Transcript Document

Treatment access for positive MSM
in the Asia Pacific
lessons learned from the analysis of
an APN+ peer-led study in 6 countries
M Choo1, VR Nair2, A Lim3, BK Raju4, N Kustantonio5, J Jan6,
T Wong6, MP Thet7, R Baldwin8, A Chen8
1 Centre
of Excellence for Research in AIDS (CERiA) Medicine, Kuala Lumpur, Malaysia
New Delhi, India,
3 Action for AIDS, Singapore
4 Blue Diamond Society, Chitwan, Nepal
5 HIVERS, Jakarta, Indonesia
6 Kuala Lumpur AIDS Support Services Society (KLASS), Kuala Lumpur, Malaysia,
7 The HELP, Mandalay, Myanmar
8 Asia Pacific Network of People Living with HIV (APN+), Bangkok, Thailand
2 NIPASHA+,
Overview
• Data: Peer-led by PLHIV CBOs in 6 countries in
2009: India, Indonesia, Malaysia, Myanmar,
Nepal, and Singapore.
• 2-stage data collection:
– (1) Survey (N=897)
– (2) FGD (at least one per country)
• Study Objectives:
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Assess treatment availability and ease of access
Explore structural and socio-cultural barriers
Assess financial constraints
Document stigma and discrimination
Methods of Analysis
• Survey data – macro information, demographics
• FGD data – interplay between (1) structural
barriers and (2) socio-cultural environment
1) Availability of treatment, accessibility, economic
costs
2) Social support, social costs, daily life
• Analytical focus: Exploring dynamic between
structural and contextual variations
• Special focus: Transgender experience
Summary of Findings:
INDIA
• Structural Barriers
– Lower social status limits treatment options
– Medical tests not included in free treatment
– Service refusal experienced by 1/3 surveyed
• Socio-Cultural Environment
– Strong heterosexual norms
– Dual lives: being married while engaging in MSM
activity
– Fear of stigma hamper disclosure to families
– Healthcare staff involved in stigmatising behaviour
Summary of Findings:
INDONESIA
• Structural Barriers
– Lack of reliable information on treatment options
– Unethical disclosure of status and sexuality high
– Institutionalised stigma in service provision
• Socio-Cultural Environment
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Secrecy and taboo of HIV status and sexuality
Disclosure of HIV status to partners low
Disclosure of sexuality to family low
Social isolation and lack of psychosocial support
Summary of Findings:
MALAYSIA
• Structural Barriers
– Rationing of medication
– Expensive medical tests a burden for those not on free
treatment
– High unethical disclosure of HIV status in healthcare
• Socio-Cultural Environment
– Fear of social reprisal leads to subterfuge
– Fear of government reversing decision on free
treatment
Summary of Findings:
MYANMAR
• Structural Barriers
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Limited treatment places in government clinics
Private treatment available, long term costs prohibitive
Reliance on NGOs for treatment and service provision
Institutionalised stigma in public/private healthcare
• Socio-Cultural Environment
– Fear of inability to access treatment when needed
– Fear of stigma hamper disclosure of HIV status and
sexual activity to families
Summary of Findings:
NEPAL
• Structural Barriers
– Treatment only available in capital, Kathmandu
– Frequency of medical tests and travel costs make
treatment prohibitive
– High institutionalised stigma, physical abuse and
unethical status disclosure by service providers
• Socio-Cultural Environment
– Social aggression towards alternative sexualities
systemic and gender‐based
Summary of Findings:
SINGAPORE
• Structural Barriers
– First world prices make treatment costs prohibitive
– Resort to medical tourism for treatment but not an
option for the infirm
• Socio-Cultural Environment
– Fear of discrimination from employers from status
disclosure
– Low disclosure of HIV status and sexuality to family
erode traditional forms of social support
Summary of Findings:
TRANSGENDER
• India and Nepal
– Almost half of transgendered surveyed uncomfortable
accessing healthcare services
– Unethical disclosure of sexuality gender-biased
– Nepal: Assaults by healthcare staff and service refusals
• Malaysia
– Transgender surveyed highly likely to face gender
discrimination in obtaining ART when needed
• Myanmar
– Positive gender-bias in ART access
Lessons Learned from PLHIV MSM/TG:
TREATMENT IN ASIA PACIFIC
1. Dynamic interplay between social environment
and structure creates practical treatment barriers.
2. Need to account for local cultures in assessing
treatment access and individual life chances.
3. Success of Universal Access depends on
negotiating localised social forces.
4. High cultural diversity make collective study
exceedingly complex.
Special thanks to the sponsors who made
this study possible