Recap of Regional Asia Pacific Webinar: Accelerating Access to HIV Services for Young Gay Men and Other Men Who Have Sex with Men

We’re only a week after the International Youth Day (12 August), and in order to achieve the Sustainable Development Goals (SDGs), solidarity across generations is key for sustainable development to ensure “no one is left behind.” In the Asia Pacific region 52% of the new infections are contributed by the young key populations. This is a very alarming situation and it is strategically important for the programme managers and policymakers to pay attention to the intensity of the new HIV infection in the young key population, particularly with young gay and other men who have sex with men (MSM) populations, and to realize how to accelerate HIV services among young key populations.

APCOM held the regional webinar titled ‘Acceleration Access to HIV Services for Young Gay Men and Other Men Who Have Sex with Men’ on 12 May 2022 from 14.00 to 15.30 (BKK time – GMT+7) on zoom.  APCOM, in partnership with PEPFAR/USAID/EpiC and in collaboration with two regional young people networks, YouthLEAD and Youth Voices Count, organized this webinar to gather and share lessons learned, as well as recommendations on implementing HIV programmes targeted to young gay men and other men who have sex with men in the Asia Pacific region. 

This regional webinar was attended by 158 participants from 15 countries in Asia and the Pacific region; Bangladesh, Cambodia, India, Indonesia, Kazakhstan, Laos, Malaysia, Myanmar, Nepal, Pakistan, PNG, Philippines, Thailand, Timor Leste, and Vietnam. In this webinar, APCOM also provided separate space for community partner organizations to share their experiences in working and advocating in the HIV field to find potential approaches/ methods to reduce obstacles for young MSM accessing HIV-related services. 

Agenda:

Time	Item	Speaker
05 mins	Welcome & Introductions:HousekeepingOverview of the sessionIntroduction of speakers	APCOM
03 mins	Interactive Session – Jamboard	APCOM
05 mins	Opening Remarks	Midnight Poonkasetwattana APCOM
05 mins	Setting the scene – YMSM HIV Data in Asia Pacific Region	Desire RwodziUNAIDS Regional Support Team for Asia Pacific
Panel 1: Success Stories and Programmes for YMSM Moderator:Justin Francis BionatYouth Voices Count With Q&A 35 mins	Mapping HIV Service Delivery in the Philippines	Justin Francis BionatYouth Voices Count
	MSM-led Service Delivery in Vietnam	Doan Thanh TungLighthouse Social Enterprise, Vietnam
	Study Findings & Innovative Approaches for YMSM in Indonesia	Azvian HamzahInti Muda, Indonesia
	MSM-targeted Initiatives in Bhutan	Tashi TshetenQueer Voices Bhutan/Youth Voices Count, Bhutan
	testBKK HIV Prevention Pack during COVID-19 in Thailand	Chartlada “JJ” SangakijAPCOM
	APCOM’s PrEP Demand Generation Toolkit in 14 Languages and its Evaluation Result	Dr. Nerys Irving-JonesInternal Consultant for The Global Fund’s SKPA Project
Q&A
03 mins	Interactive session – Jamboard	APCOM
Panel 2: YMSM Ground Realities Moderator:Leo VillarYouth LEAD 20 mins	Communities to share their views on their experience in working, advocating in the field and obstacles	Ram Dulip Mr Gay World Sri Lanka 2021/Y-PEER Asia Pacific Tebeio Tamton BIMBA/Youth Voices Count, Kiribati Jeremy Tan Fok JunMalaysia Lattavanh SengdalaCHIAs, Lao PDR Korkuson “George” SongsaengaThailand
Going Forward 07 mins	Generating & Sharing Evidence for Prevention: New Asia PrEP survey and your thoughts on a biomedical prevention community of practice	Dr. Heather-Marie SchmidtWHO and UNAIDS Regional Office for Asia and the Pacific
Reflections 05 mins	Reflections on the situation of HIV and YMSM response in the region	Panus Na NakornUSAID Regional Development Mission for Asia (RDMA), Thailand
Closing  02 mins	Thank you to the speakers and Close	APCOM

The regional webinar’s key discussed points,
key messages, and recommendations that emerged during this event are provided below;

Desire Rwodzi I UNAIDS Regional Support Team for Asia Pacific

• 99% of the new infection among key populations and their partners. 
• 52% of the new infections are contributed by the young key populations.
• HIV prevalence is high among young MSM in countries such as Indonesia, Vietnam, and Malaysia, which indicates that HIV is an essential issue for the age group among MSM.
• Emerging risks associated with Chemsex among MSM and TG in AP are: 67% never had PrEP, 34% never had STD test, 21% never had HIV test, 46% never had HCV test, and 30% never had HBV test. 
• Need to scale up innovative interventions and differentiate HIV services across the prevention and care cascade continuum.
• Need to modernize and differentiate service delivery, including scale-up of combination HIV prevention (particularly PrEP and harm reduction interventions), self-testing, multi-month dispensing, and maximizing the benefits of U = U (Undetectable = Untransmittable).
• Uptake of PrEP remains very slow despite the overwhelming evidence of its effectiveness.
• Innovative solutions for service delivery are not disseminated and are not scaled up enough.
• Less than 10% of PLHIV, women, and girls, and key populations experiencing gender-based inequalities and gender-based violence. 
• Less than 10% of countries have punitive laws     and policies that limit access to HIV prevention and care services in Asia Pacific. 

Panel 1:
Success Stories and Programmes for Young MSM

Moderator: Justin Bonat I Youth Voices Count, Philippines
Speakers: Doan Thanh Tung Lighthouse Social Enterprise, Vietnam; Azvian Hamzah Inti Muda, Indonesia; Tashi Tsheten Queer Voices Bhutan/Youth Voices Count, Bhutan; Chartlada Sangakij (JJ) APCOM; Dr. Nerys Irving-Jones Internal Consultant for The Global Fund’s SKPA Project

Justin Bonat

• ‘A Human-Centered Design Approach to Engage Young People in the Philippines with Dialogues about HIV Service Delivery’, this case study work started in October 2021 and ended in December 2021 and this will be released soon in a book chapter format. 
• Access to services by the young key population in the Asia Pacific is an ongoing challenge. It depends on several factors such as accessibility, affordability, availability, proximity, inclusivity, and friendly services. 
• Map nationwide service delivery network (SDN) for YKP services, develop a theory of change to improve the integration and impact of these interventions, and develop and strengthen care pathways for YKP.
• Positive transformation in HIV and STI-related service delivery is complex as it involves emotional and cultural considerations. Even more so in terms of adolescent sexuality.
• The importance of HCD processes in encouraging young people to think, reflect and visually map service delivery networks. 
• This project involved interviews with service providers and engaged young people in conversations and visual mapping exercises.
• The holistic view of the complex service system provides a platform for meaningful dialogues that could generate transformative pathways in the ways young people navigate the health system. However, it will take meeting young people where they are at and engaging in discussion around sexuality. 

Doan Thanh Tung

Peer-Led, YKP-friendly, and one-stop HIV/AIDS service model. 

• Barriers for YKP to access HIV/AIDS Services are:
  • Policy – Age of consent, social health insurance requirements, lack of protective laws;
  • Society – Social stigma, social and gender norms, lack of social services
  • Health Service –  Limited health services information, lack of specialized and sensitized services, health provider stigma. 
  • Interpersonal – Poor engagement in the community network, peer stigma, sexual violence.
  • Individual –  lack of adequate knowledge, self-stigmatized, fear of disclosure, stimulant use, mental disorder, economic status.

• Community-Led Programme
  • Community Empowerment
  • Community Outreach and Communication
  • Provide peer-to-peer services
    • Mobilize trained peers to be service providers
    • Provide appropriate supervision and technical support to peer service providers
    • Develop and provide clear SOPs of services
    • Create a friendly environment
    • Diversify the services and its delivery according to the community’s needs (Mobile, Tele, home based-services, flexible hours..)
    • Mobilize the community in monitoring and service quality improvement.
    • Community exchange and network development
  • Counseling and Supporting sexual partners
  • Maintain Client’s relationship and engagement
  • Community feedback and Monitoring

• One-Stop Services
  • HIV plus COVID preventive commodities
  • HIV counseling and testing: HIV community testing, HIVST, ICT/PNS
  • ARV treatment for PLHIV & TB screening, preventive treatment
  • PrEP/nPEP & STIs and viral hepatitis
  • Mental health screening and support
  • Chemsex and ATS counseling and support
  • NCD services (Diabetes, hypertension, Physiologic)
  • Other services according to the community’s needs

Azvian Hamzah

•  Reasons why young MSM are accessing HIV services:
  • Desire to get to know their health status for the first time
  • Fear of getting infected by HIV
  • Support from peer educators, social workers, outreach worker
  • Monthly routine test
• Obstacles in accessing youth-friendly HIV services:
  • Stigma and Discrimination
  • Lack of information
  • Administration issues
  • Cost and Distance to the healthcare services
  • They have already passed away

• Some recommendations: 
  • Allow young MSM to access the services without any structural problem
  • Strengthen community systems strengthening. 

Teshi Tsheten 

•  Community-Led Monitoring intervention programme is implemented in Bhutan. But still there exist challenges for the communities to access health-related services in the health care centers. Most of the community members accessing services in health care centers have been experiencing stigma and discrimination. 
• One of the factors that decelerate HIV services is the Government health programme, 
• HIVST has just started, but there exist some limitations and the community; for instance the community is not allowed to carry HIVST. 

Chartlada 

• Safe Play Pack. It consists of condoms and lubricants, Andrew Christian underwear and other souvenirs. 
• Safe Play Pack distribution in 2021:
  • June 2021 – 520 packages
  • July 2021 – 601 packages
  • August 2021 – 614 packages
  • September 2021 – 670 packages
• Safe Play Pack distribution in 2022:
  • February 2022 – 200 packages
  • March 2022 – 200 packages
  • April 2022 – 200 packages
  • May 2022 – 200 packages
• Party Pack in 4 Countries proposed partnerships supported by DFAT Australia and UNAIDS (in Cambodia, Indonesia, Philippines, and PNG)

Dr. Nerys Irving Jones

Evaluation of the Translated APCOM PrEP Demand Generation Toolkit Acceptance and Use in Cambodia, Indonesia, Laos, Mongolia, Nepal, Philippines, Sri Lanka, Thailand, and Timor-Leste

Program Goal and Purpose: 

• Goal: Comparing the acceptance and use of the PrEP Demand Generation translated toolkit versus the stand-alone English version.
• Purpose of the evaluation: Its primary purpose was two-fold:
  • Review, analyze, and evaluate the performance of the start-up phase
  • Set out key findings and recommendations for future APCOM assistance to leverage the impact of future PrEP investments.
• Timeframe: The evaluation was concerned with the implementation phase of the toolkit program.
• Countries and Organizations: Nine countries, 139 country implementers made-up of Community-Based Organizations, NGOs, International NGOs, and Government Agencies.

Evaluation Methodology

• Design: focused on qualitative (online survey) rather than quantitative data.
• Sampling: Convenience (non-probability). Primary selection criterion related to the availability of participants.
• Based on the 92 respondents using a 95 % confidence level with a 5.84 % margin of
• Error, a sample size of 92 respondents was calculated for the survey.
• Instrument: SurveyMonkey online survey used and pre-tested.
• Survey development: Eleven questions addressed two focus areas. The survey was divided into three sections: demographics (organization type and country), and sections relating to the two evaluation questions.
• Limitations: Readiness of data, availability of quantitative data, time constraints,
• Lack of data collectors at the country level and incomplete survey responses.

Findings:

• Lack of awareness among CBOs, INGOs, NGOs, and GAs. The lack of responses from the potential pool of 139 participants in the survey indicated that respondents of the survey are not fully aware of the PrEP DG toolkit.
• Lack of understanding of how to use the toolkit. Based on the answers provided by the respondents, there is a need for a ‘roll-out’ training program to help the country’s points of contact to maximize the materials and guidance in the PrEP DG toolkit.

• Lack of follow-up assistance on how to use the toolkit. Many respondents mentioned they would like to see additional training aids available online that they can use to assist them when developing their strategies and materials in support of the PrEP Demand Generation toolkit.
• Poor translation of the toolkit. Most of the respondents of the survey mentioned
• that the toolkit was poorly translated and lacked cultural nuances to their particular language.
• Lack of response to the English-only survey. The emphasis here is that future.
• surveys need to consider the translation of the online survey into the individual country’s language.

Panel 2:
What are the best approaches to reach young MSM in the pacific?

Moderator: Leo Villar Youth LEAD
Speaker: Lattavanh Sengdala, CHIAs, Lao PDR; Ram Dulip, Mr Gay World Sri Lanka 2021/Y-PEER Asia Pacific; Jeremy Tan Fok Jun, Malaysia; Korkuson “George” Songsaenga, Thailand; Tebeio Tamton BIMBA/Youth Voices Count, Kiribati

Question: How does the MSM and TG community view testVTE and what are the results of the campaign?

Lattavanh Sengdala

• The online and digital campaign of TestVTE which was launched by CHIas in Laso has provided the key population communities with information about HIV, PrEP, and prevention-related information. 
•  TestVTE online digital campaign has been recognized by various parties, government partners and CSO partners regarding HIVST, HIV care and management. 
• Online booking for PrEP, HIVST, and HIV testing booking is available on testVTE website.
• Online platforms such as Facebook (900 followers) provide counseling for about 5-10 sessions a month. 

Question: Can male gay pageants add value to the health and well-being of young gay men and other MSM?

Ram Dulip 

• Male pageants bring a different perspective to the entire community and bring our background to the front line to the educational background, professional achievements etc. 

Question: What are the barriers in the MSM community in accessing HIV-related services? 

Jeremy Tan 

• The biggest barrier to accessing HIV services in Malaysia is the age of consent, internalized feeling of stigma and discrimination from the health service providers. 
• The existing Government policy in Malaysia does not allow PLHIV to access HIV testing services. 

Korkuson Songsaenga 

• Misinformation and misconception of being gay and gender equality is not recognized in the mainstream value. 

Dr. Heather Marie Schmidt I WHO and UNAIDS Regional Office for Asia and the Pacific. 

• Oral PrEP is increasingly available and new long-acting PrEP
• To help improve HIV prevention services and support choices in products, we need evidence. 
• We’re conducting the survey in 17 countries in Asia and the Pacific to understand the values and preferences of key population communities. This survey will contribute to the efforts to reduce new HIV infections. 

Panus Na Nakorn I USAID RDMA

• We have now a clear picture of what HIV service should be accelerating for young gay men and MSM and able to access the services as needed.
• To utilize social media platforms to advance and accelerate HIV-related services. 
• To introduce innovative approach and to scale up to reach the services to young gay and MSM

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