Men Loving \ Pleasuring \ Using Men in Lao PDR

UNESCO Bangkok is publishing the first ethnographic study of male-to-male sex, sexuality and erotics in Laos. Researched by Chrys Lyttleton from the Macquarie University in Australia and a team of Lao researchers, Thadum Sayarath, Santiphap Laungbouheuang and Chittaphone Santavasy, this long awaited work provides an in-depth and rare insight into a culture that remains mostly hidden and inaccessible to Westerners.

Below is the foreword to this study by Sheldon Shaeffer, Director of Unesco Bangkok. Extract of the interviews conducted by the researchers will follow. The report can be downloaded from the UNESCO HIV and AIDS Education Clearinghouse.

Unprotected male-to-male sex with multiple partners is one of the three main modes of transmission of the human immunodeficiency virus (HIV) in the Asia-Pacific region (the other two being unprotected sex in the context of sex work and unsafe injecting drug use). According to a recent report of the Commission on AIDS in Asia (2008), at least 75 percent of all HIV infections in Asia are caused directly by these three behaviors; among adolescents this figure reaches 95 percent of all infections.

In Thailand, 30.7 percent of a sample of men who have sex with men (MSM) recruited in Bangkok entertainment venues tested positive for HIV in 2007, and men who have sex with men currently contribute to 21 percent of all HIV infections in Thailand.

In Lao People Democratic Republic, a recent survey (2007) found that 5.6 percent of MSM in the capital Vientiane tested positive for HIV. Condom use is very low and the prevalence of sexually transmitted diseases is high. Meanwhile, the general population prevalence of HIV stands at 0.2 percent. This would mean that a large proportion of HIV infections in Lao PDR are caused by the male-to-male transmission route – perhaps more than 75 percent of all infections. In contrast to what was thought not very long ago, the HIV epidemic driven by male-to-male sex is not an isolated ‘boutique’ epidemic – and it probably has never been. HIV prevention among MSM is now deemed more important than ever, and Asian countries will be unable to retain their status of ‘low level’ epidemic and/or reduce overall population prevalence below 0.1 percent without scaling up HIV prevention, care and support interventions for MSM.

We know that unprotected anal sex is an effective route for transmission of HIV. It is more difficult to understand in which situations, contexts and circumstances men do or do not use condoms and water-based lubricants to protect themselves. Understanding better the context of unsafe sex will enable us to design interventions that can lead to behavior change. It is essential that we focus not only on the behavior and the context in which it takes place, but also on the individuals engaging in it and the communities in which they live. The variety of men who have sex with men is enormous in terms of age, class, religion, and ethnicity, but also in terms of self-identity and how this identity fits (or does not fit) with the society in which an individual is a part.

It has been stated that while quantitative studies look for a limited number of attributes across a large population, qualitative studies focus on describing the wide variety of attributes across a limited number of people in a population. This serves to deepen our understanding of a problem or phenomenon – in this case the HIV vulnerability of Laotian who have sex with men.

Chris Lyttleton and research team members Thadum Sayarath, Santiphap Laungbouheuang and Chittaphone Santavasy have done an outstanding job unearthing the dynamics of maleto- male sex, sexuality and erotics in Vientiane. It is hoped that the persons responsible for designing HIV prevention programmes for MSM will take notice of this study’s findings. It may remain a formidable challenge to translate its complex and in-depth findings into suggestions and inputs for behavior change communication. In many countries. there is a wealth of data and information, but it is often not effectively shared, used and applied. UNESCO is eager to continue to contribute to better and more effective HIV prevention, care and support interventions for MSM in Lao PDR, including the task of putting the key findings and recommendations from this study into practice.

After having supported research on MSM in Cambodia and Viet Nam, UNESCO Bangkok is proud to have supported this effort in Lao PDR. To our knowledge, it is the first in-depth ethnographic study of male-to-male sex in the country to date. We hope it will inspire other countries and cities to do the same.

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