Men Shaping Asia-Pacific's Aids Epidemic
1 December 2001, World AIDS Day
Men are driving the AIDS epidemic in Asia and the Pacific, accounting for 70 to 80% of all infections.
In Australia, China, Japan, Malaysia, New Zealand, Singapore and Viet Nam, 80% or more of those infected are men. Everywhere in the region, men's sexual behaviour and habits have determined the epidemic's course and extent. It is from men that the virus spreads to women, their wives and partners, and then to children.
Many more men than women have large numbers of sexual partners. Studies show that in general, Asian women have few sexual partners - many have only one. Typically, a small group of sex workers will service many male clients.
Men are also far more likely to use drugs and engage in other behaviour that can lead to infection with HIV, the virus that causes AIDS.
Yet, although this is essentially a male epidemic, AIDS programmes have not necessarily targeted men. Men were therefore selected as the theme for this year's World AIDS Day on 1 December. The campaign - which has the slogan, ""I care. do you?"" - calls on men to join the battle against AIDS.
""Men need to be part of the solution, not just part of the problem. It is men who can change the direction of the epidemic,"" said Dr Shigeru Omi, Regional Director for the Western Pacific of the World Health Organization (WHO).
Not all men put themselves at risk of HIV infection - indeed it is estimated that only one in four men do. However, cultural notions about manhood influence the behaviour of men. In many countries, men are encouraged to have many sexual partners. In some countries, it is almost a rite of passage for young men to visit sex workers.
Young men under 25 years are the most likely to engage in behaviour that leads to a risk of HIV infection. They may, for example, indulge in excessive alcohol or drug consumption, which research shows increases the likelihood of unsafe sex. Currently, they make up the age group most affected by AIDS globally, accounting for about one in four of all people with HIV.
In Australia, New Zealand and the eastern Pacific area, more than 92% of those infected are male - largely young men who have sex with men.
In much of Asia, there are often three times as many men infected than women. The sex industry is usually an epicentre for the epidemic, with the virus passing between a small ""core"" group of female sex workers and a larger group of male clients.
Another key factor in Asia's epidemic is injecting drug use - a largely male habit. It is the major route of HIV transmission in Malaysia, Nepal, Vietnam and Yunnan province in China and Assam state in India. It is estimated that about 80% of all injecting drug users worldwide are men.
The campaign calls for men to become involved in the fight against AIDS. Among the strategies suggested:
- Tailor HIV programmes to men's needs and seek their participation. Programmes are more effective when aimed at groups with a higher risk of infection, such as migrant workers, truck drivers, gay men, soldiers and men attending clinics for sexually transmitted infections.
- Promote condoms more aggressively to men. The 100% Condom Use Programme in entertainment outlets in Cambodia and Thailand - which resulted in significant drops in HIV infection - targeted men as well as sex workers.
- Encourage men to seek health information and services. In many countries, men are far less likely to seek health care than women. Also, men are often left out from sexual and reproductive health initiatives, leaving them with little knowledge about such issues.
- Make men recognize their responsibility to their partners and children. In some Asian countries, it is not unusual to find infected men demanding sex from their uninfected wives - without the use of condoms. Women may be unable to refuse sex out of a fear of violence. A recent study claims that one in three women has been beaten, abused or coerced into sex in her lifetime.
- Target younger men and boys, who have a higher risk of HIV infection and are also more likely to change their behaviour than older men.
""By making young men partners in the fight, we have a better chance of beating this epidemic. And we can also help improve the lives of men - and their families - in the next generation,"" said Dr Omi. ----------------------
Estimated Number of Infected Men in the Western Pacific Region (2000)
Country Estimated HIV Estimated amount prevalence (number) of men among (age 15 to 46) HIV+ adults (%)
Cambodia 169 000 66
Papua New Guinea 15 000 50
China 600 000 88
Viet Nam 122 000 80
Malaysia 42 000 90
Japan 10 000 86
Philippines 10 000 60
Republic of Korea 3 800 87
Singapore 3 900 80
Australia 12 000 93
New Zealand 1 200 83
For more information, contact the Public Information Office at
(632) 528 9991 to 93 or email: PIO_Unit@wpro.who.int