Text: James Lo

Safe sex has been promoted for the past 30 years as the best way to minimize the risk of HIV infection. Every gay man in Hong Kong knows that condoms protect against HIV. So why is it that in the past five years the number of gay men in Hong Kong who are getting infected with HIV has trebled? Now 1 in 25 gay men in Hong Kong are HIV positive, from just under 1 in 100 in 2003. Similar rates of growth in infections can be found all over Asia: in Bejing and Shenzhen, the percentage has increased fivefold, and 1 in 10 gay men in Chengdu are HIV positive. Away from China, the statistics are just as alarming – rates in Taiwan, Singapore, Japan have all trebled in the past five years. And in Bangkok and Yangon, almost 30% of gay men are HIV positive.

Researchers point to the growth in internet sex and cross-border “party circuits”. But in essence, the problem is behavioural. With the advent of antiretroviral treatments in 1997, “the balance has shifted for gay men between fear of getting HIV and the search for pleasure and generally that pleasure involves sex without a condom” observes Stevie Clayton, CEO of ACON, a New South Wales based LGBT community HIV/AIDS organization. “We’re probably reaching the stage where we need to accept that there’s safe sex, which is sex with a condom, there’s unsafe sex and in between there’s an area of safer sex that involves risk reduction practices, and that’s where most gay men really are at the moment.”

Groups such as ACON have been adapting to the shifting focus of HIV prevention, and the shifting attention of the groups they are trying to target. Their approach has been very successful: New South Wales is the only region of Australia where HIV rates have remained stable for the past 11 years, and last year the rate even fell.

ACON attributes this success to the singular way that Australia has handled the AIDS epidemic from the very start. Unlike most other countries in Asia (including Hong Kong), the Australian government put together a coordinated and comprehensive response almost immediately after the first infection, which looked not only at HIV prevention, but also at treatment and most importantly policy. In fact, one of the first things that the Australian government did was to set up a panel of experts to look at existing laws to see how they could be changed to support public health measures around HIV/AIDS – for instance, the repeal of sodomy laws, regulation of the sex industry and the introduction of needle and syringe programmes.

In contrast, sex between men is currently still illegal in two-thirds of countries in Asia-Pacific. Even in Hong Kong, while homosexuality has been decriminalized for many years, discrimination still abounds – for instance, the Domestic Violence Ordinance did not originally cover same-sex couples, and the government does not recognize same sex relationships as a matter of legal status. Without an environment where gay men can openly discuss issues such as HIV, the implementation of services targeting them is impossible.

One further factor in Australia’s success has been the involvement of affected communities in determining strategy and response. Community organisations such as ACON are funded directly by the government and so are financially resourced to do the work that they need to do. The government recognized that many of the messages that needed to get out to affected communities would be politically sensitive. For example, research has shown that for the message to hit home, materials distributed to gay men have to able to be explicit – something community organisations can produce which the government cannot without fear of a backlash.

The flexibility of this approach can be seen in the way that ACON itself has evolved. ACON arose from the need to provide HIV/AIDS support to the LGBT community. But over time, and as a result of the success of ARVs, their remit has expanded. “When antiretroviral treatments came along in 1996, HIV suddenly became less central in the lives of gay men. So we decided to put HIV in the same context as it existed in gay mens’ lives, “ explains Stevie Clayton. “If gay men aren’t using [condoms and lube] then it means there are other reasons behind that decision like drugs, like getting older, like issues of esteem, like mental health problems or homelessness. They’re the programmes that we built, so everything we’ve done is about doing better HIV prevention programmes, but they are programmes that are in and of themselves important to the community.”

ACON is now looking to reach out to other organisations in the region. “The challenge for us is how do we maintain a downward trend where rates of HIV are going up everywhere else. You can’t exist in a vacuum, so part of our focus is going to be working with partners in the region.” Partnership has led to some innovative collaborations. ACON are working with AIDS Concern in Hong Kong to look at the issue of sex workers from Hong Kong and mainland China who are working in Australia. Similarly, they have developed a new Thai language project with the Rainbow Sky Association of Thailand to target Thai men who have sex with men simultaneously in both Sydney and Bangkok.

The example of government and community partnership in Australia has been an instructive one for Loretta Wong of AIDS Concern in Hong Kong. “Strong government leadership is lacking in Hong Kong. All we get is a recommended strategy. It’s not clear who is meant to implement what or even what is to be done.” In spite of this, AIDS Concern is stepping up to the challenge. For instance, they are looking into implementing programmes such as in-depth counselling that target individuals who show a consistent record of engaging in unsafe sex.

This need to adapt the message of safe sex has encouraged groups like ACON and AIDS Concern to look beyond their original mission statements to implement programmes such as cross-border collaboration. Their situation is best summed up by Loretta Wong, “Why are HIV rates still increasing? Because fundamentally we are dealing with human beings. Previously a lot of attention was being paid to information giving, but information alone cannot change people’s behaviour. We need to develop programmes to change people’s behaviour and to make behavioural change more sustainable.”

paradigm shift.”