How Repressive Legal Environments Inhibit the Fight Against HIV in Asia

A new report by the UN Development Program shows how discriminatory laws against men who have sex with men (MSM) and transgender people undermine the fight against HIV/AIDS in the Asia Pacific region. The report is thorough and exhaustive, but the gist is this:  In 19 of the 48 countries included in the study, sex between consenting male adults is illegal.  Authorities and vigilantes use the legal prohibitions against MSM to harass, intimidate and extort MSM and transgender people. This, in turn inhibits their ability to seek medical help and form other kinds of support groups.  For example, the report shows that “laws banning sodomy discourage the formation of support groups, which are vital for effective peer-based HIV prevention, care and support.”

Aside from these laws being an affront to a basic sense of human decency, they are deeply problematic from a public health perspetive because HIV prevalence is significantly higher among MSM than the population at large in the Asia-Pacific region.  Check out this chart:  


The report actually offers estimates on the number of MSM and transgender people in the Asia-Pacific region. I’m sure how they arrived at these numbers (you’ll have to consult the footnotes) but these figures help put into perspective the very large number of people who are at a heightened risk of contracting HIV for the fact that they live in places with discriminatory legal environments. 

Estimates of the percentage of men who have ever had sex with another man ranges from 3 to 19 percent in East Asia, 6 to 34 percent in South Asia and 7 to 12 percent in South East Asia. Estimates of the percentage of men who had sex with another man in the last year are 7 to 8 percent for South Asia and 4 percent for South East Asia. Recent estimates of MSM (based on numbers of men who had sex with another man in the last year) include approximately 3.8 million in Bangladesh, 30.5 million in India, 3.8 million in Pakistan, 615,000 in Nepal and 502,000 in Sri Lanka  Other MSM estimates include 560,000 in Thailand, 70,000 in Ho Chi Minh City, 1.6 million in Indonesia, 240,000 in Myanmar and 10 million in China.

Transgender people often have culturally-specific identities and form distinct communities in Asia and Pacific island countries (see Annex I).Estimates of male-to-female transgender people include 26,000 waria in Indonesia; 200,000 to 300,000 kathoey in Thailand; between 50,000 and 100,000 mak nyahs in Malaysia; a million or more hijras in India; and 12,000 hijras in Bangladesh.41

To me, the question of discrimination is first and foremost a human rights issue. But a study like this also puts into perspective how public health is also endangered by laws that drive MSM and transgender people underground and away from social services. 

Thankfully, there is already some movement for this at the supra-national level. A number of European countries, supported by some in Latin America (and with the election of President Obama, the United States too ) have put forward a General Assembly resolution condemning discriminatory laws against MSM and homosexuality in general.   The idea is to create widely accepted global norms to ban the criminalization of homosexuality (much in the same way that, for example, chemical weapons are frowned upon.)  As the report shows, this kind of global ban could not come soon enough. Millions of lives are potentially at stake.