Men who have sex with men Last updated: December 2018

CONTENT Population size estimates HIV prevalence and epidemiology Risk behaviors Vulnerability and HIV knowledge HIV expenditure National response

Population size estimates

Men who have sex with men size estimates Country Estimated size Definition Adult males As% of males (15-49) Afghanistan(2015) 10,700 Males 15+yrs; both active and passive 8,049,121 0.1 Australia(2011) 190,000 Self identify as men who have sex with men 5,614,708 3.4 Bangladesh(2015) MSM:101,695 MSW: 29,776 MSM: Males 10+ yrs; who had sex with males with consent in the last year regardless of whether they have sex with women or have a personal/social gay or bisexual identity but do not sell sex. MSW: Males who sell sex to other males in exchange of money or gifts in last 3 months 53,473,975 MSM: 0.2 MSW: 0.1 Cambodia(2015) 20,000 Information not available 4,083,152 0.8 China(2013) 3,960,000 Males 15-65 yrs; who have sex with men in recent year 400,323,128 1.0 India(2009) 357,000 365,281,206 Indonesia(2016) 754,310 Biological males aged 15-49 years or older who had sex with a man in the last 12 months 71,618,154 1.1 Japan(2013) 519,721 27,384,599 1.9 Lao PDR (2018) 54,624 1,817,676 2.8 Malaysia(2017) 140,000 Males 18+ yrs, who had engaged in anal sex with men at least once in the previous six months 8,472,244 2.0 Mongolia(2014) 3,118 Males 15-49 yrs; who had anal or oral sex with men in the past 12 months 836,336 0.4 Myanmar(2015) 252,000 Males 15+ yrs; who has had anal sex with another male in the past 6 months 14,349,533 1.8 Nepal(2016) MSM: 60,333 MSW: 18,287 MSM: Males who have oral and/or anal sex with other biological males, at least once, in the past 12 months. MSW: Males 16+yrs; who had oral and/or anal sex with other males in the past 12 months in exchange for money or other benefits. 7,145,550 MSM: 1 MSW: 0.3 Pakistan(2016) MSM: 832,213 MSW: 55,340 MSM: Male 13+ yrs who has sex with other men as a matter of preference or practice, regardless of their sexual identity/orientation, and irrespective of whether or not they also have sex with women MSW: Males 13+yrs; who undertakes sexual activity with a man in return for money or benefits 51,045,195 MSM: 1.6 Philippines(2015) MSM: 531,500 MSW: 86,600 MSM: Males 15+ yrs; who had oral or anal sex with a male in the past 12 months. MSW: Males 15+yrs; who had oral or anal sex with a male in the past 12 months and accepted cash or kind in exchange for sex regardless of establishment-based or not 24,435,734 MSM: 2.2 MSW: 0.4 Sri Lanka(2013) 7,551 All men who have sex with other men as a matter of prevalence or practice, regardless of their sexual identity or sexual orientation. 5,049,250 Thailand(2016) MSM: 590,700 MSW: 15,000 MSM: Male 18+, anal or oral sex with male in the past 12 months. MSW: Male 18+ who exchange money or goods for sexual services either regularly or occasionally in the last 12 months 17,559,378 MSM: 3 MSW: 0.2 Viet Nam(2017) 174,944 Male 18+ yrs; who have oral or anal sex with another man in the past 12 months 26,182,125 1.5 Source: Global AIDS Monitoring reporting 2016 to 2018, China 2013 HIV estimation, and United Nations, Department of Economic and Social Affairs, Population Division (2017). World Population Prospects: The 2017 Revision

HIV prevalence and epidemiology

Distribution of new HIV infections by population, 2017 84% of new HIV infections in Asia and the Pacific are concentrated among key populations and their sexual partners Distribution of new HIV infections by population, 2017 84% of new HIV infections among key populations and their partners Sex workers People who inject drugs Men who have sex with men Transgender Clients of sex workers and partners of key populations Rest of population Source: Prepared by www.aidsdatahub.org based on UNAIDS (2018). Miles To Go: Closing Gaps, Breaking Barriers, Righting Injustices

New HIV infections will escalate if we continue “business as usual” Philippines Malaysia Source: Prepared by www.aidsdatahub.org based on AIDS Epidemic Modelling submitted for the HIV estimates 2018

Select geographical locations where HIV prevalence is higher than 5% among MSM, 2013-2017 Source: Prepared by www.aidsdatahub.org based on 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.; Global ADIS Response Progress Reporting 2016; Global AIDS Monitoring 2017 and 2018

High and/or rising HIV prevalence among men who have sex with men in cities, 2007-2017 Source: Prepared by www.aidsdatahub.org based on HIV Sentinel Surveillance Reports and Integrated Biological and Behavioral Surveillance Reports; GARPR Reporting and Global AIDS Monitoring

HIV prevalence among MSM by region, latest available year, 2011-2017 * Capital region/city, ++ 4 provinces, +++ 3 cities (Bangkok, Chiang Mai, and Phuket) 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; and 4.Global AIDS Monitoring

Active syphilis prevalence among men who have sex with men, 2011-2018 Source: Prepared by www.aidsdatahub.org based on 1) HIV Sentinel Surveillance Reports; 2) Integrated Biological and Behavioral Surveillance Reports; and 3) Global AIDS Response Progress Reporting and Global AIDS Monitoring 2018

Risk behaviours

Proportion of MSM who reported condom use at last anal sex with male partner, 2014-2017 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org; Global AIDS Response Progress Reporting and Global AIDS Monitoring

Consistent condom use among men who have sex with men, 2011-2018 Prevention gap: consistent condom use is less than 60% in many countries where data is available Consistent condom use among men who have sex with men, 2011-2018 90% * casual (non-transactional) male partners; ** when bought sex Source: Prepared by www.aidsdatahub.org based on Country Global AIDS Response Progress Reports; Integrated Bio-Behavioural Surveys; HIV Sentinel Surveillance Surveys and Behavioural Surveillance Surveys

Condom use at last anal sex and consistent use among MSM, 2010-2018 * with commercial/paid male partners; ** casual male partners Source: Prepared by www.aidsdatahub.org based on Country Global AIDS Response Progress Reports 2012; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveys

Proportion of surveyed MSM who sold sex to men, 2011-2018 Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveys

Proportion of MSM who reported buying sex from male and female, 2009-2016 Source: Prepared by www.aidsdatahub.org based on Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveys

Proportion of MSM reported consistent condom with male commercial partners in the last month, 2013 - 2017 HCMC = Ho Chi Minh City Source: Prepared by www.aidsdatahub.org based on Integrated Bio-Behavioural Surveys and Behavioural Surveillance Surveys

Proportion of MSM reported consistent condom use with non-commercial/casual partners, 2010-2018 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioural Surveys, and Behavioural Surveillance Surveys; 2) Chan, R., Chio, M., Lim, S., Poh, K., Tan, A., Loh, B., & Foong, J. (2013). Outreach HIV Testing Project in Venues Frequented by Men who have Sex with Men (MSM) – August 2013 – October 2013; 3) Bavinton, B., Singh, N., Naiker, D. S., et al. (2011). Secret Lives, Other Voices: A Community-Based Study Exploring Male-to-Male Sex, Gender Identity and HIV Transmission Risk in Fiji. Suva, Fiji: AIDS Task Force of Fiji

Proportion of MSM who had sex with female partners in the last year, 2009 - 2018 Source: Prepared by www.aidsdatahub.org based on 1. Integrated Biological and Behavioral Surveys; 2. Behavioral Surveillance Surveys; and 3. Bavinton, B., Singh, N., Naiker, D. S., et al. (2011). Secret Lives, Other Voices: A Community-Based Study Exploring Male-to-Male Sex, Gender Identity and HIV Transmission Risk in Fiji. Suva, Fiji: AIDS Task Force of Fiji.

Proportion of MSM who inject drugs, 2012-2018 * Capital city Source: Prepared by www.aidsdatahub.org based on 1. Integrated Biological and Behavioural Surveys and 2. Behavioural Surveillance Surveys

Prevailing stigma, discrimination and violence against MSM Physical violence Sexual violence Stigma and mental health * Experienced violence or rape in the last year Source: Prepared by www.aidsdatahub.org based on Integrated Behavioral and Surveillance Surveys

Proportion of MSM who had been raped/forced to have sex in the last 12 months, 2010-2018 *Last 6 months; ** ever experienced forced sex/rape PNG is mixed sample of MSM and TG Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys ; 2. Behavioral Surveillance Surveys

Vulnerability and HIV knowledge

Proportion of MSM with comprehensive HIV knowledge, by age group, countries where data is available, 2008-2016 Source: Prepared by www.aidsdatahub.org based on 1) Integrated Biological and Behavioral Surveys ; 2. Behavioral Surveillance Surveys and 3) UNGASS and Global AIDS Response Progress Reporting

HIV expenditure

15% 6% 21% 4% 81% 3% Bangladesh Nepal Philippines Mismatch in investments: too little has been spent for MSM prevention programme where big chunk of new infections are occurring among MSM Proportion of MSM among Adult (15+) new HIV infections Spending on MSM HIV prevention programme out of total AIDS spending 15% 6% Bangladesh 21% 4% Nepal 81% 3% Philippines New HIV infections among MSM Spending on MSM prevention programme Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting; and Country submitted AEM-Spectrum files for GARPR 2016 reporting

Key populations account for 60-90% of new HIV infections in Asia and the Pacific countries but only a third was spent for key populations HIV prevention programme Proportion of prevention spending among key populations in Asia and the Pacific region 35% 19% 10% 6% of total prevention spending 15 countries: Afghanistan, Bangladesh, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Nepal, Palau, Pakistan, Philippines, Solomon Island, Sri Lanka, Thailand and Vietnam Source: Prepared by www.aidsdatahub.org based on GARPR reporting

Prevention spending on key populations is heavily dependent on international financing sources Distribution of prevention spending by financing source in Asia and the Pacific, latest available year, 2009-2014 Spending by service category is not available for India and China Source: Prepared by www.aidsdatahub.org based on Global AIDS Response Progress Reporting

Proportion of AIDS spending by major spending category, Asia and the Pacific, 2009-2013 AIDS spending breakdown is not available for China and India Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of prevention spending by category, 2009-2013 Youth Prevention mother-to-child General prevention and others Sex workers and their clients People who inject drugs Men who have sex with men Note: Data from latest available year. China and India did not report prevention spending breakdown. Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Proportion of MSM prevention spending from domestic public sources is still very low Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Trends in proportion of spending on MSM prevention programmes out of total prevention spending, countries with >5% HIV prevalence among MSM in national estimates from surveys Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

Spending on HIV prevention programmes focused on MSM, 2009-2013 Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org

National response

HIV testing response gap to reach Fast-Track target: less than half of men who have sex with men know their HIV status HIV testing coverage among men who have sex with men, 2014-2017 90% *Dhaka and Hili; ** Programme data Source: Prepared by www.aidsdatahub.org based on www.aidsinfoonline.org ; Global AIDS Response Progress Reporting; and Global AIDS Monitoring

Proportion of MSM reached with HIV prevention programmes, 2015-2017 Definition of reach: In the past three months, MSM reported receiving two or more of the prevention interventions listed below - Given condoms and lubricants Received counselling on condom use and safe sex Tested for sexually transmitted infections Source: Prepared by www.aidsdatahub.org based on Global AIDS Monitoring Reporting 2017 and 2018

Criminalisation of same-sex sexual activities between consenting adult males in South-East Asia and the Pacific countries South-East Asia   Pacific Brunei YES Fiji NO Cambodia Kiribati Indonesia Marshall Islands Lao PDR FSM* Malaysia Nauru Myanmar Palau Philippines Papua New Guinea Singapore Samoa Thailand Solomon Islands Timor-Leste Tonga Viet Nam Tuvalu Vanuatu 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 *Federated States of Micronesia

Criminalisation of same-sex sexual activities between consenting adult males in South Asia and East Asia countries South Asia   East Asia Afghanistan YES China NO Bangladesh Japan Bhutan Mongolia India DRP Korea Maldives Rep of Korea Nepal Pakistan Sri Lanka 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

slides compiled by www.aidsdatahub.org THANK YOU slides compiled by www.aidsdatahub.org Data shown in this slide set are comprehensive to the extent they are available from country reports. Please inform us if you know of sources where more recent data can be used. Please acknowledge www.aidsdatahub.org if slides are lifted directly from this site