and be recognized for the unique community that we are."

One of the largest breakout sessions was Living with HIV whose participants recommended the inclusion of HIV positive MSM in prevention messages, from conceptualisation to implementation, and called for the messaging to be more upbeat, in terms of an individual's ability to live a healthier and better life given access to treatment which in turn helps protect oneself and one's partners. The social research breakout session recommended significantly scaling up research into the factors that contribute positively to the lives and well-being of MSM in the region and not just negative factors, along with the promotion of evidence-based programming and health outcomes informed by research findings. Conducting robust social research to generate evidence to help advocate for better services was the conclusion.

"Men who have sex with men, transgender persons, people living with HIV, government representatives, United Nations organisations - there's truly unity in diversity," said Shivananda Khan, while unveiling the Busan Declaration that reiterates APCOM's commitment to working on all the fronts explored during the "Beyond Numbers" forum. "The APCOM rank and file may not always be in agreement on every issue, but we engage in honest and transparent debate with one common goal - the eventual eradication of HIV and AIDS in our region, and our world. Today's forum is proof that we're doing all we can to get to zero - the UNAIDS vision of zero HIV infection, zero stigma and discrimination and zero AIDS-related deaths. It's a lofty goal, but we don't believe it's impossible. The very fact we're all here together today is proof of that."

Download the Busan Declaration here:

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Note for the media:

The media are invited to attend the APCOM Forum plenary at 4pm on August 25, 2011 at the APEC Room, BEXCO Conference Centre, to ask questions of the distinguished panelists present. There will also be opportunities at ICAAP for one-on-one interviews with the APCOM Secretariat and Governing Board representatives from the various sub-regions. For media queries, contact Roy Wadia at or +91-98205-28007, and Paul Causey at or +6681-984-6515.

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