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Thinking inside the Box: You Are the Man!

The expression “thinking outside the box” is one of the most ridiculous fad (common amongst idealist) I have ever heard and I uncontrollably cringe each time I hear it. Thinking outside the box is leading nowhere. Imagine you are lost in the middle of the Sahara with no water and no food, no amount of thinking outside the box if going to help you…

Great discovery and progress were made because people were thinking within the box. They knew the box very well and that’s why they could come up with something innovative. Think about the bankers behind the credit crunch, think about Bill Gates who revolutionised the personal computer. As much as bankers are despised or Bil Gates is despised, they knew the box very well and that’s why they found ways out of it and in the case of Bill, we are nowadays all enjoying the pleasure of endless digression and online nonsense.

Back to business, Orange Cambodia is showing how well they know the “box”, and in this case the TV box. Indeed Orange partnered with USAID to promote HIV awareness through a TV programme they sponsor and called You Are The Man.

Over a two-month period, six Cambodian men between the ages of 18 and 35 will undergo numerous challenges to compete for the title of “real man”.

“This program is very important for men in our country because it will challenge the perception that Cambodian men usually look down on women and go out to drink alcohol,” said Ben L Cheav, brand consultant and media manager of the Orange Brand Elements production company, adding that the program will also educate contestants and viewers about the issue of HIV/AIDS.

The six competitors will be given mark and the winner of the show will receive a grand prize of, hold your breath, US$3,000 and a “cool” motorbike!

How cool, and clever, is that! So, how cool it would be if HIV prevention would start “thinking inside the box” and come up witth some innovative campaign?

HIV on the rise in the Philippines: Will condoms do any good?

Since the papal comment about condoms and the HIV epidemic, there has been a flurry of articles written in support of the pontifical nonsense. These often call upon a comparison between “sinful” Thailand, awash with HIV and condoms, and the “holly” Philippines where there is not such thing as HIV or condoms (a bit like in Iran).

Does this sound slightly over the top? Not really. Kathleen Gilbert writing for the LifesSiteNews website quotes Yolly Eileen Gamutam, head of the Asia’s Catholic Association of Doctors, Nurses and Health Professionals (ACIM-Asia) saying that “Condoms are highly dangerous.” Gilbert added that “by the end of 2003, Thailand, with a population of 63 million, registered 570,000 HIV-positive adults and children. Gamutam compared the statistic to the Philippines, where only 9,000 Filipinos were HIV-positive out of a population of 80 million. 500 died of AIDS in the Philippines that year, while 58,000 perished in Thailand.”

peripheries has already addressed this misleading and inappropriate comparison but it is necessary to add that comparing two countries at one time point is rather meaningless. That the head of an association of doctors allows herself to be so unscientific is rather disappointing, if not telling that religion and science are definitively two nonoverlapping magisteria.

But let’s look at the figures available from UNAIDS and let’s compare the number of People Living with HIV and AIDS (PLWHA) at two time points:

In 2001 there was 660,000 adults and children living with HIV and AIDS and this figure dropped to 610,000 in 2007. In the Philippines, the number of PLWHA rose from less than 1,000 to 8300 and has been continuously on the rise since 2006.

Without fear or shame and against all evidences, Yolly Eileen Gamutam concluded that “the condom use program in Thailand is not effective.” Mechai Viravaidya, politician and leading Thai AIDS activist who introduced a 100% condoms policy in brothel where HIV was raging and henceforth contributed to a reduction of the number of PLWHA from 2% to 1.4% in 10 years (1997-2007) and the successful containment of the epidemic, will appreciate how his work and continuous efforts are being so promptly dismissed.

The rise in the number of HIV infections in the Philippines may not seem dramatic now but it may have some serious consequences later if not controlled. Conscious of the consequences of inaction, the Filipino government, who in the past adopted an approach to the epidemic that limited its progression in the general population, was considering a controversial bill on reproductive health at the end of 2008.

Another worrying concern about the rising HIV epidemic in the Philippines is that it is so far mostly observed amongst Men who have Sex with Men. The health departmental HIV/AIDS registry recorded 210 new infections among MSM in 2005, 309 in 2006 and 342 in 2007 and from January to September 2008, there were already 395 cases, up 96 percent since 2005.

And as we all know, before or next to condom, homosexuality is the next “abomination” that the Catholic church condemns with wrathful vehemence.

“The Catholic Church’s centuries-old doctrine, created by a bunch of celibate priests, on sex only for procreation leaves many people ignorant about sexual health. This is the sad reality.

Taking away people’s right to protect themselves, and their right to education and to responsibly manage their sex lives is certainly taking away some of their humanity.” write William Sparrow for the Asia Times.

But not all Catholics are dogmatic or blinded by credo and for example, Catholics for Choice an organisation initially founded to support women’s moral and legal right in a world led by Bishops, started an unprecedented worldwide public education effort to raise public awareness about the devastating effect of the bishops’ ban on condoms. In a recent press release the organisation wrote:

“According to a recent poll commissioned by Catholics for Choice, which interviewed Catholics in Ghana, Ireland, Mexico, the Philippines and the United States, support for condom use among Catholics is overwhelming. When asked if “using condoms is pro-life because it helps save lives by preventing the spread of AIDS,” 90% of Catholics in Mexico, 86% in Ireland, 79% in the US, 77% in the Philippines and 59% in Ghana agreed. Unfortunately, the Catholic hierarchy’s position holds the most sway in the countries least able to deal economically and medically with the disease.”

A sway leading to death. And as for the role of condoms, they certainly won’t do any harm.

Buying sex: not a male-only habit

It has all the elements of your usual sex worker story, set in the busy alleyway of the red light district of an exotic town, a low-rise stage on which naked, sexy and sweaty bodies gyrate in the night on the sound of thumping music, a crowd of patrons eyeing at the right number, a dancer who believes that “the sex industry is like any other service-oriented profession”; but this time, the dancers are male and the patrons are female.

In a rare report for The Bangkok Post, Yvonne Bohwongprasert unveils the life of men who sale sex to women in Bangkok. Articles on women sex workers or men sex workers selling to men are rather common, but for the first time, a taboo is broken: women, from Asia or abroad, also buy sex in Asia (and probably elsewhere).

Bohwongpraser interview of a male go-go dancer reveals an interesting understanding and justification of why women buy sex:

Male sex workers during the 2006 Bangkok Pride © peripheries

‘This topic is taboo because our society would prefer to think it doesn’t exist,” said Ken, a 24 years old male go-go dancer. ”Asian women in general have become more outgoing and don’t want society to dictate to them how they should spend their money. The purchasing power of women today is much greater than one would have imagined. Just like buying a new bag or shoes, paying for our services is another way to let off steam for my female clients. I think it’s about time we respected that. Being a male sex worker is not just about what goes on behind closed doors, often we also become their confidants.”

Ken also believes that Thai society should accept the fact that women have the same rights (emphasis mine) as men in choosing to pay for sex “which he thinks is a convenient way to release one’s sexual urges with no strings attached.” reflexion of a man’s point of view on buying sex or real women’s perception? The answer may come from one of the patrons interviewed by Bohwongpraser:

”Men and women experience the same sexual feelings. The double standards in our society, however, condone men for purchasing sexual services, despite the fact that they have girlfriends and wives, so when the tables are turned what’s the fuss about? Women have the right to choose how they would like to satisfy their sexual urges. I believe opting to pay for it is so much better than having an affair with a married man or someone in a committed relationship. Wouldn’t you agree?”

Overall this is a good article though Bohwongpraser can’t refrain to make a few bleeding heart comments: “Judging from the male sex workers we spoke to, it was pretty evident that most of them took drugs and alcohol to get them through the day.” Drugs and alcohol are a real problem in Thailand and often more prevalent amongst sex workers, but many do not take drugs and those who do, do because they can afford them. She also assume that sex workers “would not risk their health if given an opportunity to make a good living”. But there are opportunities to make a living in Thailand and though some young men and women do end up in the sex trade more by need than by choice, many have made a reasoned out choice, as many of the sex workers I know have explained to me and as Bohwongpraser observed, “In terms of education, most of them have completed college and some even university. Some even hold regular day jobs and moonlight in these clubs at night”. Many are willing to do something else, but that is when they have saved enough money from work. The truth is that if your are successful, this is a trade that pay, and people know that.

Some of the SWING crew World AIDS Day 2006, Bangkok. © peripheries

What sex workers need is to be recognised and supported. This is what another article by Bohwongpraser about Service Workers in Group (SWING) expands on. Created by Surang Janyaem five years ago, SWING offers education, counselling and mentoring to its members. It is not always easy as the police and authority hold sex workers and organisations that support them in contempt.

Like in most place, governments and foreign organisations, prejudiced or ill-good-intentionned, rarely consults sex workers when it comes to deal with the issues they have to face in their daily job (health, HIV prevention, abuse) and prefer to impose top down or foreign solutions that rarely achieve anything good. When it comes to support it is esential to consult those involved and to ask then what they want rather than tell them what they need.Surang is setting an example by starting a community programme in which young police cadets undergo a first-hand study of the sex industry for three weeks.

Women do buy sex from men and men do sale sex to women. As Laura Agustin wrote, “Because the prostitution controversy is about women who sell sex to men, most of male sex work passes unnoticed. And people who do talk about it often slip into the assumption that it’s a phenomenon happening between men, whether you call them gay or MSM.” This is not the case and there are more than anecdotal evidences that men sale sex to women all over the world, from Japan to Russia, London to Bangkok.

Why men who sale sex are not perceived as victims and do not receive as much attention as female sex workers? Why is it that women who buy sex from men are not seen as using their status to realise their desire at the expense of vulnerable men? Is this an indication that the debate on sex work is biaised by gender and gender perception? If true, then, as long as this is the case, sex work cannot be framed within a purposeful context that would contribute to the recognition of sex workers and their protection.

HIV Prevention: Hypocrisy Too Kills

On 21st of February, the 2nd Chiang Mai Gay Pride Parade had to be called off following a stand-off with a small group of “Rak Chiang Mai 51″ red-shirted pro-Thaksin demonstrators who objected to the event taking place in a public space.

According to The Nation, “The protesters launched verbal attacks through a megaphone saying the event tarnished the city’s reputation.” The previous day, “a leading member of the “Rak Chiang Mai 51″ group said local residents disagreed with the parade as it was against the old city’s culture and could tarnish its image. He said such an event should be held in Phuket or Pattaya, which were tourist entertainment cities. He said if the organisers wanted to spread the message about Aids then that should have been the main focus of the parade, not homosexuality. “Chiang Mai people cannot accept this and will stop the parade by all means, even violence.”"

Such comments and protests threatening to use of violence are shocking and particularly infuriating when Thailand is on the verge of a second wave of HIV and when it has finally been acknowledged that Men who have Sex with Men (MSM) are more vulnerable to HIV infection. The cancellation of a benign and anticipated event by the “Rak Chiang Mai 51” is a reminder that hypocrisy is still a powerful force driving the HIV epidemic.

From the start of the HIV epidemic, the “cultural argument” has often been used to brush away if not to deny the existence and the threat posed by HIV. The words of a Thai government official are often quoted as an early cultural reaction to the epidemics: “The general public need not be alarmed. Thai-to-Thai transmission is not in evidence.”

Cultural relativism, the idea that some people don’t behave (or do behave) in a particular way because it is not (or because it is) in their culture, has been and is still a major obstacle to prevent the spread of HIV. It is expressed both externally and internally. In “Sex at the Margin” author Laura Agustin recalls how information about oral sex was not included in an HIV information leaflet for West Africans sex workers in Spain because “it appears that it [oral sex] doesn’t form part of the culture of the group to which the leaflet is directed” a decision supported by a doctor from an association of Equatorial Guineans who added “That’s right, we don’t do that”.

The sanctimonious reasoning behind the Rak Chiang Mai 51 opposition to the Gay Parade is that homosexuality or Men having Sex with Men is not part of the “Chiang Mai Culture”. It is that such behaviour does not happen in the North of Thailand, but is, or rather should be, limited to entertainment areas which incidentally cater for foreign tourists. It implies that this is not something “Thai” but something provided to tourists, to foreigners. Rak Chiang Mai 51 (“Love Chiang Mai 08″) revives the argument that “the general (Thai) public does not do that”.

Accordingly and unsurprisingly the famous Welcome to Thailand song does not refer to this cultural aspect of Thailand; happy time in Thailand can be found in visiting temples and old cities, not in Gay parade or in the company of Chiang Mai bar girls/boys.

What this cultural relativism denies is that beauty pageants have existed for a very long time and that they bring together all kind of people, including Kathoye. The annual Miss AC/DC contest held in Bangkok is a landmark alternative to Miss World. This historical component of Thai culture is not confined to the capital and neither is what some perceive as “tarnishing” Thai culture. Chiang Mai has a thriving night life that does not only include bar girls as one would find in Pattaya and Phuket but also MSM venues scattered across town.

The Rak Chiang Mai 51 hypocrisy, and that of others, pushes away further elements of the population which need to come forward in the open, which need to be able to access information about HIV and which need to be able to live their life without the fear of being kept behind closed doors because it is allegedly not part of the “National Culture”.

One of the last barrier in HIV prevention is stigma. Like hypocrisy, stigma is a powerful force driving the epidemic and it is often born out of hypocrisy. By denying facts of life, hypocrisy too kills.

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Photo © Chiang Mai Bar Girl, Miss AC/DC 2007 and Ubon Ratchathani Candle Festival

Global vs. targetted HIV prevention: Building on sound ground

It is revelation’s time for AIDS Inc. Two months ago Kevin de Cock, the epidemiologist heading the HIV-AIDS program with the World Health Organisation, briefly acknowledged, before recanting, that the threat of an heterosexual AIDS pandemic outside of Africa had disappeared and this month at the XVII International AIDS conference in Mexico, it was finally recognised that “a giant wave of infections moved like a tsunami through communities of gay men in Asia, Africa and Latin America” as The Sidney Morning Herald puts it.

“Men who have sex with men are now nearly 20 times more likely to be infected with HIV than the general population, yet they often receive as little as 1 per cent of global funding.”

Quoting Kevin Frost, the chief executive of the American Foundation for AIDS Research (amfAR), The SMH adds that “The story is one of abject failure on the part of the institutions that have been charged with leading the response to HIV/AIDS at local, national and international levels” and that “Men who have sex with men continue to have little or no access to HIV services of any kind and as a result are plagued by high rates of infection.”

A giant step towards a better understanding of the HIV epidemic but still a small step towards long-awaited programmes targeted at Men who have Sex with Men, and this for many reasons. One being that most countries where the HIV epidemic is moving like a giant Tsunami wave are still in complete cultural denial of the existence of MSM, from government to civil society and to MSM themselves. The other being that there is no such thing as an MSM community at least in the sense we understand it in the West.

This really is big problem that has yet to be recognized because throwing money in the air hoping the wind will blow in the right direction won’t be very much effective. Indeed there is no “Castro” in Bangkok where HIV prevalence amongst MSM recruited in MSM venues is over 30%. There is no “Soho” in Kuala Lumpur, no “Marais” in Phnom Penh. No Pink Paper in Singapore, no Gay Times in Shanghai. No Elton John in Luang Prabang. In short, there are not many “Gay lighthouses” in the East, not as we can identify them in the West.

Instead, as reported in 2003 in a review of knowledge about the sexual networks and behaviours of men who have sex with men in Asia by Dowsett, Grierson and McNally from Latrobe Uiiversity,

“The literature reveals that there are no socially or self-defined groups of men that fit into an overarching category of MSM. What the review shows is that there are just men!! Fishermen, students, factory workers, military recruits, truck drivers, and men who sell sex, and so on: all these categories of men are to be found in the studies and programmes reviewed.”

There were no similar traits in all of the MSM population studied other than them being males, and engaging in sex with other men.

In other words, for those familiar with the London scene: MSM in Asia don’t go for a drink in Soho reading QX before going for a meal in Balans and clubbing in G.A.Y or Vauxhall or to see Kilye in concert. Not all Gay men in London (here we can use Gay instead of MSM) have this lifestyle but many had or will and were or will be accessible at this point in there life.

The question and the challenge is “How does one design programmes specifically targeting or aimed at MSM in Asia when they don’t exist only as such?” Could it be that general prevention could be more efficient? The jury is not out yet because there is little to judge on. But the coming years will be crucial.

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