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.