FOREPLAY - The final push towards three zeros

A series of community events was held across two days in the lead up to ICAAP11, to allow community delegates to come together and network, and to be discuss key issues related to HIV and key populations in Asia and the Pacific.

The first of these events was FOREPLAY, a one day community pre-conference hosted by APCOM on 17 November.



Topics examined during the pre-conference included a situational analysis of HIV epidemics among different countries and populations; current MSM and transgender research; and discussions about the impact of criminal laws on MSM and transgender communities.

Midnight Poonkasetwatta opened the forum providing background information on the HIV epidemic in Asia and the Pacific. He said that while we already know that MSM and transgender people are at increased risk of acquiring HIV, HIV and young MSM is now a particular concern because 40% of new HIV infections in the region are among young MSM.

Midnight stressed that fighting stigma and discrimination is crucial, and that increased investment and strategy are essential for scaling up combination prevention approaches required to curb the growing HIV epidemic among MSM across the region. "Although we are aiming for zero new infections, zero death and zero discrimination, business as usual is not enough," he warned.

He urged participants to be proactive and to focus on action, saying: "We are here to listen, learn and inspire each other to protect people from HIV and protect human rights."

 "I hope that this meeting will be an important opportunity to further discussion on what we can do differently," he concluded.

Chris Beyrer

One of several keynote addresses delivered at the pre-conference was given by Dr Chris Beyrer from the John Hopkins School of Public Health. His presentation focused on the science and technology of HIV prevention and discussed 'network level risks' (the way people live and have sex in networks) as a key driver of the growing epidemic among MSM.

He described an "extraordinary rate" of HIV acquisition among MSM across the region, particularly among young MSM. He said that addressing this is an "incredible challenge", reiterating Midnight's assertion that 'business as usual' is not helping.

He said there were a series of unique features among communities of MSM that increase the network level risk of acquiring HIV, such as sexual versatility. He said the fact that men can play both the insertive and receptive role during sex makes onward transmission of HIV extremely efficient and effective among networks of MSM. He also pointed out that the risk of HIV transmission from receptive anal intercourse (regardless of the gender of the partner) is 18 times higher than for vaginal sex, making it an enormously efficient mode of HIV transmission.

Rapid onward transmission of HIV among networks of MSM is another key driver of infection rates among MSM. He said that research of MSM networks in China, Australia and a minority of networks among MSM in the US, shows that increased size and lower density networks are associated with increased HIV rates.

He urged governments and developing organisations to move away from a narrow focus of individual level practices, such as condoms, and to also focus on network level interventions such as PrEP and treatment as prevention. He stressed that although PrEP has been proven to be extremely effective as an HIV prevention measure, we have seen very little uptake and pressure from communities on the issue. "We have a lot more work to do to understand how this may be useful," he said.

He also stressed the urgent need to address rates of HIV among young MSM across the region, saying that because although rates of HIV in Asia and the Pacific remain relatively stable among the general population, they continue to grow at an alarming among young MSM.  In one study, 30% of young MSM had become HIV positive within a five year period. "I know an epidemic when I see one, and we certainly have an epidemic among young men in this region," he said.

He said that stigma contributes to increased rates of HIV among young men because it creates developmental issues for young guys: "If you grow up and are not gender conforming, you get negative messages from an early age - all this stigma and discrimination leads to internalised homophobia, depression and substance use."

Midnight Pooknasetwatta addresses FOREPLAY
community delegates

Midnight Poonkasetwatta responded to his presentation by saying, "We must act now to work in particular with young MSM and transgender communities if we are to stop this trend. The international community must maintain its commitment to AIDS funding and building the strength of local organisations to address these issues."

UNAIDS Deputy Director, Jan Beagle, who also presented at the plenary, responded by saying:
"MSM communities must and should play a key role in helping to reverse epidemic trends. For an effective response there must be genuine partnerships between governments and civil society. Governments must ensure that MSM communities and organisations are meaningfully engaged in all stages of the HIV response with dignity and respect."

The keynote presentations were  followed by community breakout sessions on issues including  MSM and transgender people living with HIV, issues for young MSM and transgender people, innovations in ICT and social media, law, policy and human rights and MSM and drug use.

The final FOREPLAY pre-conference session was entitled 'filling the evidence gap', and examined the need for more work research and community engagement among key populations including transgender people and sex workers.

Overall, FOREPLAY provided a rich and varied introduction to many key themes that continue to be raised as the ICAAP conference and associated events unfold.

More information: APCOM media release