Insular Southeast Asia Consultation Final Report

Insular Southeast Asia Consultation

on Male to Male Transmission of HIV
Bali, Indonesia, 4 – 6 August 2009

Meeting Report
ACKNOWLEDGEMENT

This report was prepared by PW Rudolf on behalf of the participants of the
Insular Southeast Asia Consultation on Male‐to‐Male Transmission of HIV, held
in Bali, Indonesia, on 4‐6 August 2009. The report was edited by Paul Causey.
The consultation work was coordinated by Sardjono Sigit under the supervision
of Dédé Oetomo.
GAYa NUSANTARA as the host, and on behalf of UNESCO, UNDP, the Asia Pacific
Coalition on Male Sexual Health (APCOM) and the Steering Committee, would
like to thank the participants for their contributions and co‐operation during the
meeting.
The voice of this meeting has been brought to the subsequent global meeting, the
9th International Congress on AIDS in Asia and the Pacific (ICAAPIX) held on 9‐13
August 2009.

The Insular Southeast Asia Consultation on Male‐to‐Male Transmission of HIV – Final Report

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SUPPORTERS AND DONORS

Host:
GAYa NUSANTARA

Coordinator:
UNESCO
On behalf of:
United Nations Development Program (UNDP)/United Nations Population Fund
(UNFPA) and the Asia Pacific Coalition on Male Sexual Health (APCOM)

Donors:
Hivos
UNDP/UNFPA
UNESCO
USAID – FHI (Family Health International)
USAID‐HPI (Health Policy Initiative)
USAID‐MSH (Male Sexual Health/ program AIDSTAR II)

Logistical Support:
APCOM (pre‐meeting)
PATA
Consultation Venue/Hospitality:
Inna Grand Bali Beach, Sanur, Bali


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Steering Committee:

Dédé Oetomo, Chairperson – Indonesia (APCOM)
Andrew Tan – Malaysia (APCOM)
Edmund Settle ‐ UNDP
Ferdinand V. Buenviaje – the Philippines (APCOM)
Jan W. de Lind van Wijngaarden – UNESCO
Lenny Sugiharto – Indonesia (APCOM)
Paul Jansen – Hivos
Philippe Girault – FHI
Rapeepun (Ohm) Jommaroeng– UNESCO
Shivananda Khan – APCOM/NFI

Focal point
Sardjono Sigit – Indonesia (GAYa NUSANTARA)

Support staff
Rafael Hendrikus (Vera Cruz) Da Costa – Indonesia (GAYa NUSANTARA)
Erick (Ericka) Yusufanny – Indonesia (GAYa NUSANTARA)
Hadi Purwanto (Angeli) – Indonesia (GAYa NUSANTARA)

Consultant
Paul Causey – Thailand (APCOM)


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ABBREVIATIONS & DEFINITIONS

MSM (men who have sex with men)
MSM is an inclusive public health term used to define the sexual behaviors of
males having sex withother males, and does not refer to an identifiable
community or gender identification. Within this context it is understood that the
word ‘man’/‘men’ is socially constructed; as well, within the framework of male‐
to‐male sex, there are a range of masculinities along withdiverse sexual, gender
and transgender identities, communities and networks.
TG (transgender)

TG is a general term applied to a variety of individuals, behaviors, and groups
involving tendencies that diverge from the normative gender role commonly, but
not always, assigned at birth, as well as the role traditionally held by society. It is
the state in which one’s “gender identity” (self‐identification as woman, man, or
neither) does not match one’s “assigned/birth sex” (identification by others as
male of female based on physical/genetic sex).

A TG individual may have characteristics that are normally associated with a
particular gender, may identify elsewhere on the normative gender continuum,
or outside of it as “third gender”.

Access to MPS Definitions and Abbreviations Used:
ART Aantiretroviral therapy (anti‐HIV drugs)
Condom & Lube Received free C&L (C&L)
Peer/Outreach Education P2P, educational sessions, social event,
Internet outreach, Hotline (all ORW)
PLHIV People living with HIV or AIDS
STI Check‐up STI Sexually transmitted infections,
symptoms &and Screening screening (STI)
Targeted media VCD, Internet, flyer/brochure, billboard
(Targeted Media)
VCT Voluntary counseling and HIV testing (for HIV
antibodies) past year and get results for those
who want to know, join survey and research
only (VCT)

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CONTENTS
Page
Acknowledgement 2
Supporters and donors 3
Steering Committee 4
Abbreviations 5
Executive Summary 7
Introduction 9
Working Groups 10
Overview:
1. Epidemiology of HIV Among MSM/TG 11
2. Socio‐cultural aspects of male‐to‐male sexuality in the
region and how these link to HIV risk and vulnerability 14
3. Legal/human right issues, including for people living with
HIV and AIDS 16
4. Coverage of interventions for prevention, care and support
of MSM/TG 18
5. Agreed‐upon minimum package of services for MSM/TG 22
6. Gaps in Knowledge and Information 24
7. Country working group feedback on proposed multi‐organizational
collaboration: the birth of a sub‐regional network 25

Program 28
List of Participating Persons 35

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EXECUTIVE SUMMARY
Background
The latest epidemiological data show that some cities in the Insular Southeast
Asia sub‐region are experiencing severe HIV epidemics among MSM and TG and
most others are standing well are their way to high HIV prevalance rates.. Those
areas with mild epidemices among MSM and TG, that is, those with low or very
low prevalance, will likely follow the others to extremely high rates unless the
stiuation is addressed quickly and effectively.
Realizing these problems are often shared by neighboring countries, coupled
with the belief that working together and in partnerships will be more effective
and efficient, the Insular Southeast Asia Consultation on Male‐to‐Male
Transmission of HIV was conducted in Bali, Indonesia on 4‐6 August 2009.
Hosted by GAYa NUSANTARA, the consultation meeting was funded by a group of
donors, including: APCOM, Hivos, UNDP, UNDP/UNFPA, UNESCO, UNESCO,
USAID – FHI, USAID‐HPI, USAID‐MSH/AIDSTAR II
. The meeting brought together 62 participants from community organizations

and networks along with government representatives, technical experts and
donors. The main objectives of this meeting were:
a. To review the epidemiology of HIV in Insular Southeast Asia
b. To review socio‐cultural aspects of male to male sexuality in Southeast
Asia and to assess linkages to HIV risk and vulnerability
c. To review legal and human rights issues, including those pertaining to
people living with HIV
d. To review the current coverage of interventions for MSM
e. To discuss the need to agree, among stakeholders, on a minimum package
of services
f. To establish an informal network of civil society organizations, donors,
technical support agencies and government representatives working in
Brunei Darussalam, Indonesia, Malaysia, the Philippines, Singapore, and
Timor Leste to decide representation/relationship of the new network to
APCOM

The expected outcomes of the Insular South‐East Asia MSM and HIV meeting
included:

1. Mechanism of Insular Southeast Asian countries on how to work as a sub‐
regional network and how to maintain communications and exchanges
with APCOM and PSN, and possibly with the Pacific Sub‐regional Network.
2. Consolidation of ‘what we know’ and ‘where we are’ on HIV and MSM in
Insular Southeast Asia, and agreement on what is missing.


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Preparations and Lead Up

As preparatory work for the meeting, a selection process has been made for the
representatives of the organizations or individuals to participate, with the
following criteria:

a. Highly motivated in the organization’s advocacy, research or
implementation of projects related to MSM and TG in their country or
sub‐region.
b. Good oral and written English.
c. Trusted to represent and make decision on behalf of the organization.
d. Willing and able to participate in the entire process of this meeting.
e. Has a passport or is willing to make one at own expense.
f. Submission of the participant form.

Key papers were identified and distributed to all participants with topics
covering epidemiology, socio‐cultural aspects of male‐to‐male sexuality and how
these link to HIV risk and vulnerability, legal/human right issues, coverage of
interventions, Minimum Package of Service, gaps in knowledge and information
as well as in technical assistance.

Goal

To contribute to more intensive, expanded, evidence‐based responses to prevent
HIV and improve access to health services and treatment for men who have sex
with men and transgender in Insular Southeast Asia.

Purpose

To strengthen collaboration and networking between organizations and
governments working on MSM and HIV in Insular Southeast Asia and to plan for
improved advocacy, better evidence, enhanced technical assistance to improve
the quality of interventions, improved information sharing and possibly the
development of a regional strategy on HIV and MSM.

Interpreters

A team of interpreters assisted the flow of discussions in order to bridge
language barriers. This two‐way interpretation allowed most if not all
participants the ability to participate in discussions, fully‐understanding content
and contexts, and to express their own opinions, make comments and offer
suggestions.


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INTRODUCTION

Twenty years after the first case of acquired immunodeficiency syndrome was
reported, HIV and AIDS has developed into a devastating global epidemic. In
Asia, an estimated 4.9 million people were living with HIV in 2007, including
440,000 people newly infected that year. Approximately 300,000 have died from
AIDS‐related illnesses. National HIV infection levels are highest in Southeast Asia
and areas of India where there exist disparate epidemic trends.

Male‐to‐male sex has been identified by UNAIDS and experts as an important
component of the epidemic from the very beginning . The most conservative
estimates for 2006 shows that there are at least 10 million men having sex with
other men in Asia and the Pacific, and those same MSM are likely to be HIV‐
infected at a rate several times more than the general adult population. Data in
Asia shows that without interventions, male to male sex will become one of the
main sources of new HIV infections in the region. Even though the region is
facing a serious public health crisis among MSM and TG, the respons in the
region has been almost nonexistent. [See AIDS in Asia Commission Report,
2008.]

In 2007, the Asia Pacific Coalition on Male Sexual Health was established to
strengthen sub‐regional coalitions of civil society, the medical sector,
government representatives, researchers, donors and community
representatives. Begun in 2005, the most advanced of these sub‐regional
networks is the Purple Sky Network, representing the Greater Mekong sub‐
region and includes Cambodia, two provinces in southern China, Lao PDR,
Myanmar (Burma), Thailand and Vietnam. Apart from that, national networks
exist in the two largest countries of China and India. UNESCO is taking the lead,
on behalf of UNDP/UNFPA and APCOM, to organize the first sub‐regional
network meeting in Insular Southeast Asia, which includes seven countries:
Brunei Darussalam, Indonesia, Malaysia, the Philippines, Singapore and Timor
Leste.1

Following similar designs of the other networks (Purple Sky Network, China and
India), The network, the Insular Southeast Asia would focus on strengthened
advocacy, mapping, joint planning based on a mutually agreed minimum package
of services for prevention, treatment and care, and sharing experiences to
ultimately achieve greater impact in efforts to scale up programs and prevent
new HIV infections among men who have sex with men and transgenders in the
sub‐region.

It is hoped that the contribution and relationships between Insular Southeast
Asia and the APCOM will be strengthened as a result of this meeting, and with the

1 The Brunei government representative had to decline participation due to the H1N1 epidemic.

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participation of several Interim Governing Board Members of APCOM on of the
Steering Committee.
WORKING GROUPS

In each day of the consultation meeting, group discussions were held (group
work was done per country). These sessions enabled an open dialogue process to
develop within the groups. After each session, groups were asked to .

The working groups were divided into 6 as there were six countries represented
in the consultation of the Insular Southeast Asia, they are:

1. Indonesia
2. Malaysia
3. Singapore
4. Thailand (large contingent of people to support the meeting)
5. The Philippines
6. Timor Leste

The Agenda:

Day 1:

a) MSM in the region: definitions and implications (morning session)
b) What would be the role of a sub regional MSM and TG network for Insular
Southeast Asia and what should it look like? (Afternoon session)

The purpose of this last part of the Day 1 was to discuss what people want this
sub‐regional network for MSM and HIV and what if any benefits there will be.

Day 2:

Adaptation/discussion of the Comprehensive package (country groups);
listing of national priorities

Day 3:

a) Regional priority + How do we work together in this region? Regional
boardmembers in Sub regional Network? Representation to APCOM?
Rotating secretariat? (Morning session)
b) Next‐steps: How to strengthen national MSM work? (Afternoon session)

Space was provided for participants to interact, communicate, discuss and arrive
at the best solution while getting to know each other’s country situations and to
compare, learn and adopt possible actions as well as establish sub‐regional
networking. In these sessions, participants could seek clarifications, express
doubts and concerns, ask questions, express opinions, offer help and
collaboration or suggest or even demand further action.


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OVERVIEW
1. EPIDEMIOLOGY OF HIV AMONG MSM/TG

HIV infections are on the rise and remain at growing risk among MSM and TG
populations on a global level. In the last few years, there have been reports of
new, newly identified and resurging epidemics of HIV infection among men who
have sex with men (MSM). High and steep increases in reports of new HIV
diagnoses among MSM were also reported from Southeast Asia, including
Greater Mekong sub‐region (GMS) and Indonesia. The key findings are
summarized below:

Epidemiology Update on HIV Infection among MSM, Male
Sex Workers and TG in Southeast Asia and the Pacific
Presented by Frits van Griensven, PhD, MPH

In selected capital cities in Southeast and East Asia, the percentage of MSM HIV
prevalence is up to 30.8% (Frits van Griensven), the highest of all, in Thailand
(Bangkok). Myanmar (Yangon) is also experiencing severe HIV epidemics with
prevalence of 29.3% ‐ which make these two cities be viewed as center of
epidemics among MSM in Asia Pacific, followed by Viet Nam (Hanoi and Ho Chi
Minh city), 9.4% and 5.3% respectively. Here, injection drug use (IDU) is also a
significant factor. Cambodia (Phnom Penh) is showing both MSM and TG
populations at risk with a rate of 8.7%. The rest are Taiwan (Taipei) with 8.5%,
Indonesia (Jakarta) with 8.1%, Laos (Vientiane) with 5.6%, Japan (Tokyo) with
4.4%, Singapore with 4.2%, East Timor with 0.9%. These compare to other
neighboring areas, India (Mumbai) at 20%, Pakistan (Karachi) 7%, Beijing 5%,

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Nepal 3.6%. Malaysia reported drastic and continuing rises in the number of
cases among MSM and TG (Zamri Sulhi). The Philippines (Manila) has very low to
almost no prevalence in current data, but this might just be a matter of time
before cases start showing. Hong Kong recorded its highest ever annual number
of HIV infections in 2007 (414 new cases – an 11% increase from the previous
year), which as attributed to promiscuous gay men, meeting up over the Internet,
engaging in unsafe sex.

Sexual high‐risk behavior, principally unprotected intercourse, continues during
anal sex, casual sex and commercial sex among MSM. Prevalence rates
attributable to MSM are higher than those found in the general population in
every place such rates have been researched. It is estimated that at least 5 to
10% of all HIV infections worldwide are due to sexual transmission between
men (MSM). HIV prevalence in Asia is 25% from MSM and 10 to 42% from TG.
Projections by the year 2020 is that if there is no effective prevention efforts
undertaken now, MSM will account for nearly 50% of new infections in Asia
(currently at 13%).

Men who have sex with men (MSM) are found in all countries and cultures.
Between 6‐12% of Southeast Asian men have same‐sex relationships at some
point in their lifetime. The role of MSM drug use is clearly a growing role in many
countries but the precise impact is not clear. But stigma and discrimination cause
many MSM to hide their activities, which exacerbates HIV epidemics and
increases high‐risk behaviors, thus driving both HIV and STI rates higher.

(Source: Report of the Commission of AIDS in Asia, UNAIDS 2008)

The graph above (Figure 1) shows a decline from early prevention successes and
an increase due to current neglect and failures. It demonstrates what the
epidemic will look like if current interventions remain as they are (neither re‐

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focused to account for changing transmission dynamics nor scaled‐up
sufficiently). The bars also representing males (red) and females (orange) “who
are not currently in high‐risk populations” represents men and women who are
not engaging in high‐risk themselves but whose sexual partners are engaging in
high‐risk, thus placing these low‐risk individuals at high risk.

Indonesia
The estimated number of PLHIV almost tripled within the last 7 years (2001‐
2007) from 93,000 to 270,000. The prevalence curve is always trending up,
regardless of the sub‐population group whose behavior is driving the HIV
epidemic. And HIV prevalence among most‐at‐risk populations by 2007 is
ranging from around 50% for MSM and 20% for TG. The latest data from Tanah
Papua shows an intermediate‐level of prevalence of 2‐3% among general
population, reflecting the existence of higher numbers of injection drug use.

Reported and projected infections in various low and highrisk populations, Indonesia, 19892020
Frits van Griensven, PhD, MPH, TUC and US CDC
The graph above (Figure 2) shows the new dynamic description of the increase,
proportionally, in the contribution to new infections that have come from sexual
behaviors, as opposed to those coming from injection drug use in the earlier days
of the epidemic in the country.

Singapore
HIV prevalence remains at a very low level in Singapore but the number of
diagnosed HIV infections among MSM decreased slightly, per 1,000 new cases.
Unsafe heterosexual behavior contributes the most as mode of HIV transmission
(70%), with unsafe homosexual behavior contributing the other 30%.

Malaysia
The number of PLHIV in Malaysia has reached 80,000. There has been a steady
increase in the numbers during the past 8 years. Prevalence among MSM, only
recently looked at, is 7.1% while for IDU it is higher at 11%.

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Papua New Guinea
HIV infection is approaching 3,000 for male and 2,000 for female though HIV
positives are highest (25%) for the female sex workers (FSW). Male clients of
FSWs and MSM are at intermediate‐level (almost 10%).

Timor Leste (Dili)
General population HIV prevalence in Dili is low, at 0.9%, with IDU being the
largest currently known risk factor. HSV2, herpes simplex virus 2 or genital
herpes, is the highest reported STI at 29.1% (n=110) followed by gonorrhea,
Chlamydia and syphilis/yaws around 15%.

Thailand (Bangkok)
Bangkok, as mentioned above, has the highest HIV prevalence among MSM in
Asia but is also the only place in Asia Pacific that undergoes regular (bi‐annual)
HIV prevalence testing among MSM and TG, which it has undertaken since 2003
and which the government has expanded to other locations in the country.

2. Socio‐cultural aspects of male‐to‐male sexuality in the
region and how these link to HIV risk and vulnerability

We need to talk more about the pressure to marry heterosexually as one of the
most important forms of oppression of MSM in Insular Southeast Asia but one
that falls outside conversations about law and rights, because nowhere is there a
law requiring marriage. We need to challenge the implicit theories of culture
change set forth by many Island Southeast Asian governments, religious figures,
etc. namely, the idea that ‘this will destroy our culture’. Historically, this has not
happened.

Societal oppression leads every aspect of the lives of MSM. Behavior to conform
to the demands of everyday norms in society, especially in Asia and the Pacific,
such as a ‘real’ family consists of a male, a female and one or more children,
leads to sexual practices conducted in secret. Norms are deeply rooted in the
socio‐cultural context and enforced by society’s institutions and practices, thus
creating social and cultural stigma. This stigma causes many MSM to hide their
activities and avoid seeking STI treatment and information services. It curtails
the social contacts and networks and results in severe isolation for MSM.

The Internet is important as it is a crucial factor in how men meet other men for
sex. Having multiple partners, practicing unsafe sex practices such as low
condom use for anal sex, and lacking skills to negotiate safer sex all play a major
role in HIV transmission among MSM. In the circumstances of married MSM and
MSM also have sex with women, also put these female partners at risk. Current
data on the prevalence of new HIV infections demonstrate high rates and steep
increases in new HIV transmission among MSM.

Fear of stigma and discrimination adversely affects people’s ability and

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willingness to disclose their positive results to others. the large range of rights of
PLHIV and their families are often violated, once disclosure has been made.

Religion plays an important role in lowering MSM and TG HIV risk but also can
contribute to vulnerability. When a religion condemns those engage in same sex
behavior, for instance, it indirectly increases risk to HIV and vulnerability.

In terms of the concept of risk, we need a better understanding of how MSM/TG
persons understand risk in everyday life. After all, simply being alive poses a risk
of death; therefore, people are used to taking risks everyday, so defining “risky”
maybe necessary.

In remote areas, for instance villages on Borneo, Malaysia, for example, male‐to‐
male sexuality is fairly undetected and undiscovered. It exists, but MSM are
unreachable by government and NGOs programs, access to condoms is very low,
so condom usage can be predicted to also be low. Thus, these MSM are very high‐
risk and vulnerable to HIV infection.

The Youth
Youth‐led and youth‐specific programs, particularly peer programs, are needed.
There are key problems in approaching this issue. First, there is a danger of
treating “youth” as a political identity or category ‐ remember, everyone grows
past being a “youth”. Secondly, one must be cautious to not participate in the
ageism prevalent in many MSM/TG communities, by having a separatist attitude.
It maybe of crucial importance, too, for older role models so that learning from
MSM/TG elders, particularly since many younger people are not personally
familiar with effects of the HIV epidemic. Youth, after all, are rarely segregated by
age in everyday life (including sex) and only in a very metaphorical sense are
they a “community”. And third, “peer” is a problematic category in that there are
many ways in which ones social standing maybe unequal within peer groups.

Acknowledging MSM/TG
In relation to the government, there is a pattern of failing to acknowledge
MSM/TG in their national plans, funding structures, research and so forth. While
there is talk of “hidden populations” it needs to be considered as to what degree
governments and their policies and laws may actually be doing the hiding? There
are findings that show that MSM “prefer” casual partners; however, could this be
because MSM cannot openly fall in love, cannot form public relationships?
On the other hand, TGs sometimes lumped in with MSM and data on both groups
is thereby compromised. (Robin Carbonnel)

Double discrimination that came come from being both MSM/TG and HIV
positive can be devastating. Stigma and discrimination is faced from many,
different places, such as within the healthcare setting when treatment is refused
and one is denied service by the healthcare professional. Often families, friends
and even partners s may reject the PLHIV, as might happen in the, community,
and in the workplace by employers and co‐workers. Some discrimination and ill
treatment occurs within the MSM/TG community itself, in gossip, in isolating the
PLHIV from social events, by name calling with things like “damaged goods” or

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blaming the person for his or her own condition (“you knew better, didn’t you?”).
It is challenging to design and implement interventions due to varying
definitions and perceptions of gender, sexual roles, stigma, homophobia, and
internalized homophobia, as well.

Impact of social mores and discriminatory laws result in social marginalization,
putting pressure on MSM to not self‐identify as gay men or other self‐identified
MSM, decreases effective community organizing and mobilizing, decreases desire
to seek health services, minimizes access to effective prevention and protective
information, mitigates prevention and care services, and undermines effective
HIV and community programming.

3. Legal/human right issues, including for people living
with HIV and AIDS

There is an existing relationship between legal systems and everyday cultural
belief. Being different to the dominant heterosexual paradigm, that is, not being
‘normal’, brings its own issues in terms of legal and human rights within society.
Legal frameworks are very important, both active and passive forms of state
criminalization or lack of protection. Homophobia and heterosexism do not
always directly connect but there is often a connection between the two in the
form of political homophobia, which must be guarded against and changed, when
possible.

Criminalizing homosexual behavior impedes public health programs by driving
underground many of the people at risk of infection. Even if the criminal laws are
not enforced, their mere existence condones societal stigmatization and
discrimination, and creates a culture of justifiable hatred and violence approved
or at least no disapproved by the state. As stated in the UNAIDS 2006 Global
Report, ”Vulnerability to HIV infection is dramatically increased where sex
between men is criminalized”.

Legal frameworks across the region need a dramatic and urgent overhaul to
allow public health sectors to reach out to MSM and TG, or the public health
consequences will be dire and stretch well beyond MSM and TG communities
into the general population.

In 2006, in response to well‐documented patterns of abuse, a distinguished
group of international human rights experts met in Yogyakarta, Indonesia to
outline a set of international principles relating to sexual orientation and gender
identity. The result was the Yogyakarta Principles: a universal guide to human
rights which affirm binding international legal standards with which all States
must comply. They promise a different future where all people born free and

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equal in dignity and rights can fulfill that precious birthright.2

For the UN, it took until December 18, 2008 for it to issue a statement on Sexual
Orientation, Gender Identity and Human Rights.

Brunei Darussalam criminalizes homosexuality, with a maximum penalty of
10 years in prison and large fines. There is no anti‐discrimination protection, and
freedom of expression and assembly are generally restricted, especially when
the subject matter is sexual orientation. They have not ratified any of the major
international human rights treaties, leaving only customary international law to
protect sexual minorities. However, Brunei Darussalam may not be bound by any
customary international law protecting sexual minorities because they have
been a “persistent objector” to its development.

The Indonesian Penal Code does not criminalize homosexuality; however, the
federal government has allowed certain municipal governments to adopt Sharia
law, which only applies to Muslim citizens. Sharia law bans homosexuality,
though the punishment is unclear. Most Sharia scholars believe homosexual acts
are treated the same as adultery, with penalties including death by stoning.
Transgender individuals, called waria in Indonesia, suffer serious discrimination,
exposure to violence, and sexual exploitation. Indonesia has ratified all the major
international human rights treaties and has domestic legislation making the
rights enshrined in those treaties binding.

Malaysia criminalizes homosexuality, and it is the strictest of the six Insular
Southeast Asian countries; the maximum penalty is 20 years in prison, with fines
and lashes. Sharia law is commonly practiced in Malaysia, which criminalizes
homosexuality, as well as cross‐dressing. Freedom of speech is seriously
restricted when the subject is homosexuality. On the other hand, there is case
law that supports post‐operative transgender individuals to have their
identification cards changed to reflect their new gender. However, until affirmed
by a higher court, lower courts are free to deny such a request. Malaysia has been
very active internationally in attempting to derail any development in
international law regarding sexual orientation and gender identity. They have
not ratified the main international human rights treaties, and like Brunei,
Malaysia could easily be considered a “persistent objector” to any emerging
customary international law protecting sexual minorities.

Philippines is by far the most liberal and progressive Insular Southeast Asian
nation regarding sexual orientation and gender identity. Homosexuality is legal
and there have been more than 15 attempts to pass anti‐discrimination
legislation to protect sexual minorities. Unfortunately, due to the strong
influence of the Catholic Church and particular notions of masculinity that are
part of Filipino culture, all attempts to pass the anti‐discrimination bills have
failed. The Philippines has signed nearly ever international human rights treaty,

2 http://www.yogyakartaprinciples.org/principles_en.htm

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but unlike Indonesia, lacks domestic legislation to give them effect.

Singapore has recently amended their criminal code to legalize consensual anal
and oral sex between heterosexual couples, but retained section 377A of the
Penal Code which criminalizes “outrages of decency” between male homosexuals
only. The Prime Minister has said that they will not actively enforce that offence,
but by keeping the law on the books the government seems to indirectly condone
homophobia. Singapore is the only Insular Southeast Asian state to allow
transgender individuals who have completed their sex reassignment surgery to
legally marry. Singapore has yet to ratify the major international human rights
treaties.

In TimorLeste homosexuality is legal. The early draft of the new Constitution
included a clause proving protection for sexual orientation and gender identity.
However, when the National Assembly voted, that clause was removed. The
Labour Code protects against discrimination on the basis of sexual orientation,
gender identity and HIV status. Timor‐Leste has signed all the major
international human rights treaties and is also the only Insular Southeast Asian
country to have supported the 2008 United Nations statement on sexual
orientation, gender identity and human rights.

The United Nations Declaration on Human Rights, Sexual Orientation and Gender
Identity was supported by Nepal, East Timor, Japan, Australia and New Zealand;
and opposed by Afghanistan, Bangladesh, Brunei, Indonesia, Malaysia, North
Korea, Pakistan, Fiji and Solomon Islands.

4. Coverage of interventions for prevention, care and
support of MSM/TG

High‐coverage of effective interventions for prevention, care and support of
MSM/TG is highly demanded. From the projected new HIV infection based on the
report of the Commission on AIDS in Asia (2008) using the Asian Epidemic
Model (AEM), it can be pictured that with no change in HIV prevention
programming, by 2019 the infections will reach up to 1 million people, and MSM
will have the highest percentage of new infections (nearly 50%). But, using
evidence‐based HIV prevention programming, the MSM HIV epidemic can be
controlled and the number minimized to below 0.2 million.

Problems have arisen in the developed countries and areas of Singapore, Taiwan
and Japan because they receive the lowest in donor support for MSM in the
world; therefore, MSM/TG are on experiencing higher‐risk and increased
vulnerability.

What are the reason for working with MSM and HIV prevention, care and
support? Because it is the right thing to do: on humanitarian grounds,
epidemiologically, and from a public health perspective.

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The data shows that more than 90 per cent of men having sex with men (MSM) in
Asia Pacific do not have access to HIV prevention and care services. MSM/TG face
continuing problems with access to care and treatment and basic information.
Therefore, interventions should urgently be intensified to avoid sharp rises of
HIV transmission in this vulnerable population in the near future.

A new area of prevention is underway, biomedical prevention. The antiretroviral
Truvada might be used to prevent HIV transmission prevention, but this will still
not be a cure. There are drug trials underway now in Peru, Ecuador and
Thailand, which should be reporting in November 2009. There may well be a
great push to biomedical prevention but very extensive investigation needs to
more forward first.

In rural versus urban settings, people are familiar with each other in rural areas,
and concern about confidentiality and disclosure affects health‐seeking
behaviour and is a barrier to access to prevention.

The existing prevention strategies cover two preventions. Primary prevention
was adopted in the 1980s resulted in a decline in new infections and reductions
in potential exposures to HIV through sexual transmission by convincing people
to take certain steps like reduce the number of partners and adopt and increase
condom use. The secondary prevention, or prevention targeted towards those
who were already infected, came into play following the success of ART. This
boosted health care‐seeking behaviors, increased those seeking HIV screening,
and lead to early detection, individual and partner treatment strategies. Failures
or at least reverses in earlier trends began in the mid‐1990s and were attributed
to: safe‐sex fatigue (no one expected risk behaviors would need to be practiced
for over 10 years much less for a lifetime) and younger people coming of age had
not experienced with devastating effects of the epidemic personally. HAART3 has
made AIDS and HIV disease be seen as a manageable chronic disease although
this is not entirely true.

National HIV responses in Asia Pacific have given little attention to prevention,
care and support for MSM/TG due to three reasons: first, a lack of high‐level
political commitment, second, inadequate policies because they do not take into
account the existence of high‐risks experience by MSM and TG. Only nine
countries in Asia Pacific include MSM‐specific interventions in national response
planning, such as peer outreach, targeted prevention programs exist in only 15
countries; overall, according to UNAIDS, less than 8% of estimated MSM are
reached by any HIV services or programs. Third, there is woeful lack of
resources committed to MSM‐specific programs – only 4% of all national HIV
spending. In Southeast Asia, only the government of Cambodia, China, Lao PDR,
Myanmar and Thailand have allocate expenditures for MSM and HIV programs
but these programs also rely heavily upon NGOs/CBOs and international donors.

3 HAART stands for highly active antiretroviral therapy.

19
There is a need to re‐conceptualize prevention and other HIV interventions,
including treatment services and policies. One such new concept is structural
interventions intended to bring about behavioral change, such as installing
condom dispensers in public restrooms on university campuses. Younger
generations who are not experienced with the devastating effects of the epidemic
must be reached particularly those at higher risk such as young gay people, drug
users and those who may be ‘experimenting’ with sexualities. New sexual sub‐
cultures are immerging on top of long‐existing traditional cultures, with
communication methods providing sexual hookups on the Internet, especially in
places where community organizing may not be possible.The increasing “virtual”
gay and MSM online community and social networking reduces opportunity for
face‐to‐face outreach, community development, and personal empowerment. but
also present opportunities for new and innovated outreach.

Interventions that are known to work include intensive HIV education of
community‐based peers and outreach workers, development of personal risk
reduction strategies, connection to community structures, like drop‐in centers in
India; integration with health services, such as MSM and TG friendly clinics for
STI treatment in Myanmar; and linked access to VCT, STI, and ART services in
Cambodia, and access to prevention commodities, for example, preparation,
target packaging and distribution of condom and water‐based lubricants like
FHI/ASA in Indonesia. Vital to supporting intervention is advocacy to national
and local police, recruitment of community opinion leaders, and law
enforcement authorities as in Thailand and improved legal and policy
environments such as what has occurred in Hong Kong.

Purple Sky Network (PSN)
With focus a on the Greater Mekong Sub‐region (GMS) of Southeast Asia, a
regional consultation in August 2005 found that regional coverage of HIV
interventions for MSM was only 1%, which is equal to no interventions in most
countries.

Through their three major components, namely: a Regional Technical Board
(RTB) comprised of regional experts from donors and implementing agencies
along with the UN, , a Regional Coordinating Secretariat (RCS), with an MSM
program coordinator, and Country Focal Points representing Working Groups of
195 representatives from more than 100 organizations in six countries. PSN is a
network of country working groups in the GMS working to reduce HIV infections
among MSM and TG, promote supportive policies and improve interventions and
services.

PSN’s learned that coordination is the key to the success of HIV interventions
among MSM and TG: local coordination and communications mechanisms are
vital to sustain momentum, with regional coordination as a key component in
facilitating collaboration; such a coordinated response can expedite mobilization
of resources and actions, and strengthen components.

PSN has been successful in helping to have MSM included in every

20
national/provincial AIDS plan in the GMS, having functioning Country Working
Groups in all countries and creating updated country‐based mapping of
interventions.

International HIV/AIDS Alliance (IHAA or Alliance)

Established in 1993, the Alliance is a global partnership of nationally based
organizations working to support community action on AIDS. It has channelled
over $140 million since 1994 to over 40 countries and supported over 3,000
projects. The Alliance created a mechanism for channelling funds and technical
support into and between communities. The primary focus is on the mobilization
and capacity development of communities affected by HIV/AIDS.

Community action reduces stigma and discrimination, increases leadership and
removes policy barriers to prevention and treatment.

China: The Alliance created understanding of the need for MSM
involvement by peer education and outreach programs/drop‐in centers,
providing opportunities for MSM to develop/design and implement
programs, tools development/sensitization of Government officials to
MSM issues, and addressing double discrimination of MSM and PLHIV.
There is an autonomous CBO, the Chengdu Gay Community Care
Organization (Sichuan), the emerging “Managed Team”, Honghe Brothers
Group (Yunnan) and two provincial level networks, Purple Sky MSM
Network Yunnan and Guangxi.

Myanmar: The Alliance Myanmar strengthened MSM community
resilience through partnerships. There are 9 informal MSM networks in 8
geographical areas, which have links with other sub‐networks in 111
townships. In prevention and safer sex promotion, the Alliance
implementation partners reach over 3,000 MSM (excluding mass public
events such as World AIDS Day, MSM Festival, Water Festival, etc., which
reach an additional 9,000). The positive MSM Care and Support includes
363 positive MSM who were provided with psychosocial support,
counseling, community home‐based care and given or referred to ARV
and opportunistic infections treatment.

‐ Cambodia: KHANA has been supporting MSM programs since 2002 and
has provided funding to MSM CBOs/NGOs/networks to implement
focused prevention programs targeting MSM/TG in the provinces as well
as in Phnom Penh. KHANA provides technical support to implementing
partners in organizational development, financial management and
program implementation.

Peer education programs, both formal and informal, drop‐in centers,
condom/lube distribution/social marketing is presented in collaboration
with PSI as a chief prevention effort. Specific for MSM/TG, the preventions
are psychosocial support, referrals for newly diagnosed MSM PLHIV
through VCT/STI services provided by Drop‐In Centers (and referrals),

21
specific Drop In Centre group sessions for positive MSM, and income
generation schemes/support including microcredit.
Cambodia has provided an enabling environment for MSM/TG by
collaborating and networking with national/provincial governments to
improve MSM access to health services. KHANA itself is a member of the
National MSM Technical Working Group, which focuses on MSM policy
and guidelines development. Cambodia has conducted sensitization to
MSM issues in the community with gatekeepers and health service
providers and special events in the community to raise awareness to MSM
and HIV issues (such as Gay Pride held this year in Phnom Penh).

Asia Pacific Coalition on Male Sexual Health (APCOM)

APCOM’s main purpose is advocating for political support and increases in
investment and coverage of HIV services in Asia Pacific. It is a regional coalition
with eight geographic sub‐regions (Australasia, China, Greater Mekong Sub‐
region, India, Insular Southeast Asia, Pacific, and South Asia) and two region‐
wide ‘sub‐regions’ (PLHIV and Transgender). APCOM is a coalition of MSM and
HIV community‐based organizations, the government sector, donors, technical
experts and the UN system.

APCOM believes that a regional approach is both effective and efficient. It is more
effective because of the many similarities across the countries and areas in the
region that affect HIV risks and vulnerability of MSM and TG. APCOM
demonstrates that a regional coalition is strengthened by its ability to bring a
diverse variety of people together when they focus on a common cause. APCOM
created, through its website, a regional focal for strategic knowledge and joint
communication covering a large range of issues.

5. Agreed‐upon minimum package of services for
MSM/TG
To make the HIV prevention, care and treatment interventions program more
effective, a minimum package of services (MPS) need to be implemented. This
approach consists of mix interventions, services and programs.
Few persons (less than 10%) have access to a minimum package of services but
there is strong evidence that there is a synergistic effect to accessing a MPS
rather than services in isolation. There are great variations in how different
services are accessed, and what ‘access’ means will differ. In terms of
comprehensive services, the idea is we need to aim for a ‘comprehensive’
package of evidence‐based services.
There are weak linkages between community and clinical services in most areas

22
now. Challenges faced for the implementation of MPS for MSM/TG include
limited resources are committed to develop, evaluate and disseminate replicable
models. Funding available is limited to scale up services, where and as much as
needed.
MPS should be targeted first to at most‐at‐risk populations participating in high‐
risk behaviors, particularly female sex workers and their clients, MSM/TG, and
drug users. Secondary targets include PLHIV and other vulnerable populations.
Strong links with HIV treatment and care services are important so that people
who are HIV‐positive can receive additional services when they need. There are
five key services for MSM, FSW and their clients:
1. Peer and outreach education
Provision of HIV/AIDS information through direct interaction with the
target populations. Includes peer outreach, special events, large‐group
and small‐group community events, hot lines, drop‐in centers, and
interactive internet chat rooms.
2. HIV counseling and testing
Voluntarily‐accessed HIV antibody testing and counseling that includes
counseling and referrals at the time that the results are given to clients
and guarantees a high level of confidentiality of all client information.
3. Targeted media campaigns
Provision of HIV/AIDS information through mass media (e.g. television,
videos, radio shows, print materials, billboards, and websites) specifically
targeted to MARPs.
4. Condom and lubricant distribution
Condom distribution or marketing, including lubricant, that is either
geographically targeted or branded for MARPs. This may also includes
distribution and marketing of female condoms and lubrication.
Information on use of female condoms for anal sex should be considered.
5. STI treatment
Includes STI screening, diagnosis and treatment, when needed, by
medically trained staff.
6. Substitution therapy and safer injection practices for IDU
Safer injection practices, access to bleach and clean water, methadone and
other substitution therapies and treatments.

23

USAID’s HIV/AIDS Programming for MSM in the Greater Mekong Region
Cameron Wolf, PhD, M.Sc., Regional HIV/AIDS Technical Advisor, USAID RDMA
The combination of these services is designed to support the high risk behavior
changes such as increased and correct condom use for anal sex. The package also
includes linkages with treatment and care services for PLHIV to care, support
and treatment services. This includes antiretroviral therapy, non‐ART medical
care, prevention of mother‐to‐child transmission, psychosocial support and
economic support.
Supportive interventions may be needed to facilitate the successful

implementation of these services, which may include increased strategic
information and research, MSM/TG community organizational capacity building,
community mobilization, advocacy for changes or enforcement of
desired/needed policies, and reduction of stigma and discrimination.

MPS: Bangkok experience

Bangkok has developed and adopted a minimum package of services for HIV
prevention among MSM and TG. It includes five categories of interventions –
peer outreach and education, free distribution of condoms and lubricants, use of
targeted media, STI screening and treatment, and voluntary HIV testing.
Coverage data have been collected through national surveys. In 2007, the
coverage of interventions ranged from 27% for VCT to 94% for targeted media;
only 11% of MSM received all five categories of services. Those who received
more than one intervention reported less frequent risk behavior, illustrating that
diverse interventions such as the internet, structural interventions and MSM‐
friendly health services are essential to increase coverage, particularly for
hidden MSM. The Internet, particularly gay or encounter sites, is being
considered as a key new approach due to its importance in networking and
promotion of casual sexual encounters.


24

Access to the Comprehensive Package of
Services MSM & TG in Bangkok and Chiang Mai, 2007
Philippe Girault, Family Health International/Asia Pacific Regional Office

6. Gaps in knowledge and information

Even when information is broadly known, knowledge does not always equate to
behavior change. A recent internet survey of MSM in
Asia was taken and included questions on self‐reporting HIV status. A majority of
the respondents were university educated and all were English speaking (the
survey was only provided in English). There were also a hight number of self‐
identified HIV‐positives. A high‐level of high‐risk behavior as reported. Clearly
targeted evidence‐based prevention efforts beyond simply educating people are
necessary.

Issues related to condom use are facts many MSM, and others in Asia Pacific, do
not want to talk about. Perpetuation of the myth that it shows trust in your
sexual partner, bravery or independence not to practice safe sex needs to be
aggressively rejected.

There is this social stigma and discrimination that hinders people to talk about
MSM and TG issues which contributes to the continuing problem of access to
care and treatment.

There is a need to talk about forms of oppression through a human rights
approach, because of legal and cultural restrictions. Some forms of oppression
are: rejection of existence of homosexuality, prejudice against effeminate‐acting
males; requirement/expectation for a man to marry a woman and have a
“traditional” family (which may be less of a requirement of religion or ‘culture’,

25
but often more to a colonial legacy. It is important to look both at different effects
of these oppressions and the linkages between them in order to better inform
best practice for service and program development.

7. Country working group feedback on proposed multi‐
organizational collaboration: the birth of a sub‐regional
network

Each country represented at the Insular Southeast Asia Consultation on Male‐to‐
Male Transmission of HIV worked throughout the meeting in breakout sessions
in country groups. The following is the response from each group on whether
they felt that a sub‐regional network was viable, would be helpful and whether
they were willing and able to commit to active participation in such a network.

1. The Philippines
The Philippines felt that being an active member in a regional network had a
high priority. Specifically, the Philippines sees the importance of having such a
sub‐regional network to include:
(1) the sharing of basic information and expertise,
(2) collectively identify common issues such as mobile populations
(3) taking action collectively; engaging with other regions.
(4) assures representation and involvement in APCOM (major
responsibility of sub‐regional networks),
(5) sub‐regional network could help strengthen the formation of the
development of national networks within the 6 countries.
Suggestions for working together includes:
(1) Developing a structure (national to sub‐regional)
(2) Involve young persons, TG and if possible, some representation from
government partners.
(3) Creating a website for the community, where its sub‐features include
an information sharing mechanism and a communication mechanism.

2. Indonesia
Indonesia established a national MSM/TG network in February 2007. Despite its
size, there are only 16 NGOs funded by donor agencies running HIV programs,
which are mostly outreach programs concentrated in Java (and lacking in other
provinces). There are ten CBOs which only sub‐contract to provincial and district

26
AIDS commissions. The national network is important because people can talk
freely, coordinate activities and identify needs, especially working with the
government.
As the Philippines, Indonesia sees the importance of communication and
networking. A regional secretariat is considered necessary, and a focal point for
each country crucial. The chief problem would be a lack of well‐educated people
who are also activists but this is a process that needs to be created.
Communication methods has to be established for this strategy to be able to
respond quickly to issues and to make quick decisions. One challenge of
communication is timely responses. A lack of English‐speaking personnel is also
an obstacle.

3. Malaysia
Malaysia has no mapping of their current work. International donors will
support this country as it is considered to be developed and not in need of
suppport. In terms of MSM/TG, Malaysia need external funding.
The AIDS commission (NACO) is doing strategic planning but without action
planning. The NSP provides the framework for Malaysia’s response to HIV and
AIDS over the next five years. It also provides the basis for co‐coordinating the
work of all partners with a view to successfully achieving UNGASS targets and
MDGs on HIV/AIDS.
The main thing realized by Malaysia is the need for continued network
development meetings. In the past what happened was informal meetings –
unstructured and informally organized. Support groups do exist but are
insufficient for the need for beginning an MSM network. Solidarity is
recommended among MSM and TG until the development of capacity for a
national network is developed; the set up of local MSM/TG CBOs is also
encouraged.
Most regional networks do not do local works or represent local interest in
Malaysia. A critical role for Insular Southeast Asia network is similar to the PSN
(GMS) model as a best‐practice model. Malaysia intends to have their country
representatives to sit in the board, influencing APCOM and other regional bodies,
for feedback and advocacy. The Malaysia group proposed the name Pink Tiger
for the Insular Network and confirmed their support and need for, and
commitment to, the Insular Southeast Asia network.

4. East Timor (Timor Leste)
At this point, only a regional network is possible as there is little local action in
Timor Leste at this time. Involvement in a regional network will provide
valuable learning experience. It is necessary to gain institutionalized support for
MSM, which may be possible since Timor Leste is a recipient of international

27
development funds. Becoming part of the network will help increase harmony in
MSM involvement.
There is no official MSM organization that can lead a national program in Timor
Leste, only an unofficial organization called MTH. They work locally but but
function much like the regional network. Therefore, the country team at this
consultation is considering to establish a formally organized MSM group in the
country although there will be serious challenges and threats from the certain
other community groups. There was agreement and commitment to be in the
network and to find an MSM leader to be the focal point.

5. Singapore
Singapore, like the case with Malaysia, is considered a wealthy and developed
country; therefore, access to public funding is limited, which has also limited the
scale of response to HIV among MSM.
Singapore proposes that the network, needs:
1. Proper mapping of those involved, including job‐
descriptions/requirements of leaders, and the relationships of key
players. This would include those who may be funders and those who
may be able to provide technical assistance for services, program and
organizational development.
2. To clearly define its chief objective, to answer the question, “What do I get
out of it?” It is imperative that the people who are involved in the
formulative stages articulate clearly how the people will participate and,
how they will benefit from active participation.
3. To lower barriers to entry, so that everyone can participate equally.
4. Effective and timely communication.

Strengthening networks
Stuart Koe and Singapore Working Group
The idea is “virtual” repository with everything from best practices, training
manuals, program descriptions, service mappings, publications, contact

28
directories, funding sources, proposal templates, and so forth – basically an
easily accessible online knowledge‐base of what people are doing. Other
communication tools include things like self‐publishing, mailing list developemtn
and management (whenever something is updated it can be pushed out to other
people immediately) and regular newsletters.
In terms of focal point representative, Singapore thinks that we all need to be
cognizant of the person selected. Having representatives in the network is not a
popularity contest but needs to be someone who communicate effectively as well
as have time to devote to the network.

Finally, the consultation ended with the groups accepting the working name of
the new network to be the Insular Southeast Asia Network (ISAN).
Representatives from Fridae.com in Singapore offered to assume the lead as the
regional focal point for and will conduct the business of ISAN from the
Fridae.com office to begin the network, under the direct guidance of Laurindo
Garcia and Stuart Koe.


29
PROGRAM

Tuesday, 4 August 2009
08.00 – 08.30 Registration
08.30 – 09.00
Dédé Oetomo, GAYa Opening Ceremony
NUSANTARA
Dr. Nafsiah Mboi, Government of
Indonesia
Jan W de Lind van Wijngaarden,
UN representative
09.00 – 09.15
Dédé Oetomo (GAYa Introduction, Rationale and

NUSANTARA Objectives of the
Consultation
09.15 - 09.30
Guest speaker: Epidemiology Update on 15 minutes presentation

HIV Infection among MSM,
Dr. Frits van Griensven Male Sex Workers and TG in
Southeast Asia and the
Chair: Pacific
Dédé Oetomo
09.30 – 09.45
Guest speaker: Self-reported HIV

Stuart Koe, Fridae.com
prevalence, HIV testing 15 mins presentation
history, and risk behavior
Chair: among MSM in 17 countries
in Southeast and East Asia:
Dédé Oetomo results of an online survey
09.45 – 10.00 15 mins presentation
Guest speaker: Improving human rights

protection for sexual
James Anderson minorities: Key to effective
HIV prevention in Southeast
Chair: Asia
Dédé Oetomo
10.00 – 10.15 15 mins Q&A (for all 3

presenters in the morning
session)
Chair: Q & A (for 3 presenters in the
early morning session)
Dédé Oetomo

30
10.15 – 10.30 Break
10.30 – 12.00
group work
Facilitator: MSM in this region:
definitions and implications
Ferdinand Buenviaje
12.00 – 13.00 Lunch Break
13.00 – 13.30
Guest speaker: Review of Global and 20 mins presentation

followed by 10 mins Q&A
Regional Policy and
Edmund Settle (UNDP) Advocacy Initiatives
Chair:
Ferdinand Buenviaje

Guest speakers: Community responses on
HIV and MSM in Southeast
Elden Chamberlain Asia and China
(International HIV/AIDS Alliance)
Chair:
Ferdinand Buenviaje
14.00 – 14.30
Guest speaker: Situation of Care, Treatment
15 mins presentation
Andrew Tan (Malaysia) and Support for Positive followed by 15 mins Q&A
Chair: MSM and TG in the Region
Ferdinand Buenviaje
14.30 – 15.00
Guest speaker: Interventions & Prevention
15 mins presentation
Dr. Claudia Surjadjaja (HPI) Strategies for MSM and TG followed by 15 mins Q&A
Chair:
Ferdinand Buenviaje
15.00 – 15.15 Break
15.15 – 15.45
Guest speaker: The Case for a Regional 15 mins presentation

Approach to Advocacy
Shivananda Khan (APCOM)
Chair:
Tono Permana
15.45 – 16.15
Guest speaker: Subregional networking: the 20 mins presentation


31
RapeepunJommaroeng PSN experience
UNESCO, former Thailand country

focal point for PSN
Chair:
Tono Permana
16.15 – 17.00
Speaker: What would be the role of a Group discussion

subregional MSM and TG
Jan W. de Lind van Wijngaarden, network for Insular
(UNESCO) Southeast Asia and what
should it look like?
Chair:
Dédé Oetomo
17.00 – 17.30
Facilitator: General Discussion
Dédé Oetomo (GAYa

NUSANTARA)
22.00 – 02.00
Host: Visiting Bali gay and TG Field Visits

areas
GAYa NUSANTARA&
(Puputan-Renon, Ubung,
Gaya Dewata gay-TG Bar)

Wednesday, 5 August 2009
09.00 – 09.20
Tom Boellstorff Review of Day One
09.20 – 10.20
Country updates – Where are 15-20 minutes each

32
Guest speakers: we at?
Iman Abdurrachman
(Indonesia),Andrew
Tan(Malaysia),Aguia Belo
Ximenes(Timor Leste)
Chair:
Paul Casey
10.20 – 10.40 Break
10.40 – 11.40
Guest speakers: Country updates – Where are 15-20 minutes each

we at?
Ramil Andag and Robin
Carbonnel (Philippines), Paul
Toh (Singapore)
Chair:
Paul Casey
11.40 – 12.15
Facilitator: Discussion / reflections
Paul Causey (APCOM)
13.30 – 14.45
Facilitator: How do we strengthen our Small group discussions

national MSM and TG (by country)
Ferdinand Buenviaje networks?
14.45 – 15.30
Facilitator: Plenary presentations and

discussion
Tono Permana (Burnet)
15.30 – 15.45 Break

Guest speakers: National strategies and
universal access targets for
Dr. Cameron Wolf (USAID) MSM and TG in the region
Chair:
Andrew Tan

Guest Speaker: Access to Comprehensive
Package of Services: MSM &
Philippe Girault (FHI) TG in Bangkok and Chiang
Mai, 2007

33
Chair:
Andrew Tan
16.45 – 17.30 15 mins for each

presenter and 15 mins
Facilitator: Adaptation / discussion of the for Q & A
Comprehensive package
Andrew Tan (Malaysia) (country groups); listing of
national priorities
Edmund Settle (APCOM)
18.00 – 20.00
Host: Solidarity Night dinner + cultural

performances from each
country
GAYa NUSANTARA&
Gaya Dewata

Thursday, 6 August 2009
09.00 – 09.20
Tom Boellstorff Review of Day Two
09.20 – 10.30
Facilitator: Plenary presentations of

yesterday afternoon’s
Paul Jansen (HIVOS) discussion
10.30 – 10.45 Break
10.45 – 12.00
Small group discussion

34
Facilitator: Regional priority + How do we (mixed)
work together in this region?
Paul Toh (Action For AIDS Regional board members in
Singapore) Subregional Network?
Representation to APCOM?
Rotating secretariat?
13.30 – 14.30
Facilitator: Plenary presentations
Paul Toh
14.30 – 15.15
Facilitator: Next Steps: How to strengthen (group work per country)

national MSM work?
Aguia Belo Ximenes (Timor
Leste)
15.15 – 15.30 Break
1530 – 1600
Facilitator: Conclusions / overview
Rapeepun Jommaroeng
(UNESCO) Dédé Oetomo
(GAYa NUSANTARA)
16.00 – 16.30
Hakan Bjorkman (UNDP Closing ceremony

Indonesia)
5 country representatives
(Indonesia, Malaysia, Singapore,
Timor Leste, and Philippines)
Cameron Wolf(Donor
community representative)
Shivananda Khan(APCOM)

35


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Insular Southeast Asia Consultation

. The meeting brought together 62 participants from community organizations

Supportive interventions may be needed to facilitate the successful

Tuesday, 4 August 2009

08.00 – 08.30 Registration

Dédé Oetomo (GAYa Introduction, Rationale and

Guest speaker: Epidemiology Update on 15 minutes presentation

Guest speaker: Self-reported HIV

09.45 – 10.00 15 mins presentation

Guest speaker: Improving human rights

10.00 – 10.15 15 mins Q&A (for all 3

12.00 – 13.00 Lunch Break

Guest speaker: Review of Global and 20 mins presentation

13.30 – 14.00 20 mins presentation

(International HIV/AIDS Alliance)

15.00 – 15.15 Break

Guest speaker: The Case for a Regional 15 mins presentation

Guest speaker: Subregional networking: the 20 mins presentation

UNESCO, former Thailand country

Speaker: What would be the role of a Group discussion

Facilitator: General Discussion

Dédé Oetomo (GAYa

Host: Visiting Bali gay and TG Field Visits

Wednesday, 5 August 2009

Tom Boellstorff Review of Day One

Country updates – Where are 15-20 minutes each

10.20 – 10.40 Break

Guest speakers: Country updates – Where are 15-20 minutes each

Paul Causey (APCOM)

12.15 – 13.30 Lunch Break

Facilitator: How do we strengthen our Small group discussions

Facilitator: Plenary presentations and

15.30 – 15.45 Break

15.45 – 16.15 15 mins presentation

16.15 – 16.45 20 mins presentation

16.45 – 17.30 15 mins for each

Host: Solidarity Night dinner + cultural

Thursday, 6 August 2009

Tom Boellstorff Review of Day Two

Facilitator: Plenary presentations of

10.30 – 10.45 Break

12.15 – 13.30 Lunch Break

Facilitator: Plenary presentations

Facilitator: Next Steps: How to strengthen (group work per country)

15.15 – 15.30 Break

Facilitator: Conclusions / overview

Hakan Bjorkman (UNDP Closing ceremony

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