The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming.

Men who have sex with men (MSM) in Western urban areas have seen substantive decreases in new diagnoses of HIV infection. This paper explores whether such declines are present among MSM and transgender women (TGW) in Southeast Asia and discusses implications for HIV policies and programming. A scoping review was conducted of scientific publications and selected documents regarding the spread of HIV infection among MSM and TGW in major urban centres of the Association of Southeast Asian Nations (ASEAN) region. Continued high HIV prevalence and incidence among MSM are found in integrated behavioural and biological surveillance (IBBS) and research studies. HIV prevalence among MSM under IBBS decreased only in Bangkok from 28.6% in 2014 to 10.3% in 2018, whereas it was increasing in Kuala Lumpur, Ho Chi Minh City, Vientiane, and Phnom Penh. HIV/AIDS case reports regarding new HIV infection diagnoses among MSM have started to decrease in Singapore since 2011 and have been plateauing in Metropolitan Manila since 2017. Where data were available, it was found that HIV prevalence among TGW was high and if IBBS was conducted, it was increasing. HIV prevalence among TGW under IBBS in Jakarta had risen to 34.0% (2015) and 14.0% (2019) in Phnom Penh. These findings suggest that most ASEAN member states have so far failed to effectively implement and scale-up scientifically proven biomedical HIV prevention measures and counter stigma and discrimination that impedes access to appropriate HIV prevention and treatment services for MSM and TGW.

A scoping review of HIV epidemiologic, sociocultural and programmatic studies related to transgender women and men who have sex with men in Cambodia, 1999-2019.

BACKGROUND: Cambodia is widely credited for its successful HIV epidemic control. However, in recent years there have been signs of increasing HIV prevalence among men who have sex with men (MSM) and transgender women (TGW). This paper reviews HIV epidemiological, social science and HIV program implementation studies conducted over the past 20 years to explore possible reasons for the rising HIV prevalence among these groups and to formulate recommendations for improved policies, HIV programmatic interventions and further research. METHODS: For this scoping review, we searched the PubMed and Google Scholar databases for scientific publications related to HIV and MSM and TGW in Cambodia published since 1999. From each of the returned citations we subsequently studied reference lists to find additional data sources. We also searched websites for reports commissioned by national and international governmental and non-governmental organizations. RESULTS: Twenty-seven relevant studies and papers were found and reviewed; most were epidemiological in nature. Recent epidemiological studies and reports show an increase in HIV prevalence among Cambodian MSM and TGW. The epidemiology of HIV infection in these groups has been relatively well-described and analyzed. While initially MSM and TGW were grouped together, in more recent years they have been studied in their own right, recognizing their specific HIV and other prevention needs. Few studies were found investigating Cambodian same-sex cultures and social and cultural contexts in which HIV transmission among MSM and TGW occurs. A few evaluation studies were found, but it remains unknown how effective current HIV service implementation modalities are, or how successful strategies to increase access to essential HIV prevention, testing and treatment services have been employed for MSM and TGW in Cambodia. CONCLUSIONS: Research about Cambodian MSM and TGW in the context of HIV primarily concerns bio-behavioral knowledge generation. Cambodia is unlikely to achieve control of the HIV epidemic among MSM and TGW without doing better in-depth social science research on its multiple sexual- and gender minority cultures, and without understanding what differentiated implementation modalities, strategies and approaches are most effective to address HIV among its increasingly diverse MSM and TGW populations.

Poor commissioning discussed in depth.

Last October's Healthcare Estates 2013 conference saw one of the first day's 'Engineering' sessions debate the topic, 'Why do so many buildings disappoint their owners and occupants?' Much of the discussion centered on the problems caused by 'inadequate management of the commissioning process'. A roundtable debate jointly staged recently in London by IHEEM and the B&ES, the leading U.K. trade association for building services engineering contractors, took the debate forward. As HEJ editor, Jonathan Baillie reports, the discussions confirmed that one of the key contributors to poor commissioning is a failure to involve specialist building services contractors sufficiently early. It was also agreed that finding a really effective 'client-side' project manager, with the panoply of skills and experience the role requires, can be 'a tough ask'. In this issue of HEJ we report on the debate's first 'half'; in June's edition, we will cover 'part two' of a lively, forthright, and positive debate.

Prevalence over time and risk factors for sexually transmissible infections among newly-arrived female sex workers in Timika, Indonesia.

BACKGROUND: HIV rates are escalating in Indonesia. At Timika in Papua, the world's largest gold mine employs many single and migrant men, who frequently have sex with female sex workers (FSWs). We investigated trends of sexually transmissible infections (STIs) in FSWs in Timika. METHODS: From 1997 to 2002, FSWs at clinics were recruited for their first STI screening. Sociodemographic and sexual behaviour data were obtained and laboratory tests were performed to diagnose STIs. RESULTS: From 1997 to 2002, 3086 FSWs were recruited. Prevalence of gonorrhoea varied from 11% to 19% (P = 0.71). Positive treponemal serology varied from 1.4% to 5.1% (P = 0.50). Trichomoniasis declined from 16% to 11% (P = 0.03). HIV infection increased significantly from 0.0% to 1.4% (P = 0.002). Chlamydia prevalence did not significantly change from 33% in 1997 compared with 41% in 1998 (P = 0.10). Consistent condom use was low, but increased from 8% to 16% (P = 0.001). Any STI was independently associated with younger age, high frequency of sexual activity, and not using contraceptives. CONCLUSIONS: The high rates of STIs, low condom use and increasing prevalence of HIV among these FSWs require enhanced interventions, and consideration of periodic presumptive treatment. A partnership with industry can aid and sustain an intervention program.

Sexual behavior and frequency of antibodies to type 1 human immunodeficiency virus (HIV-1) in a group of Perúvian male homosexuals

The most important risk factor for HIV infection in North América amd Western Europe is homosexual behavior. This article describes a 1988 survey of active male homosexuals in Lima, Perú, that investigated patterns of homosexual behavior and HIV seropositividad