Programmatic coverage for men having sex with men remains inadequate across the Asia and the Pacific region, Director of UNAIDS Asia and the Pacific Steven Kraus told People’s Daily Online on Sunday. Male-to-male sex becomes the prominent contributing factor to new HIV infections, pointed out by UNAIDS in a latest report on HIV in the region.

The following is the excerpt of People’s Daily Online’s written interview with Kraus on this year’s World AIDS Day.

PD Online: UNAIDS report mentioned that men infected by having sex with HIV-infected men are growing significantly. Why does it become so serious?

Steven Kraus: The fastest-growing epidemics in the region are among men who have sex with men. And what we are seeing is that these epidemics are typically concentrated in major cities—HIV prevalence among men who have sex with men is over 10 percent in at least 10 Asian metropolitan areas.

This is not a new phenomenon. Five years ago, the Commission on AIDS in Asia predicted that if men who have sex with men did not become a greater focus of HIV prevention efforts, this population would bear nearly half of all new infections by 2020 and represent the largest share of new infections among key populations at higher risk. Now, overall trends of new HIV infection hint that the Commission’s prediction is becoming a reality.

PD Online: Have Asia-Pacific countries been aware of this trend?

Steven Kraus: One of the challenges is that programmatic coverage for this key population remains inadequate across the region. So that means not enough men who have sex with men are accessing essential HIV prevention services (such as peer outreach, distribution of condoms and lubricants, HIV testing and counseling, antiretroviral treatment and linkages to other services). We’re seeing evidence that suggests fewer than half men who have sex with men used condoms consistently in the cities with rising HIV prevalence. And over two-thirds of men who have sex with men in the region do not know their HIV status.

Many men who have sex with men avoid health and HIV services and/or seeking help for fear of legal and social repercussions, discrimination and even violence. Some 18 out of 38 countries in Asia and the Pacific criminalize same-sex sexual activities.

Financing for programs and services for men who have sex with men must increase dramatically. Although countries in Asia and the Pacific have increased overall HIV spending over the last few years, very little is spent on programs and services for men who have sex with men — even in countries recording high percentages of HIV transmission through unprotected sex between males. For instance, in 2011, the Philippines spent 9 percent of its prevention budget on men who have sex with men, but they represent 80 percent of newly reported HIV cases.

PD Online: What will UNAIDS do to help the countries to find solutions to the problem?

Steven Kraus: Addressing HIV among men who have sex with men is one of the key priorities for the AIDS response in Asia and the Pacific and this is one of the central issues of focus for UNAIDS. There is a lot that can be done. We have the tools, evidence, experience and know-how to rapidly mobilize to action, across all sectors, and turn the epidemic among men who have sex with men around.

We urgently need innovative, appropriately designed programs that can be rapidly scaled up and supported by a range of investments by governments, donor agencies, the private sector, and communities of men who have sex with men. Responding to the evidence, city-based responses ensuring links between HIV testing, counseling, prevention and treatment, need to be prioritized.

Meaningful involvement of men who have sex with men in the initiation, development and delivery of HIV programs and services, as well as in advocating for safe sex and increased HIV testing and counseling, is critical and proven to have a significant impact. Community leaders can provide critical information and evidence on HIV testing and the benefits of knowing one’s status for early treatment, mobilizing the larger community as a whole.

• Asia and the Pacific needs more funds to fight AIDS

• HIV stigma, discrimination remain widespread in Asia-Pacific region

• More efforts needed by Asia-Pacific countries to create an AIDS-free generation

• China's fight against AIDS gains 'huge progress'

• Full text of interview with Steven Kraus, Director of UNAIDS Asia and the Pacific