September 17, 2016
In recent years, the countries of Central Asia have experienced some of the fastest growing rates of HIV infection in the world. One of the key populations at risk is men who have sex with men (MSM).
However, an acute lack of data on the health of that population -- due in large part to intense stigmatization of homosexuality -- may be obscuring the region's HIV epidemic. That's according to a recently published paper co-authored by Alisher Latypov, a Tajikistan-born researcher with Columbia University's Global Health Research Center of Central Asia. The paper presents a rare overview of what's known, and unknown, about infection rates among men who have sex with men across the region.
RFE/RL correspondent Richard Solash spoke with Latypov about his findings.
RFE/RL: As far as researchers know, how prevalent is HIV among men who have sex with men in Central Asia?
Alisher Latypov: According to findings of biobehavioral studies, in Kyrgyzstan for 2008, we had a 1.2 percent HIV prevalence rate among MSM in Bishkek. In Tajikistan in 2011, the prevalence rate was 1.5 percent in Dushanbe. In Uzbekistan in 2009, the prevalence rate was 6.8 percent in Tashkent. In Kazakhstan in 2010, there was a 1 percent prevalence rate of HIV among MSM. In Turkmenistan, the government basically is reporting zero HIV infections overall.
These are the rates that we have as they are reported by the national authorities. We can see that the HIV rate is lower among MSM than among people who inject drugs, for example. But normally, when we look at the national reporting of diagnosed HIV cases, the percentage of MSM among those cases is also very small. This is misleading, I would say, because people who get tested would often not report that they have sex with men. There is not much information about the reliability of the data.
RFE/RL: How acute is the lack of data and why?
Latypov: Because of various social and cultural constraints, it is, indeed, very difficult for people to come out about this issue, to speak about this issue, and it's equally difficult to collect data on this issue.
In many countries in Central Asia there are only a few NGOs who will work with the MSM population and they often emphasize that it is very difficult to access the population and that there might be some problems in interpreting the data because of the access issue.
In terms of those MSM who speak about these issues, there are many reports which show that police harassment is a major issue, very often involving physical and sexual violence. I do think the [data] situation is changing. Especially over the past few years, I do think there is more and more data, including on MSM, with the involvement of the Global Fund [to Fight AIDS, Tuberculosis, and Malaria].
In Tajikistan, for example, the first time the [government] did a surveillance study with the MSM population was 2011. In other countries, they started earlier, but in many cases the data collection was often limited just to a particular city or site, most often the capital city. There is a major need to focus more on this population.
RFE/RL: What practical problems does this lack of data create?
Latypov: When there is not much data it creates this false image that there is no problem at all. At the same time we do have more data on other key populations but not much on MSM. And because of stigma and discrimination and because of the legal consequences in some Central Asian states, some of the cases that might have been [registered] as heterosexual might have actually been among men who have sex with men, so that's also an issue.
When you don't have good data it becomes very difficult to plan programs and to think about accessing the population and covering them with services, particularly when we are talking about testing and prevention.
RFE/RL: Which countries in the region have made the most and least effort to track HIV among men who have sex with men?
Latypov: In Kazakhstan, Kyrgyzstan, and Tajikistan, consensual sex between men was decriminalized, but in Uzbekistan and Turkmenistan it was not. From the legal point of view those are the two countries where it's a big issue.
In terms of the actual work that is being done, we need to look at two different things: We have funding issues and we have civil society issues. From the funding issue point of view, Kazakhstan is certainly best positioned and is a model for the other countries in terms of the government's commitment to support HIV prevention in general -- not necessarily among MSM. In terms of civil society it's a different story.
In Kazakhstan, the NGOs which work with key populations are not as active, for example, as in Kyrgyzstan. NGOs in Kyrgyzstan and even Tajikistan might be more active than in the other countries of the region, I would say.
RFE/RL: As you mentioned, Turkmenistan and Uzbekistan are the only nations in the World Health Organization's Europe region where sex between men remains illegal. Is there a public health argument for changing that policy?
Latypov: Of course there is strong evidence -- there is overwhelming evidence -- telling us that we should, actually, aim to create an enabling environment, social and legal, so that key populations would not be hidden [and] so that HIV prevention-program implementers would be able to reach out to these people and engage them in programs.
When an environment in a particular setting is not enabling it makes things worse, not better.
This article was originally featured on Radio Free Europe Radio Liberty: http://www.rferl.org/content/hiv-central-asia-msm-/24977075.html