The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points: - HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%. - HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates. - Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services. - MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.

1. Global and Sri Lanka HIV
situation among MSM
15 th October 2015
SCOV Annual scientific sessions

2. Introduction
• HIV epidemic is declining , HIV prevelence , PLHIV & new infections are declining and AIDS free world is become a
reality
• Despite decades of research and community, medical, and public healt efforts, high HIV prevalence and incidence
burdens havebeen reported in MSM throughout the world. This risk has been presentsince the syndrome now
known as AIDS was fi rst described in previously healthy homosexual men in Los Angeles (CA, USA) in 1981. Past 3
decades HIV has severely affected gay & other MSM In many
• high-income settings—including Australia, France, the UK, and the USA—overall HIV epidemic trends are in
• decline except in MSM, where they have been expandin in the era of highly active antiretroviral therapy (HAART
• MSM excluded from surveillance in settings where same sex behaviour is stigmatised or criminalised
• Stigma , criminalisation bar access to asses burden, difficult to reach pockets
• size of the population /denominator
• Now LGBT made success international gay community developing through internet & other media, net working,
demanding recognition, rights , challenge social exclusion , discrimination
• data is sparse or limited ,96 out of 196 (most countries ) have not reported MSM rates last 5 years,
• Re-emergent MSM epidemics in high income countries UK, USA ,France , epidemic among MSM increase in
(HARRT) ART era increasing 8% /year since 2011
• Asia , Africa Latin america the highest rates of HIV among any KAP is is MSM
• 3% -5% middle east & North africa to caribbean

3. Who is a MSM
• Definition –introduced in 1992 to capture a range
of male to male sexual behaviour avoid
charactersing men engaging in these sexual
behaviours by gender identity or sexual
orientation that happens in any male setting
• TG -Biological men choosing to have female
identity -TG or transgendered women if gender
assignment surgery done carry risk if receptive
anal sex but due to nature of female identity is
not considered as MSM

4. Background
• From 2000 to 2014 new HIV infections fell by 35% globally ,sharpest declines
occurred in the Caribbean (50% decline) and sub-Saharan Africa (41% . Asia and
the Pacific fell by 31%.
• In 2 Regions Eastern Europe and central Asia and the Middle East and North Africa,
new infections however have increased since 2000.
• New infections appear to be stable among gay and other MSM ,with small peaks in
Caribbean , Eastern Europe and central Asia.
• overall HIV epidemic trends are in decline except in MSM. HIV prevalence has not
declined as seen among sex workers & IDU globally.
• Past 3 decades HIV has severely affected gay & other MSM In many high-income
settings—including Australia, France, the UK, and the USA—Re-emergent MSM
epidemics, epidemic among MSM increase 8% /year in (HARRT) ART era
increasing since 2011
• Prevalence is not a good indicator of disease burden in the ART Era , incidence
surveys are lacking

5. • MSM excluded from surveillance in settings where same sex behaviour is
stigmatised or criminalised . Data is sparse or limited ,96 out of 196 (most
countries ) have not reported MSM rates last 5 years
• MSM are 19 times more likely to have HIV than the general population, review of
15 countries found that around 20% transgender people are living with HIV.
Transgender women are almost 50 times at risk of HIV than adults in the general
population
• In China, it is estimated that more than one third of the people acquiring HIV
infection are men who have sex with men.
• Projections for Asia indicate that unprotected sex between men could account for
half or more of all new infections by 2020
• Fewer than one in 10 MSM worldwide have access to most basic package of
services , services are not sensitive to their need or they are not led by community
members
• HIV testing and know the status is low 42% and condom use at last sex is very low
among gay , MSM.
• a median of 69% of men who have sex with men were reportedly reached with HIV
prevention programmes .
• Countries lack legal protection for MSM , 25 countries had protecting laws while
75 reported negative

6. Total: 36.9 million [34.3 million – 41.4 million]
Middle East & North Africa
240 000
[150 000 – 320 000]
Sub-Saharan Africa
25.8 million
[24.0 million – 28.7 million]
Eastern Europe
& Central Asia
1.5 million
[1.3 million – 1.8 million]
Asia and the Pacific
5.0 million
[4.5 million – 5.6 million]
North America and Western and Central Europe
2.4 million
[1.5 million – 3.5 million]
Latin America
1.7 million
[1.4 million – 2.0 million]
Caribbean
280 000
[210 000 – 340 000]
Adults and children estimated to be living with HIV  2014

7. Estimated number of adults and children
newly infected with HIV  2014
Middle East & North Africa
22 000
[13 000 – 33 000]
Sub-Saharan Africa
1.4 million
[1.2 million – 1.5 million]
Eastern Europe
& Central Asia
140 000
[110 000 – 160 000]
Latin America
87 000
[70 000 – 100 000]
Caribbean
13 000
[9600 – 17 000]
Total: 2.0 million [1.9 million – 2.2 million]
Asia and the Pacific
340 000
[240 000 – 480 000]
North America and Western and Central Europe
85 000
[48 000 – 130 000]

8. New infections among key populations
70000110000
330000
140000
1865000
New infections among key populations
sex workers
people who injects drugs
Men who have sex with men
clients of sex workers
other adults

9. Why risk is high & what drives HIV in MSM-
• High probability of per act- and per partner transmission through
receptive anal sex
• Spread speedily in large networks
• Clustering of HIV is high in networks
• High rate of dual & multivariant HIV in MSM than heterosexual

10. Global prevalence of MSM

11. Pooled HIV prevalence among men who have sex with men in
low- and middle income countries, by region, 2000–2010
0
5
10
15
20
25
30
HIV Prevalence among MSM
percentage

12. HIV prevalence by Region& country
0 5 10 15
Armenia
Belarus
Georgia
Kazakhstan
Kyrgyzstan
Republic of Moldova
Ukraine
Uzbekistan
Azerbaijan
Tajikistan
2011
2012
2013
2014
0 10 20 30 40 50 60
Democratic Republic of the Congo
Lesotho
Madagascar
Malawi
Mali
Mauritania
Senegal
United Republic of Tanzania
Benin
Botswana
Central African Republic
Congo
Nigeria
Seychelles
Togo
Uganda
Cameroon
Côte d'Ivoire
Ghana
Guinea
Mauritius
Kenya
Swaziland
2012
2013
2014
Latin America Sub Saharan Africa
percentage

13. 0 5 10 15 20 25 30 35 40
Belarus
Georgia
Kyrgyzstan
Republic of Moldova
Uzbekistan
Barbados
Cuba
Jamaica
Bahamas
Dominica
Haiti
Saint Vincent and the Grenadines
Argentina
Colombia
Guyana
Honduras
Nicaragua
Panama
Paraguay
Peru
Belize
Brazil
El Salvador
Mexico
Uruguay
Chile
Costa Rica
Ecuador
europe&CAcaribbeanlatinAmrica
2011
2012
2013
2014
Regional variation in HIV prevalence among MSM in Latin America, Caribbean
Europe & central America

14. Disparity by urban cities
• HIV epidemics among men who have sex with men are expanding rapidly in urban
areas across the region
• In Thailand overall, an average 7% of men who have sex with men are estimated to
be living with HIV, but in Bangkok, the figure is closer to 25%.
• Similarly, in Nigeria, the HIV infection level among men who have sex with men is
17%; in the Federal Capital Territory it is more than twice as high (38%)
• A study in 24 Mexican cities among men who have sex with men found that about
17% of them were HIV-positive.
• Since 2007 there has been an upwards trend of HIV infections from 1% to nearly
7%in Quezon city in Philippine

15. MSM behaviours by Region
Average condom use HIV test uptake
Sub Saharan Africa 54%
Caribbean 40 -80% 16-99%
Asia Pacific 1-90% 2-87%
Middle East & North America
<50%
(except 75% in Lebanon) 60%
Latin America
7-100%
Majority <50% < 50%
Western & central Europe 20-77%
majority less than
50%
Eastern Europe &central Asia 50%-80% 24-74%
*Wide Variation between countries in the Regions Can we reach new global 90 90 90 Targets?
Is C urrent behavior modification (IEC/ BCC strategies make sense? Bio medical interventions?

16. MSM are disproportionately affected
In Asia
Have a higher risk of HIV infection
Asian Epidemic Model projects
by 2020, around 46% of new
infections in Asia will be among
MSM.
Estimated Population of MSM in
Soth East Asia & pacific is

17. Fig 14a :Adult new infections by mode of transmission
in Non-Papua Indonesia
-
20,000
40,000
60,000
80,000
100,000
120,000
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
Husband->wife Wife->husband Casual sex Needle sharing
Sex work Male-male sex Waria sex
Source ;National AIDs control programme Indonesia, based on ASIA epidemic
model and spetcrum

18. population size estimates
Asia Pacific

19. MSM size estimates, countries where data is available
Estimated MSM (a) Year of estimate Year of reporting HIV prevalence (b)
1 Afghanistan (Kabul) 1,729 2012 2014 0.5 (2012)
2 Australia 190,000 2011 2014 10.9 (2012)
3 Bangladesh 110,581 2010 2014 0.7 (Dhaka, 2013)
4 Cambodia 21,000 2008 2014 2.1 (2010)
5 China 3,830,000 2011 2014 7.3 (2013)
6 Hong Kong SAR 120,000 2011 … 4.08 (2011)
7 India
427,000 [High risk MSM, interventions]
3,500,000 [MSM at-risk]
2012 2014 4.4 (2010-11)
8 Indonesia 1,095,970 2012 2014 8.5 (2011)
9 Lao PDR
17,000 [High risk MSM]
49,330 [All MSM and TG]
2011
2010
2014 3.1 (Vientiane, 2011)
10 Malaysia 173,000 2009 2014 12.6 (2012)
11 Maldives 4,100 2009* 0 (2008)
12 Mongolia 11,500 -15,000 (homo and bisexual) 2006 10.7 (Ulaanbaatar,2012)
13 Myanmar 230,000 2010 2014 10.4 (2013)
14 Nepal 196,270 2012 2014 3.8 (2012)
15 Philippines 540,000 (390,733-689,529) 2011 2011* 3.3 (2013)
16 Singapore 90,000 2011 3.1(2013)
17 Sri Lanka 7,551 2013 2014 0.9 (2011)
18 Thailand 550,571 2010 2014 7.1 (2012)
19 Timor Leste 11,197 2010 1.3 (2011)
20 Viet Nam 382,506 2013 2014 3.7 (2013)
Prepared by www.aidsdatahub.org ; Note: a) Please see next slide for references; b) National HIV Sentinel Surveillance surveys and Integrated
Biological and Behavioral surveys reported in GARPR 2013 and 2014
* Year of source reference

20. 0.1 1 1 1 1 1 1.5 1.6 1.6 2.2 2.3 3.1 3.1 4.3 4.8
0
5
%
Regional median 1.6%; Range 0.14% - 4.8%
Size estimates of MSM as proportion of adult male
population (15-49) years
Source: Prepared by www.aidsdatahub.org based on size estimates of MSM ( please see the information provided in the previous 2 slides) and the data on adult male population (15-
49) years is based on 2012 population based on UN Population Division. (2013). World Population Prospects: The 2012 Revision - Extended Dataset.

21. HIV prevalence and
epidemiology Asia Pacific

22. 7.1 7.3
8.5
10.4
12.6
0
5
10
15
20
Thailand (2012) China (2013) Indonesia (2011) Myanmar (2013) Malaysia (2012)
%
Countries with >5% HIV prevalence among MSM in
national estimates from surveys, 2011-2013

23. 6.0 6.5
7.7 7.9 8
10.1 10.3 10.4 10.7
12.4 12.5
13.6 13.7
14.8 15
17.2 17.8
19.5
24.4
0
5
10
15
20
25
30%
Source: Prepared by www.aidsdatahub.org based on National AIDS Committee Thailand. (2012). Thailand Global AIDS Response Progress Report, 2012;
HIV Sentinel Surveillance Reports; Integrated Biological and Behavioral Surveillance Reports; Lan, W., et al. (2012). HIV Prevalence and Influencing
Factors Analysis of Sentinel Surveillance among Men who have Sex with Men in China, 2003-2011 and Chengdu Center for Disease Control and
Prevention. (2014). Intensifying HIV response among MSMs with city-approach in Chengdu city, China.

24. Countries and select cities with rising HIV prevalence trend
among MSM, Asia pacific 2000-2013
7.3
17.8
8.5
17.2
3.3
7.7
0
5
10
15
20
%
China
China (Chengdu)
Indonesia
Indonesia (Jakarta)
Philippines
Philippines (Cebu)
Source: www.aidsdatahub.org

25. Cities with stabilizing/ declining HIV prevalence trend among
MSM, 2000-2013
10.5
6.0
3.8
0
10
20
30
40
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
%
Bangladesh (Dhaka) India (Manipur)
Myanmar (Mandalay) Nepal (Kathmandu Valley)
Source: Prepared by www.aidsdatahub.org

26. HIV prevalence among MSM by region, latest available
year, 2008-2013
0
0.7 0.5 0.9
3.8
4.4
0.5
4.4
7.3
10.7
1.3
2.1
3 3.1 3.1 3.3 3.7 4.2
7.1
8.5
10.4
12.6
0
5
10
15
20 Maldives(2008)
Bangladesh(2013)*
Afghanistan(2012)
SriLanka(2011)
Nepal(2012)
India(2010-11)
Fiji(2011)
PNG(2009)**
China(2013)
Mongolia(2012)***
Timor-Leste(2011)
Cambodia(2010)
Rep.ofKorea(2011)
Singapore(2013)
LaoPDR(2011)****
Philippines(2013)
VietNam(2013)
Japan(2010)
Thailand(2012)
Indonesia(2011)
Myanmar(2013)
Malaysia(2012)
South Asia Pacific East Asia South-East Asia
%
*Dhaka, ** Port Moresby, *** Ulaanbaatar,
****Vientiane

27. 54
22 21
11
2 1 4
12
41
66
70
0
20
40
60
80
100
%
newly reported HIV cases cumulative HIV cases
* both homosexual and bisexual
Proportion of newly reported and cumulative HIV cases
attributable to homosexual transmission, 2011-2014
Source: Prepared by www.aidsdatahub.org

28. Adult new infections by mode of transmission
in Non-Papua Indonesia
-
20,000
40,000
60,000
80,000
100,000
120,000
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
Husband->wife Wife->husband Casual sex Needle sharing
Sex work Male-male sex Waria sex
Source ;National AIDs control programme Indonesia, based on ASIA epidemic
model and spetcrum

29. HIV and AIDS Data Hub for Asia-Pacific
Correlation between reported homosexual mode of
transmission and HIV prevalence among MSM
Source: Prepared by www.aidsdatahub.org based on data from Ministry of Health HIV statistics and AIDS Registry; HIV Sentinel Surveillance Reports; Country Global AIDS
Response Progress Reports 2012 to 2014
3 6
9
12
15
19 21
7.3
0
2
4
6
8
0
5
10
15
20
25
2007 2008 2009 2010 2011 2012 2013
%HIVprevalence
%homosexual
transmission
China
% homosexual transmission
HIV prevalence (National)
2
5
7
11
8.5
0
2
4
6
8
10
0
2
4
6
8
10
12
2007 2008 2009 2010 2011 2012 2013
%HIVprevalence
%homosexual
transmission
Indonesia
% homosexual transmission
HIV prevalence (National)
70.4 72 78 80 79
3.3
0
1
2
3
4
0
20
40
60
80
100
2007 2008 2009 2010 2011 2012 2013
%HIVprevalence
%homosexual
transmission
Philippines
% homosexual transmission
HIV prevalence (National)
34 41 36
46 51 51 54
3.1
0
1
2
3
4
0
10
20
30
40
50
60
2007 2008 2009 2010 2011 2012 2013
%HIVprevalence
%homosexual
transmission
Singapore
% homosexual transmission
HIV prevalence (National)

30. Syphilis prevalence among MSM, 2011-2013
0.7
0.8
1.7
2
4.1
6
7.1
7.5
8.4
10.2
18.4
19.9
2
24.4
0 5 10 15 20 25 30
Viet Nam (2013)
Nepal (2012) *
Bangladesh (2013) *
Philippines (2013)
Mongolia (2012) *
Myanmar (2013)
Timor-Leste (2011)
China (2012)
Guangxi, China…
Afghanistan (2012) *
Singapore (2013) #
Indonesia (2013) #
Sri Lanka (2011) **
Thailand (2013) #
%
Source: Prepared by www.aidsdatahub.org based on 1) HIV Sentinel Surveillance Reports; 2) Integrated Biological and Behavioral Surveillance Reports; 3) Global AIDS Response Progress
Reporting 2013 and 2014 ; 4) Wang et al.(2014). HIV and syphilis prevalence trends among men who have sex with men in Guangxi, China: Yearly cross-sectional surveys, 2008–2012. BMC
Infectious Diseases 2014, 14:367

31. Risk behaviours

32. Mean number of male sexual partners among MSM in
last month, countries where data is available, 2006-
2012
1.3
2.7
3
2.5
3.2
6
0
1
2
3
4
5
6
7
8
9
10
Bangladesh
(2006-07) *
Cambodia
(2010)
PNG
(2010) *
Nepal
(2012) *
Philippines
(2011)
Viet Nam
(2009) *
Meannumber
male commercial partner male sex partner

33. 58
49 48
43
38
13
4
34
8
23
60
10
27
64 63
44
0
10
20
30
40
50
60
70
80
90
100
%
last 12 months last 6 months last 3 months
last month last sex Undefined period
Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveys; 2) Lan, W., Lu, W.,
L.Norris, J., Dong-min, L., Wei, G., Zheng-wei, D., & Ning, W. (2012). HIV Prevalence and Influencing Factors Analysis of Sentinel Surveillance among Men who
have Sex with Men in China, 2003-2011. Chinese Medical Journal, 125(11), 1857-1861.; 3) Bavinton, B., Singh, N., Naiker, D. S., Deo, M. N., Talala, M., Brown,
M.,Navokavokadrau, S. (2011). Secret Lives, Other Voices: A Community-based Study Exploring Male-to-Male Sex, Gender Identity and HIV Transmission Risk in
Fiji.;4) Philippines Department of Health, National Epidemiology Center (2013). 2011 Integrated HIV Behavioral and Serologic Surveillance (IHBSS)

34. Proportion of MSM who reported buying sex from male
and female, 2006-2013
8 8
19 20
27 29
58
62
3
6
14
16
4
49 50
25
0
10
20
30
40
50
60
70
80
90
100
%
bought sex from male
bought sex from female
Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveys

35. 23 27
34 36 36
44 49
56
0
20
40
60
80
100
Sri Lanka
(2006-07)
Nepal
(2012)*
Philippines
(2011)
Cambodia
(2013)
Mongolia
(2012) *
Fiji
(2010) **
Viet Nam
(2009) *
Bangladesh
(2006-07) *
%
Risk of transferring infection
to General population
Proportion of MSM who had sex with female partners
in the last year, 2006- 2013

36. Proportion of MSM who reported condom use at last anal sex
with male partner, 2006-2013
91
87 86
82
79 77
70
66 66
63 61 60
51 49
41
21
17
1
65
0
20
40
60
80
100
Condomuseatlastsex(%)
Still many have not
reached the target

37. Condom use at last anal sex and consistent use among
MSM, 2009-2013
90
85
64
74
70
60 5868 68 66
41 43
48
25
6
57
0
20
40
60
80
100
National,2013*
National,2013*
National,2010
Bangkok,2010
ChiangMai,2010
National,2012
National,2012
National,2011
National,2011
Ulaanbaatar,2011
Ulaanbaatar,2011
National,2011
Jakarta,2011*
Bandung,2011*
Manipur,2009
**Mumbai,2009
Cambodia Thailand Viet Nam China Mongolia Indonesia India
% Condom use at last sex Consistent condom use

38. Figure 24: Percentage of men who have sex with men using condoms during last anal
sex, South-East Asia Region 2011
0
20
40
60
80
100
Condom use at last anal
sex all
<25 years >25 years
82
84
78
75 75
76
85
85
85
66
61 61 61
60
64
58
29
37
23
%ofMSMusingcondom
Myanmar Nepal Thailand Timor Leste
Sri Lanka Indonesia Bangladesh
Target
Condom use in
MSM is below the
target in
most countries
Source: Monitoring and reporting on the global response to HIV and AIDS 2008- 2011; Reports of behavioural surveys, national AIDS programmes. Sample size was
adequate as per national protocols.

39. 0
20
40
60
80
100 %
Total <25 yr 25+ yr
Percentage of MSM with comprehensive HIV knowledge, by
age group, countries where data is available, 2005-2009
Source: Prepared by www.aidsdatahub.org based on UNGASS Country Progress Reports 2006,2008 & 2010

40. 77
70 69 68 67
64 64
53
46
42
24 23 23
64
0
20
40
60
80
100
Preventioncoverage(%)
Definition of reach : Know where to go to receive an HIV test
and had been given condoms in the last 12 months * Programme data
** Data for Kathmandu
Proportion of MSM reached with HIV prevention programmes
in the last 12 months, 2009-2013

41. Proportion of MSM who received an HIV test in the last 12
months and know their results, 2006-2013
87
79
68
65
56
48 46
42 39 36
33
29
26
17 16 15 14
10 9
0
10
20
30
40
50
60
70
80
90
100
Testingcoverage(%)
Data is not strictly comparable across countries since
methods and sampling varied.

42. HIV and AIDS Data Hub for Asia-Pacific
Criminalisation of same-sex sexual activities between
consenting adult males in South-East Asia and the Pacific
countries
42Sources: Prepared by www.aidsdatahub.org based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC.
(2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014 *Federated States of Micronesia
South-East Asia Pacific
Brunei YES Fiji NO
Cambodia NO Kiribati YES
Indonesia NO Marshall Islands NO
Lao PDR NO FSM* NO
Malaysia YES Nauru YES
Myanmar YES Palau NO
Philippines NO Papua New Guinea YES
Singapore YES Samoa YES
Thailand NO Solomon Islands YES
Timor-Leste NO Tonga YES
Viet Nam NO Tuvalu YES
Vanuatu NO

43. HIV and AIDS Data Hub for Asia-Pacific
Criminalisation of same-sex sexual activities between
consenting adult males in South Asia and East Asia
countries
43
South Asia East Asia
Afghanistan YES China NO
Bangladesh YES Japan NO
Bhutan YES Mongolia NO
India YES DRP Korea NO
Maldives YES Rep of Korea NO
Nepal NO
Pakistan YES
Sri Lanka YES
Sources: Prepared by www.aidsdatahub.org based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in
Asia and the Pacific in October 2014

44. HIV and AIDS Data Hub for Asia-Pacific
Adult new infections by mode of transmission
in Non-Papua Indonesia
-
20,000
40,000
60,000
80,000
100,000
120,000
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
Husband->wife Wife->husband Casual sex Needle sharing
Sex work Male-male sex Waria sex
Source ;National AIDs control programme Indonesia, based on ASIA
epidemic model and spetcrum

45. HIV and AIDS Data Hub for Asia-Pacific
Young Key Populations
45

46. HIV and AIDS Data Hub for Asia-Pacific
46
“The analysis carried out by the Commission shows
that over 95% of all new HIV infections among young
people occur among most-at-risk adolescents.”
Report of the Commission on AIDS in Asia. Redefining AIDS in Asia: Crafting an
Effective Response (2008), p. 146.

47. HIV and AIDS Data Hub for Asia-Pacific
The ethical considerations needed to include minors in
studies that ask questions that relate to their sexual
behavior, use of drugs and other risk behaviors
What is different about surveying young key
populations(YKPs)?

48. HIV and AIDS Data Hub for Asia-Pacific
Data need for young key populations
To understand how HIV affects young key populations…
• Surveys have to include enough of young key populations
to yield meaningful results
• Reports of surveys have to include the age disaggregated
data and results
• Age of inclusion differs , comparison difficult
Age of inclusion

49. HIV and AIDS Data Hub for Asia-Pacific
Age of inclusion of YKPs in surveys of key populations, based on
available data from survey reports
49Source: Prepared by www.aidsdatahub.org based on National HIV Sentinel Surveillance, HIV Prevalence Surveys and Behavioral Surveys; Global AIDS Response Progress
Reports 2012 to 2014; UNGASS Progress Reports (2010).
HIV prevalence surveys
– 9-14yrs : Maldives (FSW 13, MSM 10); Pakistan (MSW 13); PNG (FSW 14, MSW 9)
– 15+yrs : Cambodia (FSW 15, MSM 18); Lao (MSM, TG 15); Maldives (PWID 17); Myanmar
(FSW, MSM, PWID 15); Nepal (FSW, MSM, PWID 16); Pakistan (FSW, Hijra 15); Viet Nam (FSW,
MSM, PWID 16)
– 18+yrs : Afghanistan (FSW,MSM, PWID 18); India (FSW, MSM, TG, PWID 18); Pakistan
(PWID 18); Malaysia (MSM,PWID 18)
Behavioral surveys
– 9-14yrs : Maldives (FSW 13, MSM 10); Pakistan (MSW 13); PNG (FSW 14, MSW 9 )
– 15+yrs : Bangladesh (FSW, MSW, MSM, TG, PWID 15); Lao (FSW, MSM, TG 15); Maldives
(PWID 17); Myanmar (FSW, PWID 15); Nepal (FSW, MSM, PWID 16); Pakistan (FSW, Hijra 15); Sri
Lanka (FSW, MSM 16, PWID 17); Timor Leste (FSW, MSM 16)
– 18+yrs : Afghanistan (FSW, MSM,PWID 18); Cambodia (FEW, MSM 18);India (FSW, MSM,
TG, PWID 18); Pakistan (PWID 18); Malaysia (MSM,PWID 18)

50. HIV and AIDS Data Hub for Asia-Pacific
Young MSM are getting infected with HIV!
50
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
HIV prevalence among MSM by age group, countries where the data
is available from 2009- 2013
0.0 0.0 0.8 1.1 1.9 1.9 2.0 2.5 3.0 3.5 5.3 5.6 6.1 6.2 8.8 10.0
1.1 0.9 0.6
4.1
5.3 6.4 6.7
4.8
30.4
4.9
16.3
7.3
9.8
16.0
12.4
11.1
0
5
10
15
20
25
30
35
%HIVprevalence
<25 yr
25+ yr
Countries with HIV prevalence
< 5% among MSM < 25 years
Countries with HIV prevalence
> 5% among MSM < 25 years

51. HIV and AIDS Data Hub for Asia-Pacific
Young PWID are getting infected with HIV!
51
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
HIV prevalence among PWID by age group, countries where the data
is available from 2010- 2013
1.1
13.0
5.1 6.5
19.4
7.7
43.9
20.7
25.3 25
48.1
0.7 1.1 2.7 3.7 4.8 5.3
11.6 11.7
25
33.9
41.2
0
10
20
30
40
50
60
%HIVprevalence
25+ yr
<25 yr
Countries with HIV prevalence
< 5% among PWID < 25 years
Countries with HIV prevalence
> 5% among PWID < 25 years

52. HIV and AIDS Data Hub for Asia-Pacific
Condom use among young MSM is generally lower than
their older counterparts
52
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
Condom use at last anal sex among MSM by age group, countries where
the data is available, 2007-2013
17
24
38 44 45
60 61 64 66 69 70 72 76
84 86 91
65
18
24
45
69
52
66
61 58
69
62
69
79 76 78
88
92
68
0
20
40
60
80
100
Condomuse(%)
< 25 yr 25+ yr

53. HIV and AIDS Data Hub for Asia-Pacific
Proportion of MSM with comprehensive HIV knowledge, by
age group, countries where data is available, 2007-2013
53Source: Prepared by www.aidsdatahub.org based on 1.UNAIDS Report on The Global AIDS Epidemic, 2010; 2. UNGASS Country Progress Reports ;
3. Integrated Biological and Behavioural Survey Reports
0
20
40
60
80
100%
Total <25 yr 25+ yr * Manipur

54. HIV and AIDS Data Hub for Asia-Pacific
Laws and regulations that allow adolescents to seek services without
parental/spousal consent, countries where data is available
54
Source: Prepared by www.aidsdatahub.org based on Department of Maternal, Newborn, Child, and Adolescent Health (WHO) at
http://www.who.int/maternal_child_adolescent/documents/countries/indicators/dashboards/en/ (accessed Feb 4, 2015)
Country
(reporting period)
Contraceptive services
except sterilization
HIV testing and
counselling services
Cambodia (Dec-2013)
India (Feb-2014)
Indonesia (Jan-2014)
Kiribati (Jun-2014)
Lao PDR (Dec -2013)
Malaysia (Dec -2013)
Myanmar (Feb- 2014)
Nepal (Jan-2014)
Pakistan (Feb-2014)
Papua New Guinea (Jan-2014)
Philippines (Mar-2014)
Solomon Islands (Dec-2013)
Sri Lanka (Jan-2014)
Timor Leste (Jan-2014)
Vanuatu (Dec -2013)
Viet Nam (Jan-2014)
Yes
No
No
information

55. HIV and AIDS Data Hub for Asia-Pacific
Compared to their older counterparts,
55
• less young key populations are being reached
by prevention programmes
• less young key populations have access to
HIV testing services and approximately 3 in 4
young key populations do not know their
HIV status

56. HIV and AIDS Data Hub for Asia-Pacific
21
30
25
21
52
47
61
73
78
64
68
78 80
61
12
18 20
29
39
43
49
55
62 63
71
76
80
49
0
20
40
60
80
100%
Proportion of MSM reached with HIV prevention programmes in
the last 12 months, 2008-2013
25+ yr
< 25 yr
Proportion of MSM reached by prevention programmes, by
age group, 2008-2013
56
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

57. HIV and AIDS Data Hub for Asia-Pacific
3 in 4 young MSM surveyed in the region do not know
their HIV status….
57
Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org
7 7 7 12 15 17 22 24 33 36 38 39 45 56 63
24
20 22
13
8
20
37
13
41
36
48
33
45
51
69
51
36
0
20
40
60
80
100 %
Proportion of MSM who received an HIV test in the last 12 months
and know their results, 2008-2013
< 25
25+
Malaysia and Indonesia data is not included in regional median calculation
since the denominators of reported proportion for HIV testing coverage do
not reflect total surveyed MSM and these denominators represent only
those who answered HIV testing related questions

58. Scenario in Sri Lanka

59.  People living with HIV/AIDS
Adults >15 Years - 3200 (2200-5600)
Children <15 Years - 100
 AIDS deaths in 2014 - 100
 Adult HIV Prevalence rate - <0.1%

60. 2133
•Cumulative Number of HIV
Positives as of 2015 2nd quarter
568
•Cumulative Number of AIDS
Cases Reported
348
•Cumulative Number of AIDS
deaths reported

62. Cumulative HIV Cases by District as of end 2014 (N= 1985)
Data not available for 88 cases.
Courtesy :Epidemiologist

64. 69%
24%
5%
2%0%
Probable Mode of transmission among cumulative
reported HIV
Hetero Sexual
Same sex/Bisexual
MTCT
DU/IVDU
N = 783

65. PLHIV (newly diagnosed) reported male to male
transmission shows an increasing trend annually….
1
2.4
6 6
8
3
12
7
16
20
27 28
0
33
72
0
10
20
30
40
50
60
70
80
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
all age groups 15-24
percentage
76.3
18.2
0.7 0.3
4.4
Hetero
Homo/Bi
IDU
Blood
Perinatal

67. MSM population in Sri Lanka
National estimate for MSM in 2013
7551
Range (6547- 8554)

68. Distribution by locations and type of MSM.
home /shanty 16%
lodge hotel, 4%
night club /massage
parlour, 0%
street /public places ,
78%
others , 6%
Cruising sites
Source :2013 size estimation survey
35%
36%
29%
MSW Nachchi
other MSM
typology

69. Geographical distribution of MSM locations-
0
1000
2000
3000
4000
5000
6000
7000
number of MSM
hot spots

70. Progressive coverage of MSM by provinces …….3 provinces
can prioritise to cover 80% of MSM to have an impact
0 10 20 30 40 50 60 70 80 90 100
western
southern
central
N central
northern
north western
Eastern
Sabaragamuwa
Uva
65%
73%
81%
86%
90%
93%
97%
99%
100%
Cumulative coverage

71. Risk behaviours for HIV

72. Sexual Risk behaviours among MSM
• Mean number of partners ranged , 10.7-12.5 in the last 6
months
• 27.5% MSM have sold sex while 19.6% have bought sex
in colombo
• 58.9% ever had sex with women, 73% during last 12
months, condom use was less than 46% , risk for
transmitting HIV to general population
• Almost all had ever anal sex 96%

73. Are MSM safe ? Risk reduction Behaviours among MSM
63.7
13.6
57.9
15.4
19.3
30.46
0 20 40 60 80 100
condom use
HIV testing
reached with prevention
comprehensive knowledge 2014 2006
percentage

74. limitations
• Data gap
Even after 30 years 90 countries have no reports past 5 years .the available available HIV prevalence and
incidence data are incomplete. Lack of population based prevalence estimates and same sex behaviour .
only one incidence estimate in Africa, 2 in Asia. few prospective cohort studies .
Social response bias in reporting anal receptive sex affects estimates of risks
Heavily Urban sampling
Lack of data from middle East & North Africa
Limited data among young MSM – shows high incidence, TI cannot wait till 18 years
Interventions
If transmission is heavily biologically determined , the current programmes Heavily dependent in IEC &
behaviour modification approaches make sense.?
Combined approaches –bio medical interventions –ART for treatment & prevention, Prep
medical circumcision , with BCC & structural interventions –reduce stigma, discriminatory laws.
More research on biology & epidemiology
Simulationmodels –converting homosex-heterosex reduces transmission by80-96%, role change from
receptive to insertive sex to
Highrates ofSTI have the same risk ofHIV transmission to no condoms