Cambodia has the highest HIV/AIDS prevalence in South East Asia, but has also made significant inroads against the disease since it first appeared in 1991. According to UNAIDS, the estimated level of infection among adults has dropped from a high of 3 percent in 1997 to 1.6 percent in 2006, which can be partly attributed to increasing HIV mortality as those infected during the period of peak HIV incidence move into AIDS.
Current surveillance data also suggest that the epidemic, largely driven by the continued patronage of commercial sex workers by Cambodian men, is changing: behavioural data now show consistently higher rates of condom usage in the sex industry, largely the result of enhanced public information campaigns and an assertive effort to promote 100 percent condom usage.
HIV incidence among sex workers and their clients appears to have been dramatically reduced, as corroborated by a reduction in the prevalence of other sexually transmitted infections (STIs) among them, but sexual networking continues to shift towards casual sex, making MSM as a risk group all the more important.
MSM PREVALENCE RATES
Prevalence in the general population has also declined in recent years, but health workers warn there is little room for complacency. According to the latest survey by the Cambodian National Centre for HIV/AIDS Dermatology and STDs (sexually transmitted diseases), the HIV prevalence rate among MSM in Phnom Penh is 8.7 percent, and their networking behaviour has become a serious source of concern.
Of the 58 percent of men surveyed in three provinces – Phnom Penh, in the south, and Batdambang and Siem Riep in the northwest – who reported having sex with female partners in the past year, almost 25 percent also reported having sex with female sex workers, with 16.6 percent having had sex with casual female partners in the past month.
“When you have a very dense network, and when you have crossovers in the network between males and females, in the presence of high risk of STIs and in the presence of very low condom usage, then you have a potential for an explosive epidemic,” Lisle warned.
“You’re looking at multipartner behaviour,” the UNAIDS official said, pointing out that not only were the men putting themselves at risk, but also the women they slept with.
MSM – A GLOBAL PHENENOMENON
Male-to-male sex is found in every culture and society, and is often defined as a social and behavioural phenomenon rather than a specific group of people. Although the description may include men who identify themselves as being homosexual or gay, bisexual or transgender, it can also include men who identify themselves as exclusively heterosexual and are often married, particularly where discriminatory laws or social stigma exist.
The manner in which Cambodian MSM define themselves blurs this distinction even more: according to a 2004 study of 1,306 MSM by Family Health International (FHI), ‘Men Who Have Sex with Men in Phnom Penh, Cambodia: Population Size and Sex Trade’, there are four times more of what are described locally as ‘short-haired MSM’ (masculine-acting MSM who have sex with each other) than ‘long-haired MSM’ (transgender MSM whose masculine sexual partners identify themselves as being from either group).
Relations between the two groups are not always cordial. Short-haired MSM enjoy a degree of privacy by being less visible than long-haired MSM, who tend to be more conspicuous, have a great deal of difficulty in securing employment and are often thrown out of their homes.
A recent report on ‘MSM and HIV/AIDS Risk in Asia’, by Therapeutics Research Education AIDS Training Asia (TREAT Asia), found that short-haired MSM were more likely to receive money for sex (20 percent regularly and 41 percent occasionally)