HIV and AIDS Data Hub for Asia-Pacific Review in slides Men who have sex with men Last updated: December 2015

HIV and AIDS Data Hub for Asia-Pacific 2 Data availability and population size estimates HIV prevalence and epidemiology Risk behaviors Vulnerability and HIV knowledge HIV expenditure National response CONTENT

Data availability and population size estimates

HIV and AIDS Data Hub for Asia-Pacific 4 Source: Prepared by based on HIV Sentinel Surveys; Bio-Behavioural Surveys; Data availability from sentinel and behavioural surveys among MSM, a)Afghanistan, Bangladesh, Cambodia, China, Fiji, India, Indonesia, Japan, Lao PDR, Malaysia, Mongolia, Myanmar, Nepal, PNG, Philippines, Rep. of Korea, Singapore, Thailand, Timor-Leste, Viet Nam b)Afghanistan, Cambodia, Fiji, India, Indonesia, Lao PDR, Mongolia, Nepal, PNG, Philippines, Timor-Leste, Viet Nam c)Afghanistan, Bangladesh, Cambodia, China, Indonesia, Malaysia, Mongolia, Myanmar, Nepal, PNG, Philippines, Thailand, Viet Nam

MSM size estimates, countries where data is available Estimated MSM (a)Year of estimateYear of reportingHIV prevalence (b) 1Afghanistan9, (2012) 2Australia190, (2013) 3Bangladesh 110, (2013) 4Cambodia20,000 (Reachable MSM) (2014) 5China3,830, (2014) 6Hong Kong SAR120, …4.1 (2011) 7 India 427,000 [High risk MSM, interventions] 3,500,000 [MSM at-risk] ( ) 8Indonesia 1,095, (2011) 9Japan 700, (2014) 10Lao PDR 56, (2014) 11Malaysia 170, (2014) 12Maldives 4, *0 (2008) 13 Mongolia (Ulaanbaatar & 2 provinces) 3, (2014) 14Myanmar 230, (2014) 15Nepal 196, (2012) 16Pakistan 150, n/a 17Philippines 540,000 (390, ,529) *3.3 (2013) 18Singapore 90, (2013) 19Sri Lanka 7, (2014) 20Thailand 550, (2014) 21Timor Leste 8, (2011) 22Viet Nam 382, (6 provinces, 2014) Prepared by ; Note: a) Please see next slide for references; b) National HIV Sentinel Surveillance surveys and Integrated Biological and Behavioral surveys reported in GARPR 2013 to 2015www.aidsdatahub.org * Year of source reference

HIV and AIDS Data Hub for Asia-Pacific References, MSM population estimation 6 1. Afghanistan Global AIDS Response Progress Reporting Australia Global AIDS Response Progress Reporting 2015 based on Prestage G, Ferris J, Grierson J, Thorpe R, Zablotska I, Imrie J, Smith A and Grulich AE. Homosexual men in Australia: population, distribution and HIV prevalence. Sexual Health 2008; 5: Bangladesh Global AIDS Response Progress Reporting Cambodia Global AIDS Response Progress Reporting 2015 based on MSM size estimation conducted in Ministry of Health China, WHO, and UNAIDS. (2011) Estimates for the HIV/AIDS Epidemic in China (Unpublished). 6. Mok, P. (2011). Sex Between Men in Your City. 7. India Global AIDS Response Progress Reporting 2014 and NACO.(2011). Strategic Approach for Targeted Intervention among MSM 8. Indonesia Global AIDS Response Progress Reporting 2015 based on Ministry of Health.(2013). Estimasi Populasi Rawan Tertular HIV di Indonesia Tahun 2012 (In Indonesian Language) 9. Japan Global AIDS Response Progress Reporting Lao PDR Global AIDS Response Progress Reporting Malaysia Global AIDS Response Progress Reporting WHO. (2009). HIV/AIDS in the South-East Asia Region Mongolia Global AIDS Response Progress Reporting Myanmar Global AIDS Response Progress Reporting Nepal Global AIDS Response Progress Reporting Pakistan Global AIDS Response Progress Repoting Philippine National AIDS Council. (2011). Estimates of the Most At-Risk Population and People Living with HIV. 18.Mok, P. (2011). Sex Between Men in Your City. 19.Sri Lanka Global AIDS Response Progress Reporting 2015 based on National STD/AIDS Control Programme and the Family Planning Association of Sri Lanka. (2013). National Size Estimation of Most at Risk Populations (MARPs) for HIV in Sri Lanka 20. Thailand Global AIDS Response Progress Reporting Timor-Leste Global AIDS Response Progress Reporting Viet Nam Global AIDS Response Progress Reporting 2014

HIV and AIDS Data Hub for Asia-Pacific 7 Size estimates of MSM as proportion of adult male population (15-49) years Source: Prepared by 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 annual population based on UN Population Division. (2015). World Population Prospects: The 2015 Revision - Extended Dataset.

HIV and AIDS Data Hub for Asia-Pacific Percentage of men who ever had sex with men, countries where data is available, * in the last 12 months Sources: Prepared by based on 1) FHI, ICDDR, B., & USAID. (2006). Assessment of Sexual Behavior of Men in Bangladesh: A Methodological Experiment; 2) National AIDS Programme Myanmar. (2005). Behavioral Surveillance Survey 2003: General Population and Youth. 3)National Institute of Medical Statistics, & National AIDS Control Organisation. (2008). National Behavioural Surveillance Survey (BSS) 2006: Youth (15-24 Years); 4) Hong Kong, and Lao PDR_ power point presentation by Frits van Grensven, Thai MOPH-US CDC Collaboration, Recognizing and confronting the epidemic of HIV among MSM in South-East Asia, September 2006: and 5) National Statistics Office Philippines, & ORC Macro. (2004). Philippines National Demographic and Health Survey 2003www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Prevalence of male-to-male sex among adult male population, their heterosexual behavior and marital status, Source: Prepared by based on Cáceres, C. F., Konda, K., Segura, E. R., et al. (2008). Epidemiology of Male Same-Sex Behaviour and Associated Sexual Health Indicators in Low- and Middle-Income Countries: 2003–2007 Estimateswww.aidsdatahub.org

HIV prevalence and epidemiology

HIV and AIDS Data Hub for Asia-Pacific Countries with >5% HIV prevalence among MSM in national estimates from surveys, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific 12 HIV prevalence among adults (15-49) and men who have sex with men, Source: Prepared by based on National HIV Sentinel Surveillance Surveys and Integrated Biological and Behavioural Surveys; UNAIDS. (2015). HIV Estimates and

HIV and AIDS Data Hub for Asia-Pacific HIV prevalence > 5% among MSM in selected geographical locations, Source: Prepared by 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, and Chengdu Center for Disease Control and Prevention. (2014). Intensifying HIV response among MSMs with city-approach in Chengdu city, China.

HIV and AIDS Data Hub for Asia-Pacific Countries and select cities with rising HIV prevalence trend among MSM, Source: Prepared by based on HIV Sentinel Surveillance Reports; Integrated Biological and Behavioral Surveillance Reports; China Global AIDS Response Progress Reports; Chengdu Center for Disease Control and Prevention. (2014). Intensifying HIV response among MSMs with city-approach in Chengdu city, China; and

HIV and AIDS Data Hub for Asia-Pacific Cities with stabilizing/ declining HIV prevalence trend among MSM, Source: Prepared by based on HIV Sentinel Surveillance Reports ; Integrated Biological and Behavioral Surveillance Reportswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific HIV prevalence among MSM by region, latest available year, Source: Prepared by based on 1. HIV Sentinel Surveillance Reports; 2. Integrated Biological and Behavioral Surveillance Reports; and 3. Bangladesh icddr,b, HIV Midline survey among MSM, MSW & TG.

HIV and AIDS Data Hub for Asia-Pacific Proportion of newly reported and cumulative HIV cases attributable to homosexual transmission, Source: Prepared by based on 1. National Epidemiology Center Philippines. (2015). Philippines HIV/AIDS Registry: August 2015; 2. Directorate General of Disease Control and Environmental Health, Ministry of Health, Indonesia (Feb 2014). Situation Progress Report of HIV and AIDS in Indonesia in 2013 (Laporan Situasi Perkembangan HIV & AIDS di Indonesia tahun 2013, Kementerian Kesehatan RI 2013); 3. Ministry of Health and Population Nepal, National Center for AIDS and STD control. Factsheet 2: Reported HIV Cases, as of Asar 2071 (15 July 2014); 4. National AIDS Control Programme Sri Lanka. (2013). Retrieved 10 October 2014, from 5. Ministry of Health Malaysia (2014). HIV and AIDS Reporting ( ); 6. Country Global AIDS Response Progress Reports.; 6. Centre for Health Protection, Department of Health Hong Kong. (2014). Hong Kong STD/AIDS Update, Vol. 19, No.1, Quarter www.aidsdatahub.orghttp://

HIV and AIDS Data Hub for Asia-Pacific Syphilis prevalence among MSM, Source: Prepared by based on 1) HIV Sentinel Surveillance Reports; 2) Integrated Biological and Behavioral Surveillance Reports; 3) Global AIDS Response Progress Reporting 2013 to 2015 ; 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, 14:367www.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Correlation between reported homosexual mode of transmission and HIV prevalence among MSM Source: Prepared by based on data from Ministry of Health HIV statistics and AIDS Registry; HIV Sentinel Surveillance Reports; Country Global AIDS Response Progress Reports 2012 to 2015www.aidsdatahub.org

Risk behaviours

HIV and AIDS Data Hub for Asia-Pacific Mean number of male sexual partners among MSM in last month, countries where data is available, * Capital city ** commercial male partners refer to male sex workers/male clients/paid or paying male partners Source: Prepared by based on Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveyswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who sold sex to men, Source: Prepared by 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, Chinese Medical Journal, 125(11), ; 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.

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who reported buying sex from male and female, Bought sex * from male = last month, from female = last 12 months; ** last month for both male and female; *** from male= last 12 months, from female = ever; # last 12 months; India: ever for both male and female Source: Prepared by based on Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveyswww.aidsdatahub.org

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who had sex with female partners in the last year, * Capital city; ** Last 6 months; *** Colombo (ever had sex with a woman) Source: Prepared by 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.

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who reported condom use at last anal sex with male partner, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Source: Prepared by based on Country Global AIDS Response Progress Reports 2012; Integrated Bio-Behavioural Surveys; and Behavioural Surveillance Surveyswww.aidsdatahub.org Condom use at last anal sex and consistent use among MSM, * with commercial/paid partners; ** with clients;

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reported consistent condom with male commercial partners in the last month, HCMC = Ho Chi Minh City; * undefined period Source: Prepared by based on 1.Integrated Biological; 2. Behavioural Surveys and Behavioural Surveillance Surveys; and 3. icddr,b. (2015). A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b.

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reported consistent condom use with non-commercial/casual partners, Source: Prepared by 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; and 4. icddr,b. (2015). A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b.

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reported consistent condom use with male partners, Source: Prepared by based on 1) Integrated Biological and Behavioural Surveys and Behavioural Surveillance Surveys; 2) Lan, W., Lu, W., L.Norris, J., et al. (2012). HIV Prevalence and Influencing Factors Analysis of Sentinel Surveillance among Men who have Sex with Men in China, Chinese Medical Journal, 125(11), Last 6 months Last year Last 3 months Last month

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who inject drugs, Source: Prepared by based on 1. Integrated Biological; 2. Behavioural Surveys and Behavioural Surveillance Surveys; and 3. icddr,b. (2015). A Survey of HIV, syphilis and risk behaviors among males having sex with males, male sex workers and hijra. Global Fund Rolling Continuation Channel Project of icddr,b. * Capital city; ** Luang Prabang

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who had been raped/forced to have sex in the last 12 months, Source: Prepared by based on 1) Integrated Biological and Behavioral Surveys ; and 2. Behavioral Surveillance Surveyswww.aidsdatahub.org * Last 6 months; ** ever raped

Vulnerability and HIV knowledge

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM with comprehensive HIV knowledge, by age group, countries where data is available, Source: Prepared by based on UNGASS Country Progress Reports 2006,2008 & 2010www.aidsdatahub.org # Port Moresby; ## Kathmandu Valley; * Colombo; ** Manipur; *** Dhaka

HIV Expenditure

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of AIDS spending by major spending category, Asia and the Pacific, Source: Prepared by based on AIDS spending breakdown is not available for China and India

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Source: Prepared by based on Proportion of prevention spending by category, Note: Data from latest available year. China and India did not report prevention spending breakdown. Youth Prevention mother- to-child General prevention and others Sex workers and their clients People who inject drugs Men who have sex with men

HIV and AIDS Data Hub for Asia-Pacific Prevention spending in Asia and the Pacific – low on HIV prevention spending among MSM, latest available year reported by countries, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Distribution of prevention spending by financing source in Asia and the Pacific, latest available year, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Latest!Latest! Proportion of MSM prevention spending from domestic public sources is still very low 39 Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific 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 40 Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Spending on HIV prevention programmes focused on MSM, Source: Prepared by based on

National response

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM reached with HIV prevention programmes in the last 12 months, Source: Prepared by based on

HIV and AIDS Data Hub for Asia-Pacific Proportion of MSM who received an HIV test in the last 12 months and know their results, Source: Prepared by based on and 1. MEN Fiji, The Draft Report of 2011 IBBS of Transgender and MSM in Suva and Lautoka reported in GARPR 2012 online report; 2. Ministry of Health Indonesia.(2014). Recalculated HIV Testing Coverage presented at the Regional Management Meeting (RMM) 2014 using IBBS 2011 Data; and * Programme data Data is not strictly comparable across countries since methods and sampling varied. In addition, many surveys were conducted in a few urban areas and it might not necessarily reflect prevailing conditions at the national level.

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 45 Sources: Prepared by 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

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 46 South Asia East Asia AfghanistanYES ChinaNO BangladeshYES JapanNO BhutanYES MongoliaNO IndiaYES DRP KoreaNO MaldivesYES Rep of KoreaNO NepalNO PakistanYES Sri LankaYES Sources: Prepared by based on UNAIDS, Data Hub, UNDP, UNFPA, and UNODC. (2014). Punitive Laws Hindering the HIV Response in Asia and the Pacific in October 2014

HIV and AIDS Data Hub for Asia-Pacific 47 THANK YOU slides compiled by 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 if slides are lifted directly from this sitewww.aidsdatahub.org